“While not as complete as in-person visits, I do love telehealth appointments because the provider has to listen to me before talking, and I absolutely take advantage of the time to share. I also feel more prepared, because I haven't had to leave the house and wait in a chair,” said Charis Hill, 33, a disability and chronic disease patient advocate and activist, in a recent Twitter chat co-sponsored by CreakyJoints and Everyday Health. Hill, who lives in Sacramento, California, has ankylosing spondylitis, a form of chronic arthritis that causes inflammation where tendons, ligaments, and bones meet.
When you live with rheumatoid arthritis (RA), it is important to stay in touch with your doctors and remain on your medications and treatment protocols. But with the shelter-in-place mandate, that can seem difficult. A telemedicine visit (consulting with your healthcare provider using a smartphone, tablet, computer or other technology), while not perfect, is a very good alternative. Indeed, telemedicine has exploded in just four short months because of pandemic constraints. For example, according to Brandon Welch, PhD, the founder of Doxy.me, the telemedicine portal logged 5.9 million minutes and 236,000 calls in January 2020. By April, those figures had jumped to 315.4 million minutes and 18.9 million calls.
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The consensus seems to be that telemedicine is helpful during a challenging time, but that it has some significant limitations. Vinicius Domingues, MD, a rheumatologist and a medical adviser to CreakyJoints, says that when the patient is doing well, telehealth is as effective as live. The doctor can review medications and lab results and make sure patients understand their particular protocol. “However, when there is an issue, it's very hard not to be able to perform a proper physical exam, feeling the joints for swelling and warmth, to see better if there's a rash. Plus, I can’t give injections over video, obviously. Thankfully we have telemedicine, because otherwise it would be challenging during these times, but it's not a complete replacement for a full visit,” he says.
Chris Phillips, MD, the chair of the American College of Rheumatology’s insurance subcommittee and a member of the ACR’s committee on rheumatologic care, understands that people with RA are anxious about COVID-19. “A lot of them are older or immune suppressed, so they're worried about getting sick. They're worried about coming into the office to see us and getting exposed to patients who are sick,” he says. More important, he has seen a few cases where patients, concerned that their immunosuppressant medications make them more vulnerable to getting the virus, just stop taking their meds, with disastrous results.
This is dangerous, Dr. Phillips says. “If you go off the medicine without checking with your doctor, you run the risk of having a significant flare of underlying disease, which you then may or may not get back under control successfully when you go back on treatment. For most patients we're recommending they continue that treatment but be extra cautious about sticking to safety guidelines. I think now more than ever, it's important that we be in communication either in person or by phone or telehealth with people who have those concerns.”
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According to Dr. Domingues, your doctor should review all your symptoms that have arisen since you were last seen, your lab tests, and discuss your medications. “Obviously, I don’t have the ability to perform a full physical exam, but I can see a swollen knee via telemedicine and make the determination that the patient needs to come in for a shot,” he says.
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Let’s say you need an injection, infusion or joint manipulation. How can you see your doctor in person safely? Most offices are following these Centers for Disease Control (CDC) precautions, says Domingues:
It looks like telemedicine is here to stay, but in what form and to what extent after the pandemic is over is still unclear. Phillips says, “It depends on whether some of the regulatory changes are left in place or not.” For the foreseeable future, enjoy not having to drive and then read endless out-of-date magazines in a waiting room!