J. Avouac, MD, PhD, A. Molto, MD, PhD, C. Frantz, MD, PhD, S. Wanono, MD, E. Descamps, MD, O. Fogel, MD, A. Combier, MD, L. Poiroux, MD, C. Miceli-Richard, MD, PhD, Y. Allanore, MD, PhD, Service de Rhumatologie, Hôpital Cochin, AP-HP, Centre Université de Paris, Paris, France.
J Rheumatol. 2022 Nov;49(11):1269-1275. doi: 10.3899/jrheum.220073. Epub 2022 Jun 15.
To describe which variables were collected by rheumatologists to monitor patients with rheumatoid arthritis (RA) during teleconsultation and identify which ones have more impact on clinician intervention.
Retrospective monocentric, routine care cross-sectional study including patients with RA seen in teleconsultation between March and September 2020. Available variables assessing disease status were collected in teleconsultation files. Clinician intervention was defined by treatment escalation and/or the need for a rapid face-to-face consultation or day hospitalization.
One hundred forty-three patients with RA were included (116 females, mean age of 58 [SD 16] yrs, mean disease duration of 14 [SD 11] yrs). The presence or absence of patient self-reported RA flares was mentioned in all medical files, followed by the presence and/or the number of tender joints (76%), the duration of morning stiffness (66%), the number of pain-related nocturnal awakenings (66%) and the C-reactive protein (CRP) value (54%). Teleconsultation led to a clinician intervention in 22/143 patients (15%), representing 51% of patients with self-reported flares (22/43 patients). Therapeutic escalation was necessary in 13 patients and/or face-to-face consultation or day hospitalization were organized for 10 patients. Multivariate analysis identified RA flares (odds ratio [OR] 15.6, 95% CI 3.37-68.28) and CRP values > 10 mg/L (OR 3.32, 95% CI % 1.12-13.27) as the variables independently associated with clinician intervention.
Our study identified patient-reported RA flares and increased CRP values as 2 red flags in teleconsultation, independently associated with therapeutic modification and/or the need for a rapid face-to-face consultation. These indicators may help clinicians' decision making in teleconsultation.
描述风湿病学家在远程咨询期间收集哪些变量来监测类风湿关节炎（RA）患者，并确定哪些变量对临床医生干预的影响更大。
这是一项回顾性单中心、常规护理横断面研究，纳入了 2020 年 3 月至 9 月期间接受远程咨询的 RA 患者。在远程咨询档案中收集了评估疾病状况的可用变量。临床医生干预的定义为治疗升级和/或需要快速面对面咨询或日间住院。
共纳入 143 例 RA 患者（116 名女性，平均年龄 58 [16] 岁，平均病程 14 [11] 年）。所有医疗记录中均提到了患者自述的 RA 发作，其次是压痛关节的存在和/或数量（76%）、晨僵持续时间（66%）、与疼痛相关的夜间觉醒次数（66%）和 C 反应蛋白（CRP）值（54%）。在 143 例患者中，有 22 例（15%）接受了临床医生干预，其中 22 例（43 例中有 22 例）患者自述有 RA 发作。13 例患者需要进行治疗升级，10 例患者需要进行面对面咨询或日间住院。多变量分析确定 RA 发作（优势比 [OR] 15.6，95%置信区间 [CI] 3.37-68.28）和 CRP 值>10 mg/L（OR 3.32，95% CI 1.12-13.27）是与临床医生干预独立相关的变量。
我们的研究确定了患者报告的 RA 发作和 CRP 值升高是远程咨询中的 2 个危险信号，与治疗改变和/或需要快速面对面咨询独立相关。这些指标可能有助于临床医生在远程咨询中的决策。
