Exploring the transformation of rheumatic disease management during COVID-19 through remote monitoring and digital tools
When COVID-19 swept across the globe in early 2020, it triggered unprecedented disruptions in healthcare delivery—nowhere more so than for patients with rheumatic diseases. For millions living with rheumatoid arthritis and similar conditions, routine in-person appointments suddenly became potential exposure risks.
These patients faced a devastating dilemma: continue essential treatments that often suppress the immune system, risking severe COVID-19 complications, or pause treatments and risk disease flares that could cause permanent joint damage.
This healthcare crisis sparked one of the most rapid transformations in modern medicine—the dramatic shift to remote clinical management. Almost overnight, rheumatology departments worldwide began reimagining how to monitor and treat chronic inflammatory conditions without face-to-face visits.
This article explores how this great unplanned experiment ultimately revolutionized rheumatology care, introducing innovative digital solutions that continue to shape patient management long after the peak of the pandemic has passed.
Why were rheumatology patients particularly vulnerable during the pandemic? Rheumatoid arthritis (RA) is a chronic autoimmune condition where the body's immune system mistakenly attacks healthy joint tissue, causing pain, swelling, and potential joint deformity. Treatments often involve immunosuppressive medications that reduce the abnormal immune response but simultaneously increase susceptibility to infections.
Research confirms this vulnerability. A comprehensive 2024 meta-analysis of 62 studies revealed that RA patients faced significantly higher risks of COVID-19 hospitalization (29% prevalence), ICU admission (10%), and death (8%) compared to the general population 3 . This heightened risk created an urgent need to minimize exposure while maintaining disease control.
Enter telerheumatology—the remote delivery of rheumatology care using information and communication technologies. While telemedicine had existed for years, the pandemic triggered its widespread adoption. Before COVID-19, regulatory barriers and reimbursement issues limited its use, but emergency measures removed these obstacles almost overnight 2 .
Real-time video or telephone consultations between patients and providers
"Store-and-forward" approaches where patients submit data for later review by specialists 2
This rapid transition represented perhaps the most significant shift in rheumatology practice since the introduction of biologic therapies. The question became: Could these remote approaches effectively replace traditional in-person care?
As the pandemic stretched from weeks to months, healthcare systems recognized the need for structured remote monitoring approaches. Researchers responded with innovative studies to determine how to best incorporate electronic patient assessments into standard clinical pathways.
One such investigation was the POS0152-HPR pilot study, which aimed to develop and test a system for remote clinical management of patients with rheumatic diseases during the COVID-19 pandemic. This study addressed a critical challenge: with reduced rheumatology staffing due to redeployments and limited outpatient capacity, how could clinicians safely monitor vulnerable patients without bringing them into healthcare facilities?
The researchers first identified patients with rheumatic diseases requiring ongoing monitoring despite pandemic restrictions. These individuals typically needed immunosuppressive medications, placing them at higher risk for COVID-19 complications.
Researchers created standardized digital assessments that patients could complete from home. These tools captured essential disease activity measures, treatment side effects, and emerging problems.
The electronic assessments were incorporated into existing clinical workflows, ensuring that submitted data reached the appropriate healthcare providers for review and action.
The team established clear protocols for how clinicians should respond to different levels of reported symptoms—from routine monitoring to urgent intervention.
The system included safeguards to identify and rapidly respond to significant disease flares or concerning symptoms that might require immediate attention.
This approach allowed rheumatology teams to maintain oversight of their patient population while minimizing COVID-19 exposure risks for both patients and healthcare workers.
The pilot study demonstrated that electronic assessments could be successfully integrated into standard rheumatology clinical pathways during a public health emergency. Key findings included:
This research provided a crucial foundation for developing more sophisticated remote monitoring approaches that continue to evolve beyond the pandemic context.
The rapid shift to remote care during COVID-19 accelerated the development and adoption of various digital tools for rheumatology management. These technologies collectively formed what we might call the "digital rheumatologist's toolkit."
| Technology Type | Examples | Primary Functions | Evidence Level |
|---|---|---|---|
| Teleconsultation Platforms | Video conferencing, Telephone consultations | Real-time patient-clinician interactions, visual assessment of joints | Strong, with high patient satisfaction 2 |
| Mobile Health Applications | RheumaHelper, Mida Rheuma, TuTOR | Symptom tracking, medication reminders, patient education | Moderate, with good usability but varying clinical utility 5 |
| Wearable Sensors | Activity trackers, Smartwatches | Passive monitoring of physical activity, sleep patterns, heart rate | Emerging, with promising correlation to disease activity 6 |
| Electronic Patient-Reported Outcome Measures (ePROMs) | RAPID3, Pt-DAS28, RADAI | Standardized assessment of disease activity, functional status, treatment response | Strong validation for multiple instruments 6 |
| Novel Assessment Tools | Smartphone accelerometers, Digital grip strength, Thermal imaging | Objective measurement of joint function, range of motion, inflammation | Preliminary, with technical and standardization challenges 6 |
Among the most valuable tools in remote monitoring are electronic Patient-Reported Outcome Measures (ePROMs). These validated instruments allow patients to report their symptoms and functional status digitally. The Routine Assessment of Patient Index Data 3 (RAPID3) has emerged as particularly valuable for remote care, as it can be completed independently by patients without clinician assessment and still provides sensitive measurement of disease activity 6 .
Research during the pandemic revealed that weekly RAPID3 scores showed significant fluctuations that might be missed during traditional 3- or 6-month clinic visits, demonstrating the potential for more responsive treatment adjustments with frequent remote monitoring 6 .
Collecting digital data is only valuable if it leads to appropriate clinical actions. Research during the pandemic helped identify which remotely collected information most strongly predicted the need for clinical intervention.
| Remote Assessment Finding | Associated Action | Strength of Evidence |
|---|---|---|
| Patient-reported RA flare | Treatment escalation and/or face-to-face consultation | Strong (OR 15.6) 4 |
| CRP values > 10 mg/L | Treatment modification and further assessment | Moderate (OR 3.32) 4 |
| Persistent fatigue lasting >3 days | Activity reduction of 12-21% correlates with persistent flares 6 | Emerging |
| Significant increase in tender joint count | Requires further assessment and possible treatment adjustment | Established in multiple studies |
A 2022 study examining teleconsultation practices found that patient-reported RA flares and elevated C-reactive protein (CRP) values emerged as the two most significant "red flags" prompting treatment changes or organizing face-to-face consultations 4 .
Despite the promise of remote monitoring technologies, significant challenges remain:
The pandemic-driven innovation in remote rheumatology care has opened several promising directions for future development:
Optimal blending of in-person and remote elements
Using wearable sensors to detect early warning signs of flares
Applications for personalized treatment recommendations
Enable seamless data flow between systems
Applications that deliver evidence-based interventions
The Digireuma study, a 6-month prospective trial testing a digital solution for real-time monitoring of electronic patient-reported outcomes in rheumatoid arthritis and spondyloarthritis, represents the type of research needed to establish the evidence base for these technologies .
The COVID-19 pandemic triggered what might be the most rapid transformation in rheumatology care delivery in history. What began as emergency measures to maintain care during a public health crisis has evolved into a fundamental reimagining of how we monitor and manage chronic rheumatic diseases.
The pilot study on incorporating electronic assessments into clinical pathways demonstrated that remote monitoring could successfully maintain care continuity during unprecedented disruptions. This approach, along with the broader adoption of telerheumatology, has permanently expanded the toolkit available to patients and clinicians.
While challenges remain, the legacy of this period is likely to be a more flexible, patient-centered approach to rheumatology care that leverages technology to improve access, convenience, and possibly outcomes. The silent shift to digital rheumatology represents one of the few positive transformations to emerge from the difficult pandemic years—one that promises to benefit patients and clinicians for years to come.
| Aspect of Care | Pre-Pandemic Standard | Post-Pandemic Innovation | Impact on Care |
|---|---|---|---|
| Consultation Format | Primarily in-person | Hybrid with significant remote component | Increased access, reduced travel burden |
| Monitoring Frequency | 3-6 month intervals | Potential for continuous between visits | More responsive treatment adjustments |
| Data Collection | Clinic-based assessments | Home-based digital monitoring | More ecological data in daily life context |
| Patient Role | Passive recipient of care | Active participant in monitoring | Improved engagement and self-management |
| Clinical Focus | Disease activity during visits | Holistic picture including function between visits | More comprehensive assessment |