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Response to: ‘COVID-19 pandemic: an opportunity to assess the utility of telemedicine in patients with rheumatic diseases’ by Lopez-Medina et al
  1. Emanuele Bozzalla Cassione1,2,
  2. Giovanni Zanframundo1,2,
  3. Alessandro Biglia1,2,
  4. Veronica Codullo1,2,
  5. Carlomaurizio Montecucco1,2,
  6. Lorenzo Cavagna1,2
  1. 1 Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
  2. 2 Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Lombardia, Italy
  1. Correspondence to Professor Carlomaurizio Montecucco, Department of Rheumatology, IRCCS Foundation Policlinico San Matteo, Pavia 27100, Italy; montecucco{at}

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We thank Lopez-Medina et al 1 for their comment on our paper and for sharing their experience with phone consultations.2 Telemedicine, in the past years, has been progressively implemented into medical practice. However, it has not been able to fully take root into routine medical care yet. The COVID-19 pandemic provided the opportunity to take a further step towards the integration between virtual and traditional medical assistance in many medical specialties including rheumatology. The restriction rules, taken over by numerous countries, together with the necessity of assuring a proper continuity of care, have forced us to adopt telemedicine tools in our routine involving chronic patients. To overcome legal matters of privacy and data protection, we have recently set up a telemedicine software provided by our institution that allows us to have visual interaction with the patient and to share files in a password-protected virtual room. This approach has revealed a useful help with a major response rate by patients, achievable thanks to the broad internet coverage and connectivity with an increasing percentage of people owning a smartphone nowadays in Italy. As expected, we have observed high response rates among the younger population, with the older ones frequently needing support from other family members (G Zanframundo et al, submitted). Furthermore, visual contact may overcome the barriers of a simple phone call. Telemedicine perfectly fits for stable, long-standing conditions, and it can be useful for intermediate follow-up visits. This would markedly reduce the burden on medical resources, better balancing population medical needs and human resources in our health system, highly stressed by COVID-19. A role for a tele-rheumatological triage to better identify those patients needing urgent or specialist evaluation could be another potential benefit. It could greatly refine outpatient clinic access, reducing the workload on third-level referral centres, in turn improving medical care. Furthermore, an increased implementation of digital and cloud-based medical visits and prescriptions might propel specialist–specialist and specialist–general practitioner interactions for the benefit of the patient. Lastly, telemedicine might take advantage of the development of remote medical technologies. There is an increasing interest in the aid that wearable devices may provide to the global care of patients as already described in chronic inflammatory arthritides and virtually applicable in every rheumatological condition.3 However, despite having represented an enormous help during the COVID-19 pandemic, telemedicine bears major caveats that must be carefully addressed and adapted to our new postpandemic routine. Indeed, certain rheumatological conditions require prompt diagnosis and rapid treatment initiation with a regular and objective follow-up. The treat-to-target approach in early rheumatoid arthritis is one clear example.4 In conclusion, we believe that this novel approach may be a rich opportunity in rheumatology when properly and timely used, taking into account the intrinsic limits of a telemedicine assessment in different patients at different times.



  • EBC and GZ are joint first authors.

  • Handling editor Josef S Smolen

  • Contributors All authors wrote the response letter.

  • 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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