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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 (> USD3,800) preferred TM, while fulltime employees preferred in-person follow-up (
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.
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 > 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