Outcomes and Quality of Care in Rheumatoid Arthritis With or Without Video Telemedicine Follow‐Up Visits

To develop a new evidence-based, pharmacologic treatment guideline for rheumatoid arthritis (RA).

Background Aiming at therapeutic targets has reduced the risk of organ failure in many diseases such as diabetes or hypertension. Such targets have not been defined for rheumatoid arthritis (RA). Objective To develop recommendations for achieving optimal therapeutic outcomes in RA. Methods A task force of rheumatologists and a patient developed a set of recommendations on the basis of evidence derived from a systematic literature review and expert opinion; these were subsequently discussed, amended and voted upon by >60 experts from various regions of the world in a Delphi-like procedure. Levels of evidence, strength of recommendations and levels of agreement were derived. Results The treat-to-target activity resulted in 10 recommendations. The treatment aim was defined as remission with low disease activity being an alternative goal in patients with long-standing disease. Regular follow-up (every 1–3 months during active disease) with appropriate therapeutic adaptation to reach the desired state within 3 to a maximum of 6 months was recommended. Follow-up examinations ought to employ composite measures of disease activity which include joint counts. Additional items provide further details for particular aspects of the disease. Levels of agreement were very high for many of these recommendations (≥9/10). Conclusion The 10 recommendations are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA based on evidence and expert opinion.

Objective The aim of this systematic review was to identify and summarize the published literature on the use of telemedicine for the diagnosis and management of inflammatory and/or autoimmune rheumatic disease. Methods We performed a registered systematic search (CRD42015025382) for studies using the MEDLINE (1946-August 2015), Embase (1974-August 2015), Web of Science (1900-August 2015), and Scopus (1946-August 2015) databases. We included studies which demonstrated the use of telemedicine for diagnosis and/or management of inflammatory/autoimmune rheumatic disease. Following data extraction, we performed a descriptive analysis. Results Our literature search identified 1,468 potentially eligible studies. Of these, 20 reports were ultimately included in this review. Studies varied significantly in publication type, quality of evidence, and the reporting of methods. Most demonstrated a high risk of bias. Rheumatoid arthritis was the most commonly studied rheumatic disease (42% of patients). Studies demonstrated conflicting results regarding the effectiveness of telemedicine (18 found it effective, one found it effective but possibly harmful, and one found it ineffective). A limited number of studies included some component of a cost analysis (n=6, 16% of patients); all of these found telemedicine to be cost-effective. Conclusion Studies identified by this systematic review generally found telemedicine to be effective for the diagnosis and management of autoimmune/inflammatory rheumatic disease; however, there is limited evidence to support this conclusion. Further studies are needed to determine the best uses of telemedicine for the diagnosis and management of these conditions.