IMPORTANCE of TELEMEDICINE in the SYSTEMIC SCLEROSIS during COVID-19 PANDEMIC

ABSTRACT

Background: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), also called COVID-19 disease, was frstly reported in December 2019 in China and soon declared a pandemic by the World Health Organization (WHO) on March 11, 2020 (1). As a result, patients' visits to medical facilities are affected. Systemic sclerosis (SSc) is a chronic systemic autoimmune disease characterized by vascular damage, autoimmunity, and fbrosis. In these patients, a tight follow-up is crucial to verify the specifc cases and clinical needs. In particular, the infection risk in SSc might also be related not only to disease activity but also to possible fares due to therapy discontinuation. Telemedicine has demonstrated as a valid alternative to improve the quality of rheumatic patients' care during COVID-19 pandemic, thus reducing hospitalizations only to urgent admissions (2) Objectives: In december 2020 the Azienda Policlincio Vanvitelli approved telemedicine by IRPLUS platform as a particular measure in the face of the COVID-19 pandemic. In this study we examined the impact of the COVID-19 pandemic on visit status of SSc patients at our centre and the patient benefts of telemedicine Methods: In this study, we retrospectively enrolled 480 SSc patients who visited in our centre between January and December 2021. Of the patients included in the study, 198 patients (18 males and 180 females) used telemedicine, while 282 patients (20 males and 262 females) did not use it Results: During televisites, we assessed possible contacts with COVID-19 patients and/or potential risk of COVID-19, investigating about the occurrence of typical symptoms in the last 15 days. No signifcant differences in background data, such as the severity of the disease, type of treatment and frequency of complications were found between these two groups. In more detail, SSc is associated interstitial lung disease was complicated by 35.4% and 31.3% of patients in the telemedicine and non-telemedicine groups, respectively (p=0.9). Besides, 53.7% of patients in the telemedicine group and 49.9% of patients in the non-telemedicine group were treated with prednisone (p=0.344). 74.1% of patients in the telemedicine group were administered immunosuppressive drugs, compared to 78.5% of patients in the non-telemedicine group (p=1.000). The number of patients who discontinued treatment was signifcantly lower in the telemedicine group, with 14 patients (7%) compared to 30 patients (11.4%) in the non-telemedicine group (p=0.003). These patients who voluntarily discontinued treatment were fnally resumed. However, the time required to resume treatment differed between the two groups. This means that the duration of treatment interruption was signifcantly shorter in the telemedicine group, with a mean (± standard deviation) of 1.85 (5.5) days compared to 7. 5 (12.1) days in the non-telemedicine group (p=0.001). There was no difference in the amount of change in laboratory data between the groups receiving telemedicine and those not receiving telemedicine. Conclusion: This study confrmed the data published by Norimatsu et al (3), as that telemedicine may help SSc patients to continue and/or resume treatment under the COVID-19 pandemic. SSc is associated to interstitial lung disease, cardiac involvement, vascular injury and prednisone and immunosuppressive agents have been used as treatment. Thus, disruptions in treatment can lead to worsening of symptoms and missed opportunities for early interventions for complications. Patients who use telemedicine may be more motivated to treat, and this retrospective study demonstered it. This study suggests that telemedicine can be useful in treating SSc and other diseases that require ongoing treatment in the COVID-19 infection.