Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease characterized by joint inflammation, functional impairment, and a significant burden on quality of life if not adequately managed. Long-term disease control depends not only on early diagnosis and effective treatment, but also on regular monitoring to achieve remission or low disease activity, as recommended by international guidelines.1

Delays in referral and diagnosis of RA remain a persistent challenge in public health systems. These delays occur at multiple stages, including patient help-seeking, primary care referral, and specialist assessment, and have been reported to exceed two years from symptom onset to diagnosis in some settings.2 Additionally, consultation time in primary care is often insufficient,3 leading to missed key elements in the initial evaluation and incomplete assessments of patients with suspected RA.4 These factors hinder the implementation of tight control strategies, despite their documented superiority over routine care.5 Beyond timely referral, maintaining this level of disease monitoring requires coordinated specialist care, which is difficult to achieve in resource-constrained systems, as the rheumatology workforce in many low- and middle-income countries is insufficient.6

As a result, continuity of care with a rheumatology specialist is frequently compromised, especially after the initial diagnosis. This highlights the need for adaptable follow-up strategies that can facilitate consistent disease monitoring while also helping to reduce the burden on rheumatologists.

Telemedicine has emerged as a promising strategy to support remote care in chronic rheumatic diseases. During the COVID-19 pandemic, its use increased substantially, prompting research into its feasibility, safety, and patient acceptability. Studies show that teleconsultations can maintain disease control in stable patients and reduce the need for in-person visits, especially when combined with self-assessment tools.7,8

Understanding the impact of remote follow-up in early disease is essential, as this period is critical for achieving optimal outcomes.9 This study aimed to evaluate the effectiveness of a telemedicine-based follow-up program in monitoring functional status, disease activity, and patient reported pain in patients with newly diagnosed rheumatoid arthritis.

This was a prospective, longitudinal, observational exploratory study. Patients with a probable diagnosis of RA were recruited from a previously established early arthritis detection program2 between May 2023 and November 2023.

At their initial in-person consultation, the diagnosis of inflammatory arthritis was confirmed by a board-certified Rheumatologist. Following baseline evaluation, patients were enrolled in a telemonitoring protocol that included two video consultations: one at 6 months and another at 12 months after the initial visit, this is illustrated in Fig. 1. During each evaluation we collected the following variables: functional status using the Health Assessment Questionnaire (HAQ)10; disease activity with the Clinical Disease Activity Index (CDAI)11; tender and swollen joint counts; patient-reported pain using a visual analog scale (VAS); and physician global assessment (PGA).

Fig. 1.

Flow diagram of study participants. Flow of participants from referral to completion of 12-month teleconsultation, with reasons for loss to follow-up indicated.

Teleconsultations were conducted by general practitioners who received prior training from a rheumatologist to standardize the guidance provided to patients for self-assessment of tender and swollen joints, ensuring consistency and proper identification according to international recommendations. Video consultations were conducted using a clinic mobile phone via the WhatsApp platform, as this was the most feasible and widely accessible tool for patients in this setting.

During each teleconsultation, participants completed the HAQ and the CDAI. Patients were also guided through a standardized self-examination procedure focused on identifying joint swelling and tenderness.12 Based on their reported findings, patients were either referred for in-person reassessment or continued under remote monitoring.

The study was approved by the local Institutional Review Board R-2022-1904-162.

A total of 34 patients were included in the study, with a mean age of 48.2±8.9 years. The majority were female (n=32, 94.1%). Most patients (n=26, 76.47%) presented with at least one comorbidity. General characteristics are summarized in Table 1. Regarding follow-up, 30 (88.2%) patients completed the first video consultation (at 6 months), and 25 (73.5%) the second (at 12 months).

Mean HAQ scores declined from 0.87 at baseline to 0.50 at one, TJC decreased from 10.5 to 3.4 SJC from 1.48 to 1.15, and VAS from 5.7 to 3.69. Similarly, CDAI values improved from 23.5 to 12.0. These findings are detailed in Table 2 and illustrated in Fig. 2.

Fig. 2.

Evolution of clinical variables over time. Mean values and standard error bars for five clinical variables measured at three timepoints: initial consultation, 6-month (Telemedicine 1), and 12-month (Telemedicine 2) follow-ups. CDAI: Clinical Disease Activity Index; TJC: Tender Joint Count; VAS: Visual Analog Scale (patient-reported pain); SJC: Swollen Joint Count; HAQ: Health Assessment Questionnaire.

The implementation of a structured telemedicine-based follow-up strategy for patients with recent-onset RA using validated clinical scores associates with significant improvements in disease activity and functional status over a one-year period.

These findings are consistent with previous studies reporting the effectiveness of telemedicine in the management of RA.13 It has been demonstrated that virtual care models, from simple follow-up calls to structured remote assessment protocols; and hybrid models combining in-person and virtual visits are feasible.14,15 Our study expands on this evidence by applying a structured remote follow-up protocol specifically to patients with early RA, a population in which tight control and timely treatment adjustments are particularly critical as disease activity tends to be more variable.16

Although tight control strategies typically recommend assessments every 1–3 months during the early phases of rheumatoid arthritis,17 achieving such frequency is challenging in real-world public health settings with limited access to rheumatologists. Our protocol included follow-ups at 6 and 12 months, this approach may not replace more intensive regimens but offers a viable alternative where resources and infrastructure are limited.

The observed improvements in clinical scores suggest that telemedicine can support disease monitoring and therapeutic decisions, even in the early stages of RA. Besides, the high completion rates in a population without previous experience in virtual rheumatologic care, underscores the feasibility of this model. We employed simple instructions to guide patients during video consultations, and we believe that this contributed to the reliability of remote assessment.

The accuracy of remote disease activity monitoring in RA heavily relies on the quality of patient self-assessment. Studies have shown that patient-reported joint counts, particularly for tenderness, can correlate well with physician assessments when supported by structured guidance.18,19 Training patients in joint self-examination has been shown to improve the reliability of their reported counts.19 Incorporating educational sessions or virtual guidance on how to perform self-assessments could therefore enhance the accuracy of remote follow-up and support clinical decision-making. Furthermore, a recent initiative developed a patient-centered educational video to support joint self-examination, which was well received and led to self-reported improvements in patients’ ability to assess tender and swollen joints.16 As telemedicine continues to expand, the development and dissemination of validated, accessible training materials will be essential to ensure accurate, reproducible disease monitoring.

In terms of patient reported outcomes (PROs) and patient satisfaction, telemedicine and in-person consults are comparable,20 hence telemedicine could be offer to monitor their disease and can serve as a valuable complement to in-person care, particularly in healthcare systems facing limitations in rheumatology access.

Our study provides an example of how standardized virtual care based on validated tools and predefined time points can be effectively implemented. The use of the CDAI is beneficial as it does not require laboratory data, this feature makes it particularly well suited for telemedicine settings. It can be calculated rapidly, without computational tools, and in real time during a virtual consultation. Its simplicity allows for frequent and consistent assessment.21,22 The value of CDAI is further supported by its stringent remission criteria, showing strong associations with good functional outcomes in international cohorts.23

However, is essential to recognize that virtual care should not replace structured, evidence-based rheumatologic practice. Virtual encounters should be considered appropriate only when they align with specific clinical scenarios, patient preferences, and resource availability. A physical examination remains a cornerstone of rheumatologic evaluation, and when a virtual visit is insufficient to make appropriate clinical decisions, an in-person assessment is required.

Our findings support the feasibility and clinical utility of a structured telemedicine-based follow-up strategy in patients with recent-onset RA, and in a setting, where logistical barriers to specialist care may be significant. This approach may facilitate disease monitoring and contribute to improved clinical outcomes in early disease management.

This study was performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments. All patients gave their consent to participate. The study was approved by the local Institutional Review Board R-2022-1904-162.

No funding was received that is directly or indirectly related to the work submitted for publication. This study did not receive support or benefits from any commercial sources.

All authors declare that they have no conflicts of interest.