ABSTRACT
Patients suffering from chronic, debilitating diseases like rheumatologic disorders (RDs) need constant support and regular interventions. This mandates the need for a multidimensional, multidisciplinary approach that includes self-care and social support to achieve an acceptable quality of life. The chronic care model, encompassing six major aspects of patient care, is one of the most widely accepted approaches to chronic healthcare. However, the large global burden of RDs calls for a revised model for improving access, minimizing logistic costs, and facilitating uniformity and quality. The integration of telemedicine into the chronic care model seems to the best answer to the problem at hand. Telemedicine involves using various information and communications technologies to overcome geographical barriers for clinical support and to improve healthcare outcomes. In this chapter, we attempt to understand the methods, advantages, and challenges of the application of telecare into management of RDs such as idiopathic inflammatory myositis (IIM). © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.
ABSTRACT
Background/Aims Patients with rheumatic diseases are known to exhibit worse outcomes with COVID-19. However, the effect on individual diseases such as idiopathic inflammatory myopathies (IIM) remain unexplored. Methods A self-report e-survey with 36 questions was pilot tested and validated to cover demographics, history of COVID-19 contact, course and severity of COVID-19 infection, influence of COVID-19 infection on physical state one-month after the infection and vaccination status. Baseline characteristics were retrieved from the MyoCite registry and biobank archive. PROMIS-10a, a validated self-report tool was used to quantify physical function. Age and gender similar healthy controls (HC) were included for comparison. Results 10 patients of IIM were compared with 40 controls. Fever was the most common symptom reported by both the groups however, fatigue, chest pain, and breathlessness were experienced more by patients of IIM compared to HC. However, severity of COVID-19 infection as substantiated by pneumonia, hospitalization, and oxygen requirement was comparable in IIM and HC, possibly due to small numbers PROMIS physical function was comparable before COVID-19 in both groups, and in HC physical function remained the same a month before and after COVID-19. On the other hand, the physical function deteriorated at 30-days after COVID-19 in the IIM group as compared with their baseline function as well as HC. Specific tasks were more challenging for IIM, including climbing stairs, bending or kneeling and shampooing hair, although the limitation was mild (Table 1). IIM patients were also less likely to be vaccinated, suggesting prevalent hesitancy in this group (50% vs 90%, p: 0.007) (Table 1). Conclusion Patients with IIM exhibit increase in fatigue, and dyspnoea during COVID-19 although there is no increase in hospitalisation and had similar disease severity compared to HC. Short term physical function is impacted at 30-days post COVID-19, suggesting the need for closer long-term follow-up. Vaccine hesitancy is prevalent and merits addressing in patients with IIM.