Clinical Services

Oral Presentation

(CS1-02) Rheumatology Care Using Telemedicine

Sunday, April 23
10:35 AM - 10:54 AM
Location: W224 AB

Objectives
Person living in many parts of the world have limited access to diagnostics and treatments for rheumatologic, musculoskeletal and connective tissue diseases. The challenge has been particularly poignant for rural areas of low- and middle-income countries. We report on the implementation of a Telemedicine program rural areas near border of Afghanistan for the evaluation and treatment of patients with rheumatologic and musculoskeletal disease. More than 4800 patients were seen remotely over a span of five years by a rheumatologist in the United States. The remote rheumatologist was aided by a general physician and a nurse at a local charity hospital that has a catchment that includes rural areas extending to the border of Afghanistan. Seventy to 90 patients were evaluated online via by the remote rheumatologist three days a week. A subset of patients were evaluated by the rheumatologist in person every 4 months.



Methods
The population of rheumatology patients was evaluated using descriptive statistics. Information collected included demographic information consisting of age, gender, and primary diagnosis.



Results
The average age of patients that were seen was 52 years and 89% of patients were women. Approximately 50% of patients were Afghan refugees. The most common disorders included osteoarthritis (1149, 23.6%), rheumatoid arthritis (653, 13.4%), axial spondyloarthropathies (647, 13.3%), lumbar spinal stenosis (427, 8.8%), meniscal tear of the knee (326, 6.7%), and psoriatic arthritis (217, 4.5%). Certain conditions were lower than expected such as lupus (19, 0.4%) and fibromyalgia (169, 3.5%). Diagnostic tests serology (1328, 27.3%), radiographs (946, 19.5%), Magnetic Resonance Imaging (899, 18.5%), Bone Densitometry (147, 3.0%), and Nerve Conduction Study (132, 2.7%). The most common medications prescribed were NSAIDs (791, 16.3%), methotrexate (764, 15.7%), pregabalin (234, 4.8%), duloxetine (230, 4.7%), sulfasalazine (177, 3.6%), etanercept (97, 2.0%), tofacitinib (64, 1.3%), adalimumab (18, 0.4%), and infliximab (9, 0.2%).

Conclusion
Telemedicine is becoming more popular. We report the successful use of this service in the evaluation and management of rheumatic diseases in a region with limited access to care. We have shown that patients can be seen, evaluated, and successfully treated with a variety of medications including biologic agents.

Michael Rezaian

Clinical Assistant Professor of Medicine
West Virginia University School of Medicine

My Name is Dr. Shims Roshani. I am a general physician who has been involved with the Rheumatology Telemedicine program for the past three years. I have seen the telemedicine program grow over the last few years from 25 patients one day a week to 100 patients now being seen three days per week. Using iPad and skype, we have been able to bring state of art rheumatology care to rural areas near border of Afghanistan. We cover a large population of refugees from Afghanistan settled in border towns. We are the only affordable provider of rheumatologic care to majority of these patients.

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Lawrence Brent

Chief of Rheumatology
Einstein Medical Center Of Philadelphia

Dr. Brent is a graduate of Penn State University and Jefferson Medical College. He completed his internal medicine residency and rheumatology fellowship at Thomas Jefferson University Hospital and a research fellowship in immunology and pediatric rheumatology at the University of Alabama Medical Center. Dr. Brent is a member of the American College of Physicians, the American College of Rheumatology and the American Association for the Advancement of Science. He is a past recipient of the Arthritis Foundation Postdoctoral Research Fellowship Award. Areas of interest include systemic lupus erythematosus, spondyloarthropathies, idiopathic inflammatory myopathies, and pediatric rheumatology. He is actively involved in clinical research and clinical trials.

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Jonathan Hardy

Content Developer for TeachMeMedicine.Org
Rural Outreach Arthritis Center

Jonathan Hardy works as a content developer for TeachMeMedicine.org. He earned his Bachelor of Science in Biochemistry from Shepherd University. Currently, Jonathan lives in Tallahassee, FL with his wife, Lindsey.

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Michael M. Rezaian

Physician
West Virginia University

Dr. Rezaian is a board certified rheumatologist and assistant professor of Medicine at West Virginia University School of Medicine. He has conducted Telemedicine over the years with his patients living in rural areas. For the past five years he has developed telemedicine programs in rural areas and in different countries including Nepal, and soon in Zimbabwe.

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