Maintaining Routine Rheumatology Care During COVID-19 Outbreak

Learn new ways to work with your doctors to manage arthritis and stay healthy.

The need to stay home and avoid exposure to the new coronavirus make regular rheumatology appointments and lab work difficult, at best. In fact, many doctor’s offices are receiving only patients who need urgent attention and who do not have COVID-19 symptoms. Patients with inflammatory types of arthritis still need routine care and checkups to keep their disease well managed. So, rheumatology and other practices are adapting. Doctors’ offices are using telemedicine extensively, labs are finding ways to minimize their patients’ exposure risk to the new coronavirus. When, patients need in-person doctor’s visit or infusion appointment, important safety steps are required.

Telemedicine appointments

Many, if not most, doctors now are using telemedicine for regular appointments as a way of protecting patients and office staff. Andrew Laster, MD, a rheumatologist with Arthritis & Osteoporosis Consultants of the Carolinas, says 70% to 80% of their visits are now via telemedicine. Appointments are scheduled as usual, and before the appointment, patients are contacted and instructed how to connect via telemedicine (his office and many others use an online portal). Office staff help patients work out any technology problems they might have before the appointment. For patients who don’t have a smart phone or computer for audio-video capability, appointments can be handled via telephone (audio only), thanks to relaxed reimbursement policies by insurance companies and temporarily loosened. If you have any upcoming routine appointment, call ahead to make sure you have the option of telemedicine.

A rheumatologist can do a fairly thorough exam via telemedicine, Dr. Laster says. He can view a rash, have a patient move in ways to check range-of-motion and balance, and look at certain joint symptoms. In some cases, says Dr. Laster, “You’re teaching the patient to perform the exam you’re doing.” For example, one patient was having trouble with her middle finger joint, so he instructed her to press on both sides and describe whether it felt bony or spongy. With that kind of information, he was able to diagnose and treat her.

Getting Lab Work

If you have to go in-person to a lab or to see a doctor for an urgent need, call ahead and find out what measures the office – and the building it’s located in – is taking to prevent exposure to the virus. Some questions you should ask include:

  • Are all common areas and exams rooms being thoroughly cleaned?
  • Are patient appointments being scheduled to reduce crowds?
  • Are waiting rooms and other areas set up so that patients can stay 6 feet or more apart?
  • Are the areas for lab patients separate from those for infusion patients and others?
  • Are all staff required to wear masks and other safety gear?
  • Can you go to a lab in the rheumatology clinic, or can staff there refer you to one where you might be at less risk of exposure than one that tests patients with many different conditions?
  • And are there any measures you’re required to take to see a lab tech or doctor?

Depending on your medication, dose and whether you have had previous abnormal test results, you might be able to delay your routine lab work if it cannot be done without risking your exposure to the new coronavirus, according to guidance from the American College of Rheumatology (ACR), but discuss it with your doctor.

Who Needs an In-Person Visit?

If your insurer doesn’t offer an at-home infusion service, here are important questions you should ask before your next appointment.  You might want to consider switching to a self-injectable form (although your insurance may have a different policy for covering injections, as Medicare does). Ask your doctor if this is an option for you.

If you have new or changing symptoms that have you worried, call your doctor. It might be something – like a rheumatoid arthritis or gout flare – that can be addressed via telemedicine and medications.

Symptoms that might require in-person attention include (but aren’t limited to) a hot, swollen joint (the doctor needs to feel it to determine whether there’s infection, Dr. Laster says), an acute flare or serious medication side effect, joint aspiration or injection, a new trauma or fracture, fever over 102F, bloody diarrhea, lack of blood flow to the limbs, acute back pain or the onset of vision problems. Other symptoms may warrant emergency attention, including seizures, labored breathing, difficulty swallowing and more.

If possible, call your doctor first not only to determine how urgent your situation is but also where you should go. For example, if you are on a biologic medication and have a high fever, “We’re trying to keep people out of the hospital because of the risk [from COVID-19], but rheumatologists may not be set up to treat people with sepsis with the testing needed,” Dr. Laster says. Whether they can be seen at their rheumatologist’s clinic depends on its size and capabilities; an emergency facility might be the better choice.

A simple step you can take to be safe during an in-person doctor’s visit is to ask the front desk if you can wait in your car until it’s your turn to see the doctor. That will minimize the amount of time you spend in the waiting room. It’s also a good idea to complete all patient forms and pay your copayment online as well. And don’t forget to wear your mask, maintain 6 ft distance from other patients and wash hands often for at least 20 seconds.

It’s also important to know whether you have COVID-19 symptoms before any in-person appointment. Learn about symptoms and other facts on our Coronavirus and Arthritis: What You Should Know FAQ page

 

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