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Research ArticleAccepted Article

Evaluation of patients with rheumatoid arthritis in teleconsultation during the first wave of the COVID-19 pandemic

Jérôme Avouac, Anna Molto, Camélia Frantz, Sarah Wanono, Elise Descamps, Olivier Fogel, Alice Combier, Lucile Poiroux, Corinne Miceli-Richard and Yannick Allanore
The Journal of Rheumatology June 2022, jrheum.220073; DOI: https://doi.org/10.3899/jrheum.220073
Jérôme Avouac
Service de Rhumatologie, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France. Conflict of interest: JA: Honoraria: Galapagos, Lilly, Pfizer, Abbvie, Bristol-Myers Squibb, Sanofi, Roche- Chugai, Nordic Pharma, Medac, Novartis, Biogen, Fresenius Kabi, Janssen, and MSD. Research grants: Bristol-Myers Squibb, Pfizer (Passerelle), Novartis (Dreamer), Fresenius Kabi; AM: Honoraria: Abbvie, Biogen, BMS, Gilead, Janssen, MSD, Novartis, Lilly, Pfizer, UCB. Research Grants: Pfizer and UCB. Financial Support: This work has received a research grant from Fresenius Kabi. Corresponding author: Pr. Jérôme Avouac Université de Paris Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP 27 rue du Faubourg Saint-Jacques 75014 Paris, France. e-mail: jerome.avouac@aphp.fr.
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Anna Molto
Service de Rhumatologie, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France. Conflict of interest: JA: Honoraria: Galapagos, Lilly, Pfizer, Abbvie, Bristol-Myers Squibb, Sanofi, Roche- Chugai, Nordic Pharma, Medac, Novartis, Biogen, Fresenius Kabi, Janssen, and MSD. Research grants: Bristol-Myers Squibb, Pfizer (Passerelle), Novartis (Dreamer), Fresenius Kabi; AM: Honoraria: Abbvie, Biogen, BMS, Gilead, Janssen, MSD, Novartis, Lilly, Pfizer, UCB. Research Grants: Pfizer and UCB. Financial Support: This work has received a research grant from Fresenius Kabi. Corresponding author: Pr. Jérôme Avouac Université de Paris Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP 27 rue du Faubourg Saint-Jacques 75014 Paris, France. e-mail: jerome.avouac@aphp.fr.
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Camélia Frantz
Service de Rhumatologie, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France. Conflict of interest: JA: Honoraria: Galapagos, Lilly, Pfizer, Abbvie, Bristol-Myers Squibb, Sanofi, Roche- Chugai, Nordic Pharma, Medac, Novartis, Biogen, Fresenius Kabi, Janssen, and MSD. Research grants: Bristol-Myers Squibb, Pfizer (Passerelle), Novartis (Dreamer), Fresenius Kabi; AM: Honoraria: Abbvie, Biogen, BMS, Gilead, Janssen, MSD, Novartis, Lilly, Pfizer, UCB. Research Grants: Pfizer and UCB. Financial Support: This work has received a research grant from Fresenius Kabi. Corresponding author: Pr. Jérôme Avouac Université de Paris Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP 27 rue du Faubourg Saint-Jacques 75014 Paris, France. e-mail: jerome.avouac@aphp.fr.
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Sarah Wanono
Service de Rhumatologie, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France. Conflict of interest: JA: Honoraria: Galapagos, Lilly, Pfizer, Abbvie, Bristol-Myers Squibb, Sanofi, Roche- Chugai, Nordic Pharma, Medac, Novartis, Biogen, Fresenius Kabi, Janssen, and MSD. Research grants: Bristol-Myers Squibb, Pfizer (Passerelle), Novartis (Dreamer), Fresenius Kabi; AM: Honoraria: Abbvie, Biogen, BMS, Gilead, Janssen, MSD, Novartis, Lilly, Pfizer, UCB. Research Grants: Pfizer and UCB. Financial Support: This work has received a research grant from Fresenius Kabi. Corresponding author: Pr. Jérôme Avouac Université de Paris Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP 27 rue du Faubourg Saint-Jacques 75014 Paris, France. e-mail: jerome.avouac@aphp.fr.
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Elise Descamps
Service de Rhumatologie, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France. Conflict of interest: JA: Honoraria: Galapagos, Lilly, Pfizer, Abbvie, Bristol-Myers Squibb, Sanofi, Roche- Chugai, Nordic Pharma, Medac, Novartis, Biogen, Fresenius Kabi, Janssen, and MSD. Research grants: Bristol-Myers Squibb, Pfizer (Passerelle), Novartis (Dreamer), Fresenius Kabi; AM: Honoraria: Abbvie, Biogen, BMS, Gilead, Janssen, MSD, Novartis, Lilly, Pfizer, UCB. Research Grants: Pfizer and UCB. Financial Support: This work has received a research grant from Fresenius Kabi. Corresponding author: Pr. Jérôme Avouac Université de Paris Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP 27 rue du Faubourg Saint-Jacques 75014 Paris, France. e-mail: jerome.avouac@aphp.fr.
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Olivier Fogel
Service de Rhumatologie, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France. Conflict of interest: JA: Honoraria: Galapagos, Lilly, Pfizer, Abbvie, Bristol-Myers Squibb, Sanofi, Roche- Chugai, Nordic Pharma, Medac, Novartis, Biogen, Fresenius Kabi, Janssen, and MSD. Research grants: Bristol-Myers Squibb, Pfizer (Passerelle), Novartis (Dreamer), Fresenius Kabi; AM: Honoraria: Abbvie, Biogen, BMS, Gilead, Janssen, MSD, Novartis, Lilly, Pfizer, UCB. Research Grants: Pfizer and UCB. Financial Support: This work has received a research grant from Fresenius Kabi. Corresponding author: Pr. Jérôme Avouac Université de Paris Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP 27 rue du Faubourg Saint-Jacques 75014 Paris, France. e-mail: jerome.avouac@aphp.fr.
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Alice Combier
Service de Rhumatologie, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France. Conflict of interest: JA: Honoraria: Galapagos, Lilly, Pfizer, Abbvie, Bristol-Myers Squibb, Sanofi, Roche- Chugai, Nordic Pharma, Medac, Novartis, Biogen, Fresenius Kabi, Janssen, and MSD. Research grants: Bristol-Myers Squibb, Pfizer (Passerelle), Novartis (Dreamer), Fresenius Kabi; AM: Honoraria: Abbvie, Biogen, BMS, Gilead, Janssen, MSD, Novartis, Lilly, Pfizer, UCB. Research Grants: Pfizer and UCB. Financial Support: This work has received a research grant from Fresenius Kabi. Corresponding author: Pr. Jérôme Avouac Université de Paris Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP 27 rue du Faubourg Saint-Jacques 75014 Paris, France. e-mail: jerome.avouac@aphp.fr.
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Lucile Poiroux
Service de Rhumatologie, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France. Conflict of interest: JA: Honoraria: Galapagos, Lilly, Pfizer, Abbvie, Bristol-Myers Squibb, Sanofi, Roche- Chugai, Nordic Pharma, Medac, Novartis, Biogen, Fresenius Kabi, Janssen, and MSD. Research grants: Bristol-Myers Squibb, Pfizer (Passerelle), Novartis (Dreamer), Fresenius Kabi; AM: Honoraria: Abbvie, Biogen, BMS, Gilead, Janssen, MSD, Novartis, Lilly, Pfizer, UCB. Research Grants: Pfizer and UCB. Financial Support: This work has received a research grant from Fresenius Kabi. Corresponding author: Pr. Jérôme Avouac Université de Paris Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP 27 rue du Faubourg Saint-Jacques 75014 Paris, France. e-mail: jerome.avouac@aphp.fr.
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Corinne Miceli-Richard
Service de Rhumatologie, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France. Conflict of interest: JA: Honoraria: Galapagos, Lilly, Pfizer, Abbvie, Bristol-Myers Squibb, Sanofi, Roche- Chugai, Nordic Pharma, Medac, Novartis, Biogen, Fresenius Kabi, Janssen, and MSD. Research grants: Bristol-Myers Squibb, Pfizer (Passerelle), Novartis (Dreamer), Fresenius Kabi; AM: Honoraria: Abbvie, Biogen, BMS, Gilead, Janssen, MSD, Novartis, Lilly, Pfizer, UCB. Research Grants: Pfizer and UCB. Financial Support: This work has received a research grant from Fresenius Kabi. Corresponding author: Pr. Jérôme Avouac Université de Paris Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP 27 rue du Faubourg Saint-Jacques 75014 Paris, France. e-mail: jerome.avouac@aphp.fr.
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Yannick Allanore
Service de Rhumatologie, Hôpital Cochin, AP-HP.Centre Université de Paris, Paris, France. Conflict of interest: JA: Honoraria: Galapagos, Lilly, Pfizer, Abbvie, Bristol-Myers Squibb, Sanofi, Roche- Chugai, Nordic Pharma, Medac, Novartis, Biogen, Fresenius Kabi, Janssen, and MSD. Research grants: Bristol-Myers Squibb, Pfizer (Passerelle), Novartis (Dreamer), Fresenius Kabi; AM: Honoraria: Abbvie, Biogen, BMS, Gilead, Janssen, MSD, Novartis, Lilly, Pfizer, UCB. Research Grants: Pfizer and UCB. Financial Support: This work has received a research grant from Fresenius Kabi. Corresponding author: Pr. Jérôme Avouac Université de Paris Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP 27 rue du Faubourg Saint-Jacques 75014 Paris, France. e-mail: jerome.avouac@aphp.fr.
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Abstract

Objective To describe which parameters were collected by rheumatologists to monitor patients with rheumatoid arthritis (RA) during teleconsultation and identify which ones have more impact on clinician intervention.

Methods Retrospective monocentric routine care cross-sectional study including RA patients seen in teleconsultation between March and September 2020. Available parameters assessing disease status were collected in teleconsultation files. Clinician intervention was defined by treatment escalation and/or the need for a rapid face-to-face consultation or day hospitalization.

Results 143 RA patients were included (117 females, mean age of 58±16 years, mean disease duration of 14±11 years). The presence or absence of patient self-reported RA flares was mentioned in all medical files, followed by the presence and/or the number of tender joints (76%), the duration of morning stiffness (66%), the number of pain-related nocturnal awakenings (66%) and the CRP value (54%). Teleconsultation led to a clinician intervention in 22/143 patients (14%), representing 51% of patients with self-reported flares (22/43 patients). Therapeutic escalation was necessary in 13 patients and/or face-to-face consultation or day hospitalization were organized for 10 patients. Multivariate analysis identified RA flares (Odds Ratio, OR: 15.6 95% CI 3.37-68.28) and CRP values >10 mg/L (OR: 3.32, 95% CI % 1.12-13.27) as the variables independently associated with clinician intervention.

Conclusion Our study identified patient reported RA flares and increased CRP values as 2 red flags in teleconsultation, independently associated with therapeutic modification and/or the need for a rapid face-to-face consultation. These indicators may help clinician's decision making in teleconsultation.

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The Journal of Rheumatology
Vol. 49, Issue 7
1 Jul 2022
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Accepted manuscript
Evaluation of patients with rheumatoid arthritis in teleconsultation during the first wave of the COVID-19 pandemic
Jérôme Avouac, Anna Molto, Camélia Frantz, Sarah Wanono, Elise Descamps, Olivier Fogel, Alice Combier, Lucile Poiroux, Corinne Miceli-Richard, Yannick Allanore
The Journal of Rheumatology Jun 2022, jrheum.220073; DOI: 10.3899/jrheum.220073

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Accepted manuscript
Evaluation of patients with rheumatoid arthritis in teleconsultation during the first wave of the COVID-19 pandemic
Jérôme Avouac, Anna Molto, Camélia Frantz, Sarah Wanono, Elise Descamps, Olivier Fogel, Alice Combier, Lucile Poiroux, Corinne Miceli-Richard, Yannick Allanore
The Journal of Rheumatology Jun 2022, jrheum.220073; DOI: 10.3899/jrheum.220073
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