Teleconsultation of infant rheumatology in Covid-19 time.

Dear Editor,

The current COVID-19 pandemic has completely transformed the care of rheumatology patients in outpatient clinics, including paediatric rheumatology. Telemedicine has been mandatory during the worst moments of the health crisis, and will be maintained once normality returns, because in every crisis there is an opportunity. Teleconsultation in adult rheumatology and to a lesser extent in paediatric rheumatology has occasionally involved telematic communication with primary care. Current teleconsultation involves patients directly and this method appears to have been well received. In this letter we show our results from paediatric rheumatology teleconsultation during the pandemic.

During the months of March, April and May 2020 we provided telephone support to the vast majority of patients who were given an appointment using a semi-structured interview. During each call we asked the patients’ parents, or the patients themselves if they were over 14 years of age, about symptoms of joint pain or inflammation and any symptoms related to their underlying disease. In the case of juvenile idiopathic arthritis (JIA), the child was considered to be in remission if they answered that they were living a normal life without pain, swelling or limping. If they reported pain or swelling or for any other justified cause, the patient was given an appointment to attend the next available consultation in person.

There was a total of 147 consultations, of which 110 (75%) were by telephone. The diagnoses of the patients seen and their demographic data are presented in Table 1 . Only nine patients (8.2%) reported feeling unwell and a face-to-face consultation was required in 13 cases (11.8%). The mean time from the previous consultation (10.7 weeks) was similar to that of the next telephone appointment (11.5 weeks). In JIA there were 34 telephone consultations and 14 face-to-face check-ups. In 32 cases (94.1%) the children were asymptomatic, however, eight patients (23.6%) required a face-to-face consultation in the following eight weeks.

Table 1

Demographics of the patients seen in March, April and May 2020.

	Total (n: 147)
Mean age in years (SD)	8.9 (4.3)
Female gender (%)	92 (62.6)
JIA n (%)	48 (32.7)
SLE/Sjögren’s/JDM n (%)	13 (8.8)
Arthralgias n (%)	29 (19.7)
Other diagnoses n (%)	36 (24.5)
Face-to-face consultation n (%)	37 (25)
Telephone consultation n (%)	110 (75)

JDM: juvenile dermatomyositis; JIA: juvenile idiopathic arthritis; SD: standard deviation SLE: systemic lupus erythematosus.

The vast majority of patients were grateful for the teleconsultation and reported that they were well or very well. However, after one or two calls some parents expressed the need to be seen in person, even if the child was asymptomatic. In the paediatric rheumatology practice we propose a format of face-to-face consultations interspersed with non-face-to-face consultations. This will allow us to distance face-to-face consultations from each other, avoiding patients crowding together in the waiting room without having to reduce the number of patients seen per consultation. Face-to-face consultations should not be neglected, especially in the follow-up of JIA, where systematic joint examination is essential as inflammation may go unnoticed by patients and parents.

Conflict of interests

The authors have no conflict of interests to declare.