Telemedicine in rheumatology: high specificity and sensitivity of follow-up virtual video consultations during COVID-19 pandemic

Abstract

Abstract Objective To evaluate the reliability of virtual video-assisted visits, added to the tight-control strategy for inflammatory rheumatic diseases (IRDs), in identifying patients who need treatment adjustment. Methods Tightly followed-up adult patients with RA, PsA, AS or SLE took part in a video consultation during COVID19 lockdown and repeated the same rheumatology evaluations through a face-to-face visit within 2 weeks. The sensitivity and specificity of the virtual visits for treatment decisions (categorized as: unchanged, adjusted/escalated, tapered/discontinued, need for further examinations), and the intraclass correlation coefficient (ICC) for virtually measured disease activity and patient-reported outcomes (PROs) were calculated with 95% CIs using face-to-face visits as the reference method. Results In 89 out of 106 patients (84.0%), face-to-face visits confirmed the remotely delivered treatment decision. Video-visiting showed excellent sensitivity (94.1% with 95% CI: 71.3%, 99.9%) and specificity (96.7%; 95% CI: 90.8%, 99.3%) in identifying the need for treatment adjustment due to inadequate disease control. The major driver for the low sensitivity of virtual video consultation (55.6%; 95% CI: 21.2%, 86.3%) in identifying the need for treatment tapering was SLE diagnosis [odds ratio (OR) 10.0; 95% CI: 3.1, 32.3; P <0.001], mostly because of discordance with face-to-face consultation in glucocorticoid tapering. Remotely evaluated PROs showed high reliability (ICC range 0.80–0.95), while disease activity measures had less consistent data (ICC range 0.50–0.95), especially for those diseases requiring more extensive physical examination, such as in SLE and PsA. Conclusion Video-visiting proved to have high reliability in identifying the need for treatment adjustment and might support the IRDs standard tight-control strategy.