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Challenges and opportunities in telerheumatology in the COVID-19 era. Response to: ‘Online management of rheumatoid arthritis during COVID-19 pandemic’ by Zhang et al
  1. Gabriel Figueroa-Parra,
  2. Carmen Magdalena Gamboa-Alonso,
  3. Dionicio Angel Galarza-Delgado
  1. Servicio de Reumatología, Hospital Universitario Dr José Eleuterio González, Monterrey, Nuevo León, Mexico
  1. Correspondence to Dionicio Angel Galarza-Delgado, Servicio de Reumatología, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León, Mexico; dgalarza{at}

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We thank Zhang et al for the interest showed in our letter1 and appreciate their comments about the care of rheumatic patients during the COVID-19 pandemic.2 We agree that the function of all rheumatology outpatient clinics around the world has changed. It is a fact that the complexity of the care of rheumatic disease patients implies challenges, both to follow-up knew patients and control their diseases and also in the evaluation of patients with onset of new symptoms who potentially could be caused by a rheumatic disease. In patients with rheumatoid arthritis (RA), from the five clinical encounter components (vital signs, patient history, physical examination, laboratory tests and ancillary studies), patient’s history and physical examination are the most important in their diagnosis and management compared with other diseases.3

Telemedicine is not a new idea; it has been used in many countries for years to improve access to specialised care in rural areas. In telemedicine, we can obtain a complete patient’s history, but we have some barriers to the physical examination. Even when we can do a proper inspection of skin lesions or identify swollen joints, it is more difficult to evaluate lung abnormalities or perform certain types of manoeuvres to identify the origin of pain. Telemedicine and telehealth approaches have taken a predominant role in our practices in the past months. It has been proposed a triage tool to guide telemedicine in rheumatology that depends on the diagnosis stage and disease state; according to this tool, good candidates to telemedicine could be those with established diagnosis and stable disease and those who need a screening prior to the in-person visit, but may not be the best option to those patients who are having a flare, need a procedure or the complexity of their disease and follow-up is difficult to do remotely.4 We proposed as an alternative to use during telemedicine consultation for patients with RA, the combination of routine assessment of patient index data 3 (RAPID3) score5 and the evaluation of fist closure and fist strength6 both of them have shown good correlation with other activity scales (that includes joint-counts) and underlying flexor tenosynovitis, respectively. The lack of telecommunication resources in low-income and middle-income countries makes the possibility of offering this type of care more difficult than others. Nonetheless, the benefits are more numerous (convenience, decreased costs of transportation to hospitals or clinics, accessibility for patients leaving in other states or countries), and particularly aim to protect patients, doctors and staff from unnecessary risk of contracting COVID-19. Work has to be done to implement these means as an aid measure in cases where medical consultation is compromised.

We believe that all the changes that we are living in also carry opportunities to innovate and optimise the care access to our patients. There will be changes that will stay from now on and we are obligated to learn, adapt and evolve by optimising these resources in performing a better healthcare approach for our patients.



  • Handling editor Josef S Smolen

  • Twitter @GaboFP

  • GF-P and CMG-A contributed equally.

  • Contributors GF-P, CMG-A, and DAG-D drafted and revised the manuscript for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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