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1.
Therapeutic Advances in Musculoskeletal Disease ; 14:1759720X2210895-1759720X2210895, 2022.
Article in English | PMC | ID: covidwho-1799155
2.
Lupus ; 31(4): 488-494, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1731440

ABSTRACT

OBJECTIVE: This study aimed to evaluate the short-term patient satisfaction, compliance, disease control, and infection risk of telemedicine (TM) compared with standard in-person follow-up (FU) for patients with lupus nephritis (LN) during the COVID-19 pandemic. METHOD: This was a single-center open-label randomized controlled study. Consecutive patients followed at the LN clinic were randomized to either TM or standard FU (SF) group in a 1:1 ratio. Patients in the TM group received FU via videoconferencing. SF group patients continued conventional in-person outpatient care. The 6-month data were compared and presented. RESULTS: From June to December 2020, 122 patients were randomized (TM: 60, SF: 62) and had at least 2 FUs. There were no baseline differences, including SLEDAI-2k and proportion of patients in lupus low disease activity state (LLDAS), between the two groups except a higher physician global assessment score (PGA) in the TM group. After a mean FU of 19.8 ± 4.5 weeks, the overall patient satisfaction score was higher in the TM group. More patients in the TM group had hospitalization (15/60, 25.0% vs 7/62, 11.3%; p = .049) with higher baseline PGA (OR = 1.17; 95% CI, 1.08-1.26) being the independent predictor. The proportions of patients remained in LLDAS were similar in the two groups (TM: 75.0% vs SF: 74.2%, p = .919). None of the patients had COVID-19. CONCLUSIONS: TM FU resulted in better patient satisfaction and similar short-term disease control in patients with LN compared to standard care. However, it was associated with more hospitalizations and might need to be complemented by in-person visits especially in patients with higher PGA.


Subject(s)
COVID-19 , Lupus Erythematosus, Systemic/therapy , Lupus Nephritis/therapy , Telemedicine , Adult , COVID-19/epidemiology , Female , Follow-Up Studies , Hong Kong/epidemiology , Humans , Lupus Erythematosus, Systemic/epidemiology , Lupus Nephritis/epidemiology , Male , Middle Aged , Pandemics , Patient Compliance , Patient Satisfaction , Severity of Illness Index
3.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-321807

ABSTRACT

Objective: To evaluate the short-term patient satisfaction, compliance, disease control and infection risk of telemedicine (TM) compared with standard in-person follow-up (FU) for patients with lupus nephritis (LN) during COVID-19. Methods: This was a single-center open-label randomized controlled study. Consecutive patients followed at the LN clinic were randomized to either TM or standard FU (SF) group in a 1:1 ratio. Patients in the TM group received FU via videoconferencing. SF group patients continued conventional in-person outpatient care. The 6-month data were compared and presented. Results: From June to December 2020, 122 patients were randomized (TM: 60, SF: 62) and had at least 2 FUs. There were no baseline differences, including SLEDAI-2k and proportion of patients in lupus low disease activity state (LLDAS), between the 2 groups except a higher physician global assessment score (PGA) in the TM group. After a mean FU of 19.8 ± 4.5 weeks, the overall patient satisfaction score was higher in the TM group. More patients in the TM group had hospitalization (15/60, 25.0% vs 7/62, 11.3%;p = 0.049) with higher baseline PGA (OR = 1.15, 95% CI 1.07–1.23) being the independent predictor. The proportions of patients remained in LLDAS were similar in the 2 groups (TM: 75.0% vs SF: 74.2%, p = 0.919). None of the patients had COVID-19. Conclusion: TM FU resulted in better patient satisfaction and similar short-term disease control in patients with LN compared to standard care. However, it was associated with more hospitalizations and might need to be complemented by in-person visits especially in patients with higher PGA.

4.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-321806

ABSTRACT

Background: Telemedicine has become an essential tool to manage patients with chronic disease during the COVID-19 pandemic in many parts of the world, and its widespread use will likely go beyond the outbreak. However, there is no study examining the factors associated with telemedicine use for follow-up of patients with SLE. Methods: Consecutive patients followed up at the lupus nephritis clinic were contacted for their preference in changing the coming consultation to telemedicine in the form of videoconferencing. The demographic, socioeconomic and disease data of the first 140 patients opted for telemedicine and 140 control patients preferred to continue standard in-person follow-up were compared. Results: The mean age of the 280 recruited patients was 45.6 ± 11.8 years. The mean disease duration was 15.0 ± 9.2 years. The majority of them had lupus nephritis class III, IV or V (88.2%) and were on prednisolone (90%). Three quarters of the patients (67.1%) were on immunosuppressants. The mean SLEDAI-2k was 4.06 ± 2.54, physician global assessment (PGA) was 0.46 ± 0.62 and SLICC/ACR damage index was 1.11 ± 1.36. A significant proportion of the patients (72.1%) had one or more comorbidities. It was found that patients with higher mean PGA (telemedicine: 0.54±0.63 vs control: 0.38±0.59, p=0.025) and family monthly income > USD3, 800 (telemedicine: 51/140, 36.4% vs control: 33/140, 23.6%;p=0.028) preferred telemedicine, while full-time employees (telemedicine: 56/140, 40.0% vs control: 71/140, 50.7%;p=0.041) preferred in-person follow-up. These predictors remained significant after controlling for age in the multivariate analysis. PGA was positively correlated with the perception that TM could reduce and routine visit could increase the risk of COVID-19 during the outbreak. No other clinical factors were found to be associated with the preference of telemedicine follow-up. Conclusions: When choosing the mode of care delivery between telemedicine and physical clinic visit for patients with SLE, the subjective disease activity as well as patient’s employment and economic status appeared to be important.

5.
Front Med (Lausanne) ; 8: 790652, 2021.
Article in English | MEDLINE | ID: covidwho-1581282

ABSTRACT

Objective: To investigate the factors associated with telemedicine (TM) use for follow-up of Systemic Lupus Erythematous (SLE) patients in the COVID-19 pandemic. Methods: This was a single-centered cross-sectional study conducted in Hong Kong. Consecutive patients followed up at the lupus nephritis clinic were contacted for their preference in changing the coming consultation to TM in the form of videoconferencing. The demographic, socioeconomic, and disease data of the first 140 patients opted for TM and 140 control patients preferred to continue standard in-person follow-up were compared. Results: The mean age of all the participants was 45.6 ± 11.8 years, and the disease duration was 15.0 ± 9.2 years. The majority of them were on prednisolone (90.0%) and immunosuppressants (67.1%). The mean SLEDAI-2k was 3.4 ± 2.4, physician global assessment (PGA) was 0.46 ± 0.62 and Systemic Lupus International Collaborating Clinics (SLICC) damage index was 0.97 ± 1.23. A significant proportion of the patients (72.1%) had 1 or more comorbidities. It was found that patients with higher mean PGA (TM: 0.54 ± 0.63 vs. control: 0.38 ± 0.59, p = 0.025) and family monthly income > USD 3,800 (TM: 36.4% vs. control: 23.6%; p = 0.028) preferred TM, while full-time employees (TM: 40.0% vs. control: 50.7%; p = 0.041) preferred in-person follow-up. These predictors remained significant in the multivariate analysis after adjusting for age and gender. No other clinical factors were found to be associated with the preference of TM follow-up. Conclusion: When choosing the mode of care delivery between TM and physical clinic visit for patients with SLE, the physician-assessed disease activity and patient's socio-economic status appeared to be important.

6.
Front Endocrinol (Lausanne) ; 12: 611526, 2021.
Article in English | MEDLINE | ID: covidwho-1305635

ABSTRACT

Background: It has been reported that dyslipidemia is related to coronavirus-related diseases. Critical patients with coronavirus disease 2019 (COVID-19) who suffered from multiple organ dysfunctions were treated in the intensive care unit (ICU) in Wuhan, China. Whether the lipids profile was associated with the prognosis of COVID-19 in critical patients remained unclear. Methods: A retrospective study was performed in critical patients (N=48) with coronavirus disease 2019 in Leishenshan hospital between February and April 2020 in Wuhan. The parameters including lipid profiles, liver function, and renal function were collected on admission day, 2-3days after the admission, and the day before the achievement of clinical outcome. Results: Albumin value and creatine kinase (ck) value were statistically decreased at 2-3 days after admission compared with those on admission day (P<0.05). Low density lipoprotein (LDL-c), high density lipoprotein (HDL-c), apolipoprotein A (ApoA), and apolipoprotein A (Apo B) levels were statistically decreased after admission (P<0.05). Logistic regression showed that HDL-c level both on admission day and the day before the achievement of clinical outcome were negatively associated with mortality in critical patients with COVID-19. Total cholesterol (TC) level at 2-3days after admission was related to mortality in critical patients with COVID-19. Conclusions: There were lipid metabolic disorders in the critical patients with COVID-19. Lower levels of HDL-c and TC were related to the progression of critical COVID-19.


Subject(s)
COVID-19/mortality , Dyslipidemias/epidemiology , Hospital Mortality , Multiple Organ Failure/mortality , Aged , Aged, 80 and over , Apolipoproteins A/blood , Apolipoproteins B/blood , COVID-19/blood , COVID-19/epidemiology , China/epidemiology , Cholesterol/blood , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Critical Illness , Dyslipidemias/blood , Female , Humans , Male , Middle Aged , Multiple Organ Failure/blood , Multiple Organ Failure/epidemiology , Retrospective Studies , Risk Factors , SARS-CoV-2 , Severity of Illness Index
7.
Int J Rheum Dis ; 24(6): 733-745, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1214741

ABSTRACT

AIM: To update previous guidance of the Asia Pacific League of Associations for Rheumatology (APLAR) on the management of patients with rheumatic and musculoskeletal diseases (RMD) during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Research questions were formulated focusing on diagnosis and treatment of adult patients with RMD within the context of the pandemic, including the management of RMD in patients who developed COVID-19. MEDLINE was searched for eligible studies to address the questions, and the APLAR COVID-19 task force convened 2 meetings through video conferencing to discuss its findings and integrate best available evidence with expert opinion. Consensus statements were finalized using the modified Delphi process. RESULTS: Agreement was obtained around key aspects of screening for or diagnosis of COVID-19; management of patients with RMD without confirmed COVID-19; and management of patients with RMD with confirmed COVID-19. The task force achieved consensus on 25 statements covering the potential risk of acquiring COVID-19 in RMD patients, advice on RMD medication adjustment and continuation, the roles of telemedicine and vaccination, and the impact of the pandemic on quality of life and on treatment adherence. CONCLUSIONS: Available evidence primarily from descriptive research supported new recommendations for aspects of RMD care not covered in the previous document, particularly with regard to risk factors for complicated COVID-19 in RMD patients, modifications to RMD treatment regimens in the context of the pandemic, and COVID-19 vaccination in patients with RMD.


Subject(s)
Antirheumatic Agents/therapeutic use , COVID-19/epidemiology , Consensus , Immunosuppressive Agents/therapeutic use , Pandemics , Rheumatic Diseases/drug therapy , Comorbidity , Humans , Rheumatic Diseases/epidemiology , Rheumatology , SARS-CoV-2
8.
Semin Arthritis Rheum ; 50(5): 885-889, 2020 10.
Article in English | MEDLINE | ID: covidwho-665551

ABSTRACT

OBJECTIVES: Patients with rheumatologic diseases might be more susceptible to COVID-19 and carry a poorer prognosis. The aim of this study is to examine the incidence and outcomes of all COVID-19 patients with rheumatologic conditions in Hong Kong. METHODS: This is a population-based retrospective study. All patients tested positive for SARS-CoV-2 by PCR with a previous diagnosis of rheumatologic diseases were reviewed. The incidence of COVID-19 in patients with rheumatologic conditions was calculated and compared to the general population in Hong Kong. Descriptive data of those rheumatologic patients with COVID-19 and the clinical course of the index infection were presented. RESULTS: Up till 27 May 2020, there were 1067 cases of COVID-19 diagnosed in Hong Kong which had a population of 7.5 million. Out of the 39,835 patients with underlying rheumatologic diseases, we identified 5 PCR confirmed COVID-19 cases. The estimated incidence of COVID-19 was 0.0126% patients with rheumatologic diseases, compared to 0.0142% in the general population. All 5 patients had inflammatory arthropathies. One patient was on hydroxychloroquine and sulphasalazine, and one was on methotrexate. None of the 3534 patients on b/tsDMARDs was infected. Four patients had leucopenia/lymphopenia and stool viral PCR was positive in 3 patients. All patients made uneventful recovery without complications or flare of underlying diseases. CONCLUSIONS: We found no alarming signals of increased frequency or severity of COVID-19 in patients with rheumatologic diseases, although extrapolation of the results to other populations with different infection control strategies should be made with caution.


Subject(s)
Antirheumatic Agents , Betacoronavirus/isolation & purification , Clinical Laboratory Techniques , Coronavirus Infections , Joint Diseases , Pandemics , Pneumonia, Viral , Rheumatic Diseases , Adult , Antirheumatic Agents/classification , Antirheumatic Agents/therapeutic use , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Clinical Laboratory Techniques/statistics & numerical data , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Female , Hong Kong/epidemiology , Humans , Incidence , Joint Diseases/drug therapy , Joint Diseases/epidemiology , Joint Diseases/etiology , Male , Middle Aged , Outcome Assessment, Health Care , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Prognosis , Retrospective Studies , Rheumatic Diseases/diagnosis , Rheumatic Diseases/epidemiology , Risk Assessment , Risk Factors , SARS-CoV-2
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