Background/Purpose: In rheumatoid arthritis (RA), access to a rheumatologist is associated with improved quality of care and outcomes. Telemedicine has been proposed as a solution to the problem of limited access to rheumatologists given the workforce shortage and concentration of rheumatologists in urban areas. Rheumatology care using live video telemedicine has been implemented within the Alaska Tribal Health System. The purpose of this analysis is to evaluate the impact of telemedicine follow-up for RA on disease activity and functional status.

Methods: Study participants with a diagnosis of RA were recruited when seeing a rheumatologist, either in-person or by telemedicine. At the study visit, participants completed the Routine Assessment of Patient Index Data 3 (RAPID3) and a telemedicine perception survey and agreed to medical record review for disease characteristics and measures of quality and access to care. Participants also agreed to telephone contact at 6 and 12 months for follow-up surveys and RAPID3. This analysis describes the results as of the 6-month follow-up RAPID3.

Results: To date, 81 participants have completed the 6-month follow-up (41 telemedicine and 40 in-person). Demographics, disease characteristics and baseline RAPID3 and functional status were similar across groups. The telemedicine group had a higher mean number of rheumatologist visits in the preceding year (3.2 vs. 2.1, p=0.002). At the 6-month follow-up, the mean RAPID3 was lower in the in-person group (3.2 vs. 4.0, p = 0.04), with no difference in functional status between groups. The change in RAPID3 and functional status over 6 months were no different in the telemedicine vs. in-person group. In multivariate linear regression, no factors (demographics, smoking status, disease characteristics, telemedicine vs. in-person group) were associated with change in RAPID3, but a worsening of functional status was more likely in smokers (p=0.009). The percent in low disease activity or remission at 6 months was low (16%) and did not differ by group. Multivariate logistic regression did not identify any factors associated with low disease activity or remission, although there was a non-significant trend toward lower odds of low disease activity or remission with a higher rheumatic disease comorbidity index (p=0.079).

Conclusion: Telemedicine can improve access to care in patients with RA. In this study, there was lower disease activity at 6 months in RA patients seen in-person compared to by telemedicine, but it was not significant in multivariate analyses. Based on this study to date, no significant differences are identified between telemedicine and in-person care on short-term outcomes in RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcomes-of-telemedicine-for-rheumatoid-arthritis-in-the-alaska-native-population/