Roberto Caporali, MD, Italy

When the pandemic first hit my home country of Italy, everything stopped. Trains quit running, curfews were set, and we were told to stay home. While this was, of course, a big change in my own life, I also quickly thought about my patients. My institution said they would no longer be allowing in-person routine care visits and, instead, we could only see urgent cases in the hospital. In my own experience and that of others discussed at this year’s ACR Convergence 2020, patients with RMD have numerous concerns, a number of which revolve around COVID-19 in the context of their disease. Some of these concerns include:

  • Fear of having a more severe COVID-19 infection due to their underlying disease1
  • Concerns regarding the use of immunosuppressive therapy2,3
  • Potentially increasing their risk for contracting COVID-19 by visiting their rheumatologist3

Not only are patients worrying about how their disease may affect and be affected by COVID-19, but data presented at ACR from an online survey of 1786 patients from Europe living with rheumatic diseases during the pandemic found that almost half of patients reported a general sense of poor well-being and a definite or borderline case of anxiety and depression.3 They also found 1 in 5 patients reported smoking and using alcohol more now than before the pandemic.3 These unprecedented impacts on our patients should be considered and discussed during telehealth visits while also asking about their disease status.3

As rheumatologists, we know that in addition to strict disease measures, we must also consider outcomes important to patients, such as pain, fatigue, and mental health. These factors are top of mind for patients living with RMDs and were reviewed in another entry on this blog.4 However, during the pandemic and while adapting to challenges with telehealth, how do we continue to assess these PROs?

At ACR we saw many abstracts discussing benefits and challenges of telehealth but only a few focused on ideas around collecting PROs in a virtual setting. Some of these include:

  • Smartphone apps to track patient outcomes5
  • Web-based surveys6
  • Video conferencing7

Many of these ideas are not without their implementation challenges, such as barriers or limited access to technology. However, we all understand the importance of PROs for patients with RMDs and therefore need to identify opportunities to assess these measures, regardless of the format of visits. Asking about disease-specific PROs during these ever-changing times also gives us another opportunity to simply provide support, education, and encouragement to our patients.

To hear more discussions on the year 2020 and its impacts on the future of rheumatology care, including PROs, 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; EULAR, European League Against Rheumatism; JAKi, Janus kinase inhibitor, MOA, mechanism of action; MTX, methotrexate; RA, rheumatoid arthritis.

References: 1. Ko K, et al. ACR Convergence 2020. Poster [abstract 0636]. 2. George M, et al. ACR Convergence 2020. Presentation [abstract 0468]. 3. Garrido-Cumbrera M, et al. ACR Convergence 2020. Presentation [abstract 0464]. 4. Nowell B, et al. ACR/ARP 2019. Poster [abstract 0435]. 5. Murray M, et al. ACR Convergence 2020. Poster [abstract 1460]. 6. Vitone G, et al. ACR Convergence 2020. Poster [abstract 0018]. 7. Batterman A, et al. ACR Convergence 2020. Presentation [session 5M011].