POS1222 FACTORS ASSOCIATED WITH USE OF TELEMEDICINE FOR FOLLOW-UP OF LUPUS NEPHRITIS IN THE COVID-19 OUTBREAK
Authors: H. So, E. Chow, T. K. LI, I. T. Cheng, S. L. Lau, C. C. Szeto, L. S. Tam
Journal: Annals of the Rheumatic Diseases (2021)

Background: It is important to weigh the potential risk of exposure to the severe acute respiratory syndrome coronavirus 2 ( SARS - CoV - 2 ) during a doctor visits against the risk of missing disease controls in patients with lupus nephritis during the COVID-19. Telemedicine (TM) follow-up is a reasonable option. Despite the recent exponential increase in application worldwide, there is no study examining the clinical factors associated with the patients‘ choice of TM use in lupus nephritis. Objectives: In this study, we aimed to examine the clinical variables associated with a higher preference for TM follow-up in patients with lupus nephritis. Methods: Consecutive patients followed at the lupus nephritis clinic were contacted for their preferred mode of follow-up. The demographic, socioeconomic and clinical data of the first 140 patients opted for TM and 140 patients preferred to continue standard in-person follow-up were collected and compared. Results: The mean age of the 280 recruited patients was 45.6 ± 11.8 years. The mean disease duration was 15.0 ± 9.2 years. The majority of them had lupus nephritis class III, IV or V (88.2%) and were on prednisolone (90%). Three quarters of the patients (67.1%) were on immunosuppressants. The mean SLEDAI-2k was 4.06 ± 2.54, physician global assessment (PGA) 0.46 ± 0.62 and SLICC/ACR damage index 1.11 ± 1.36. A significant proportion of the patients (72.1%) had one or more comorbidities. It was found that patients with higher PGA and family monthly income (&gt; USD3,800) preferred TM, while fulltime employees preferred in-person follow-up (Table 1). These predictors remained significant after controlling for age in the multivariate analysis with odd ratios for PGA 1.05 (95% CI 1.01-1.09), family income &gt;USD3,800 1.90 (95% CI 1.24-3.79) and fulltime employment 0.53 (95% CI 0.32-0.88). PGA was noted to be positively correlated with the perceptions that TM reduces (r=0.13, p=0.036) and routine visit increases (r=0.12, p=0.04) the risk of COVID-19 during the outbreak. Conclusion: When choosing the mode of care delivery between TM and clinic visit, the patient’s disease activity as well as employment and economic status appeared to be important. Table 1. Demographic, socio-economic and disease data of the recruited lupus nephritis patients with comparison between the telemedicine/standard follow-up groups Overall (n=280) Telemedicine group (n=140) Standard follow-up group (n=140) P-value Age in years 45.6±11.8 44.6±11.4 46.6±12.1 0.159 Gender: Female 256 (91.4) 127 (90.7) 129 (92.1) 0.669 Ever presence of rash 170 (60.8) 87 (62.1) 82 (58.6) 0.527 Ever presence of joint pain 174 (62.1) 92 (65.7) 82 (58.6) 0.247 Disease duration in months 15.8±9.5 15.0±9.3 16.5±9.6 0.176 24 hour urine proteinuria in gram 0.45±0.60 0.50±0.63 0.40±0.57 0.176 Daily prednisolone dose in mg 8.82±6.1 5.28±4.46 6.35±7.37 0.143 Use of immunosuppressant 188 (67.1) 96 (68.6) 92 (65.7) 0.611 SLEDAI-2K 3.39±2.35 3.51±2.28 3.26±2.41 0.366 PGA 0.46±0.62 0.54±0.63 0.38±0.59 0.025 LLDAS 196 (70) 92 (0.66) 104 (74.3) 0.160 Presence of comorbidity 202 (72.1) 100 (71.4) 102 (72.9) 0.790 SDI 0.97±1.23 0.95±1.21 1.00±1.26 0.732 HAQ-DI 0.20±0.40 0.23±0.45 0.18±0.34 0.300 HADS: Anxiety scale 5.93±3.98 5.86±4.06 6.00±3.91 0.776 Depression scale 5.57±3.91 5.56±4.25 5.59±3.54 0.954 Education level: tertiary or above 122 (43.6) 63 (45.0) 59 (42.1) 0.746 Fulltime employment 127 (45.4) 56 (40.0) 71 (50.7) 0.041 Occupation: professionals 36 (12.9) 22 (15.7) 14 (10.0) 0.181 Monthly family income &gt; USD3,800 84 (30.0) 51 (36.4) 33 (23.6) 0.028 Data are reported as mean ± SD or number (%). HAQ-DI: Health Assessment Questionnaire Disability Index; HADS: Hospital Anxiety and Depression Scale; PGA: physician global assessment; LLDAS: lupus low disease activity state and SDI: Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index. Disclosure of Interests: Ho SO: None declared, Evelyn Chow: None declared, Tena K. Li: None declared, Isaac T. Cheng: None declared, Sze-Lok Lau: None declared, Cheuk-Chun Szeto: None declared, Lai-Shan Tam Grant/research support from: Grants from Novartis and Pfizer