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We thank our colleagues So and Tam from Hong Kong for their comments1 on our recommendations for the management of patients with inflammatory rheumatic diseases (IRD) during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/COVID-19 pandemic published in this journal.2 In our manuscript, we have recommended to ensure necessary controls for therapy and disease monitoring; however, we have suggested to always weigh the individual risk of an infection associated with a visit to the doctor’s office (eg, while travelling to and from as well as being present at the medical facility) against the risk of missing controls. In many IRD, temporary prolonged intervals of monitoring patients with stable disease and stable efficacious therapy may well be justified. Thus, in these patients, this measure may help to decrease the risk of getting infected with SARS-CoV-2. However, prolongation of monitoring intervals should be limited in time and as the pandemic continues, patients will have to be monitored again in order to receive appropriate care. Moreover, some concern relates to the extension of monitoring intervals in particular circumstances, for example, in patients with diseases that are known to frequently flare and therefore may cause irreversible tissue damage when allowed to attack central organs uncontrolled. These diseases comprise many of the vasculitides as well as connective tissue diseases, such as systemic sclerosis, dermatomyositis and polymyositis, Sjogren’s disease or systemic lupus erythematosus. A safe, reliable and efficacious means to perform controls on disease activity and medication toxicity in these patients is eagerly awaited.
So and Tam have observed a drop of 14.4% of patient visits in their lupus nephritis clinic during the first 8 weeks of the COVID-19 pandemic as compared with the same time period in 2019. As these patients were felt to be at risk of disease flares, the authors conducted an online survey to analyse the patients’ acceptance and perceptions regarding the use of telemedicine for follow-up of lupus nephritis during the COVID-19 outbreak. Of the 155 patients who responded, 89 (57.4%) were willing to perform a telemedical follow-up. Interestingly, however, only 40% of all of the patients declared to be confident in telemedicine while even 14.9% disagreed or strongly disagreed to perform remote follow-ups. The data from Hong Kong show that despite its great potential, telemedicine is still a long way from being generally accepted by patients and thus also from becoming a widely used alternative for conducting necessary disease control in patients with IRD.
Beside a different patient behaviour driven by fear of an infection with SARS-CoV-2, the lockdown regulations themselves although successful in general to halt the pandemic3 have also led to an acute restriction of outpatient care options for patients with IRD. In Germany, this led to a temporary decrease in physical patient visits to doctors’ offices of up to 50%.4 As a consequence, care was widely switched to telephone and telemedicine. These measures were highly accepted by the patients as one of the most requested information was related to the continuation of disease modifying antirheumatic drugs (DMARD) therapy, which could easily be addressed remotely, in particular as the recommendations had been published.2 However, it remains to be shown whether telephone and telemedicine will be continued to be accepted as useful when the relaxation of the lockdown restrictions will allow outpatient care closer to the situation before the COVID-19 pandemic and recommended visits to the doctors’ offices and laboratory tests even when the rheumatic disease is stable become a relevant issue.2 5
We agree with our colleagues from Hong Kong on the future value of telemedical cocare, regardless of the current emergency situation caused by the COVID-19 pandemic. The treatment and care of patients by rheumatologists will be further complicated in the future by the limitation of human resources, and new ways of supporting care must be sought. Telemedicine is probably one of the most promising possibilities. The extent to which this can be implemented in severe systemic diseases such as systemic lupus erythematosus will have to be further investigated in studies. It is conceivable that the corona crisis has catalysed the increasing importance of telemedicine in rheumatology.6
Handling editor Josef S Smolen
Contributors All authors wrote and revised the manuscript.
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.
Provenance and peer review Commissioned; internally peer reviewed.
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