Roberto Caporali, MD, Italy

This year has brought unprecedented change that none of us could have ever imagined. Italy, my home country, was hit especially hard during this pandemic, leading to a long lockdown period. What felt like overnight, we had to change the way we delivered medications to be more home-based and had to learn how to conduct virtual visits within the legal and logistical constraints. Similar changes were seen across the globe and were discussed at this year’s ACR Convergence 2020, where we saw an abundance of abstracts and oral presentations focused on the impacts of COVID-19 on the field of rheumatology.

For me, a perfect kick-off to the virtual event was the opening message from ACR President, Ellen Gravallese. She said, “what I have witnessed in the field of rheumatology in response to this pandemic has been nothing short of remarkable” stressing the significant impact on and agility of rheumatologists, displayed in the way they delivered healthcare during the pandemic. In her presentation and across the meeting some key themes around COVID-19 and rheumatology included:

Risk in Patients with RMDs

Initial data from the COVID-19 Global Rheumatology Alliance registry showed that patients living with rheumatic diseases do not have an increased risk of contracting the virus; however, keeping disease activity low by focusing on treat-to-target strategies is recommended as a best practice to aid in prevention.1,2 Heeding this advice, it is important to keep in close contact with patients and continue providing them with information on the importance of following their medication regimen, following the international and national prevention guidelines, and assessing their sources of information.

Impact on Patients

We have been surveying our patients here in Italy to better understand the impact they have felt from all aspects of this pandemic. We found that patients living with rheumatic diseases have many of their own concerns around infection risk, use of their RA medication, and how their disease activity would fare in a virtual setting.3,4 At ACR we saw several others report similar findings, including:

  • Patients often acted on their concerns and self-stopped their medication themselves3,4
  • Patients’ attitude towards virtual visits was largely positive and cancellation rates of virtual visits was very low5-7

These impacts on patients highlight the importance of continued engagement with our patients and ongoing discussion around risks of COVID-19 on their disease.

Use of Telehealth

Before the pandemic, telehealth had a very limited role in my practice or that of many other medical clinics.4 Other physicians and I had to learn a new platform for virtual visits and determine how to best assess patients in real-time in a world that was changing daily. I have always preferred to see my patients in-person, but as I have had to use more electronic means of patient care, I am starting to see the potential value of telehealth. This view was also reflected in the opening session, where Dr. Gravallese stated the commitment of ACR to helping rheumatologists extend their reach and optimise care through telehealth and suggested a “need to broaden our collaboration with other specialities and learn how to best use telehealth so that face-to-face interactions do not become a lost relic.” Across ACR we saw several clinics presenting posters on how they tried to meet this suggestion by staying agile, reducing barriers around telehealth, and increasing patient engagement.6,7 There will always be a need for in-person visits, especially in newly diagnosed patients, but I am hopeful that the use of telehealth can broaden my reach as a rheumatologist by bringing routine virtual care to my patients with stable disease and reaching those I may not have had access to before.   

The Future of Virtual Rheumatology

Considering all of the changes that have happened this year, I believe it is important to take time to reflect on what worked and what did not during this time. It’s seeming all but assured we will need to prepare for additional waves and the chance of another pandemic in our lifetime. By continuing to build on new ideas and ways to optimise healthcare in a multitude of situations we become stronger, wiser, and more prepared to continue providing the best care for our patients and each other.

Other experts and I will be doing just that by continuing this discussion in an upcoming webinar, where we will look at the insights from ACR and learnings from 2020 and reflect on the expected changes to the field of rheumatology.

Be sure to register for the upcoming webinar by clicking here.

Roberto Caporali, MD
Professor of Rheumatology, Department of Clinical Sciences and Community Health, University of Milan
Head, Clinical Rheumatology Unit, Gaetano Pini Hospital, Milan, Italy

ACR, American College of Rheumatology; RA, rheumatoid arthritis.

References: 1. Landewé RBM, et al. Ann Rheum Dis 2020;79:851–858. 2. Grainger R, et al. ACR Convergence 2020. Presentation [abstract 2F042]. 3. Ko K, et al. ACR Convergence 2020. Poster [abstract 0636]. 4. Garrido-Cumbrera M, et al. ACR Convergence 2020. Presentation [abstract 0464]. 5. Watrous D, et al. ACR Convergence 2020. Poster [abstract 0017]. 6. Thomas J, et al. ACR Convergence 2020. Poster [abstract 1585]. 7. Alkilany R, et al. ACR Convergence 2020. Poster [abstract 1584].