POS1243 TELEMEDICINE AND MANAGEMENT OF THE PATIENT AFFECTED BY GIANT CELL ARTERITIS DURING THE COVID-19 PANDEMIC - TELEMACOV
Authors: S. Parisi, M. C. Ditto, A. Laganà, C. L. Peroni, E. Fusaro
Journal: Annals of the Rheumatic Diseases (2021)

Background: Giant cell arteritis (GCA) is the most common primary systemic vasculitis in western countries with the highest incidence among persons 70–79 years of age. Treatment has been with glucocorticoids (GCs) alone for many decades but recently Tocilizumab (TCZ) has demonstrated efficacy in reducing GC dose and flare rates in patients with GCA. Therefore, both early diagnosis and regular monitoring are necessary for the correct management of GCA. The COVID-19 pandemic has led to decisions by the governments of the countries involved, aimed above all at reducing the contagion. This has also led to reductions in health activities, limiting them to those of urgency by reducing or canceling checkups involving the risk of a time gap which for the GCA meant the interruption of clinical monitoring and therapeutic adjustment. At the same time, the pandemic situation has stimulated remote monitoring activities, through telephone contacts or video calls carried out by the rheumatologist. EULAR identified a minimal data set aimed at research and for clinical use, which includes the main clinical and instrumental data to be taken into consideration in monitoring the patient. For many data a clinical examination is not necessary but an interview is sufficient. We activated the TELEMACOV protocol (TELEmedicine and Management of the patient affected by giant cell arteritis during the COVid-19 pandemic) monitoring the follow-up of patients affected by GCA through telemedicine tools in order to maintain an effective and risk-free follow-up in a pathology with a high risk of relapse. Objectives: The purpose of the study is to evaluate the effectiveness of telemedicine in the follow-up of the patient with GCA. Methods: We evaluated patients (pts) with a clinical diagnosis of GCA (received in previous periods) who were admitted to the our Rheumatology Unit. They were monitored monthly by telephone from 9 March to 9 June 2020 (during lockdown). All patients were asked questions divided according to the sub-groups listed below: - Onset of new symptoms or their recurrence - Exams carried out - Current therapy - Satisfaction of telephone call Results: We performed 148 remote monitoring visits in 37 pts. The cohort was mainly composed by female (77,8%) and had a mean age of 71,85 ± 9,25 years. They were affected by GCA, with a mean duration of 5,3±2,3 months. The characteristics of these pts and the course of the disease are reported in Table 1. Pts treated with TCZ reduced their GC dose more than patients treated with GC alone (p: 0.032). Only one patient (treated with GC alone) had an ocular flare with the need to increase the dosage of the GC with good response and rapid improvement. Furthermore, all patients considered this type of monitoring very satisfactory according to the Likert scale (1-5) with mean 4,4±0,2. Conclusion: Our study has shown how telemedicine can be well used in pts with GCA as a possible alternative, for a limited period, to traditional visits, especially in a fragile population such as the elderly and more exposed to the risk of SARS-COV2 infection. References: [1]Ehlers L et al. Ann Rheum Dis 2019 Sep;78(9):1160-1166 [2]Wagner E et al. Prim Care. 2012 Jun;39(2):241-59. Table 1. Disease course and remote monitoring Parameters Baseline (at diagnosis ) Pre-lock down First Interview Second Interview Patients treated with only GC (19 pts ) Mean SD Mean SD Mean SD Mean SD ESR 74,08 23,95 13,02 8,2 12,75 6,42 9,84 6,63 CRP mg/l 47,4 42,2 1,01 1,1 1,55 2,29 1,56 2,24 Hgb mg/dl 11,6 2,6 13,2 2,24 12,75 3,19 13,58 2,12 PGA (1-10) 7,55 2,05 2,71 1,79 2,24 1,59 2,15 1,04 EGA (1-10) 6,99 1,85 2,19 1,42 1,97 1,13 1,43 0,97 GC mg 52,72 18,3 10,1 6,95 7,6 4,51 6,67 3,1 Patients treated with GC and TCZ (18 pt ) ESR 74,56 36,58 11,3 3,85 9,89 4,71 3,37 4,4 CRP mg/l 47,8 41,7 1,13 0,65 1,58 0,85 1,62 0,73 Hgb mg/dl 11,36 3,88 12,98 4,91 12,43 4,3 13,25 5,15 PGA (1-10) 7,14 3,11 2,47 2,15 1,89 0,4 1,93 0,72 EGA (1-10) 6,93 2,72 0,95 0,73 0,68 0,43 0,41 0,72 GC mg 51,76 18,85 8,04 4,38 5,88 3,92 4,16 4,32 PGA: Patient Global Assessment EGA: Evaluator Global Assessment; Disclosure of Interests: None declared