[Telemedical care and IT-based systems in rheumatology]. / Telemedizinische Betreuung und IT-gestützte Verfahren in der Rheumatologie.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic and also the ever-increasing demands on the healthcare system, have led to a focus on the further development of telemedical services in rheumatology. OBJECTIVE: What is the evidence for telemedical services in rheumatology? MATERIAL AND METHODS: Narrative review of existing literature on telemedicine in rheumatology. RESULTS: Electronic patient reported outcomes (ePROs) can be determined by patients from their home and sent electronically to the rheumatologist. In future, ePROs may help with the decision whether a patient needs to attend the clinic for a visit or the visit can be rescheduled due to remission and well-being. Telemedicine has already been used for well-controlled patients with rheumatic diseases with good results in terms of safety and disease activity compared to conventional face-to-face visits. Telemedicine represents an interesting tool for appointment prioritization and triaging, while automated algorithm-based applications are currently too imprecise for routine clinical use. The role of smartphone applications in the care of patients with rheumatic diseases is still unclear. DISCUSSION: Telemedicine represents an interesting option for certain patient populations with rheumatic diseases. Apart from research on the effectiveness and safety of telemedical interventions, decision makers need to set clear rules on how telemedicine should be used to provide the best possible care for the individual patient.

Polypharmacy in Middle-European Rheumatoid Arthritis-Patients: A Retrospective Longitudinal Cohort Analysis With Systematic Literature Review.

Objective: To assess polypharmacy and related medication aspects in Middle-European rheumatoid arthritis (RA) patients, and to discuss the results in view of a systematic literature review. Methods: In this retrospective cohort study, charts were reviewed from RA-patients consecutively recruited between September 27, 2017 and April 29, 2019. Drugs were assigned to the Anatomical Therapeutic Chemical (ATC) groups as proposed by the World Health Organization (WHO). Results were compared to those of a systematic literature review. Results: One hundred seventy-five consecutive RA-patients were included. The mean number of drugs was 6.6 ± 3.5, with 2.4 ± 1.2 drugs taken specifically for RA-compared to 2.6 in the literature. 33.7% of patients experienced polypharmacy defined by ≥5 drugs, compared to 61.6% in the literature-with women affected more frequently than men. After 7 years of follow-up, the number of drugs increased in all ATC-groups by an average of 12.7 %, correlating with age (Corrcoeff = 0.46) and comorbidities (Corrcoeff = 0.599). In the literature, polypharmacy is not always defined precisely, and has not been considered in management guidelines so far. Conclusion: Polypharmacy is a frequent issue in RA-management. With an increasing number of comorbidities during the course of the disease, polypharmacy becomes even more relevant.