Telehealth for Ankylosing Spondylitis During COVID-19

Use, Benefits, Barriers, and Solutions

Living with ankylosing spondylitis (AS) means living with joint pain and stiffness of the back, hips, buttocks, ribcage, and other joints throughout the body. And because you live with an unpredictable and progressive condition, it is important to stay in touch with your treating physician.

But right now, the need to stay home and avoid exposure to COVID-19 makes it harder to attend rheumatology appointments in person. A telehealth visit—also called telemedicine—where you consult with your doctor using a smartphone, tablet, computer, or other technology, is a good alternative to in an in-office visit.

What Is Telehealth?

Sometimes called "telemedicine" or "virtual healthcare," telehealth facilitates care from a distance through electronic information systems. Telehealth encompasses a broad range of electronic delivery systems that include live video chats, mobile apps, online visits, and secure messaging via text or email.

Here is what you need to know about telehealth and how it can be used to manage your AS care.

Learning from doctor online
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COVID-19 and Ankylosing Spondylitis

COVID-19 is a newly identified type of coronavirus that triggers a respiratory tract infection affecting the upper respiratory tract (sinuses, nose, and throat) or lower respiratory tract (windpipe and lungs).

Having AS puts you at risk for COVID-19 because of your weakened immune system. Additionally, the medications you take to treat AS—especially biologic therapies—suppress the immune system, making you even more susceptible to infection.

The newest research on COVID-19 shows people with rheumatic conditions (any condition affecting the joints, tendons, ligaments, bones, and/or muscles) are not any more likely than others in the general population to develop severe symptoms that require hospitalization or to die from COVID-19, provided they receive appropriate treatment.

But if they do develop symptoms that require hospitalization, they are more likely to need major intervention, including intensive care and medical ventilation, compared to others without AS or another rheumatic condition.

Additionally, based on what is known about COVID-19, older age and comorbidities (co-existing conditions) play a bigger role in poorer outcomes. A study reported in 2019 in the Turkish Journal of Physical Medicine and Rehabilitation found 60% of their AS study participants had at least one comorbid condition.

If you have AS with at least one comorbidity, you might be more susceptible to complications of COVID-19. That means it is important to practice social distancing. It also makes sense that you would want to use telemedicine options.

AS Treatment During Pandemic

Being in a global pandemic doesn’t change the fact people with AS still need to be treated to prevent severe problems and disease complications down the line. Telehealth can be an effective tool for preventing, diagnosing, treating, and controlling rheumatic diseases, according to a 2020 systemic review of studies reported in the journal BMC Public Health.

According to the review’s authors, telemedicine was determined to be the best method to prevent direct contact, reduce morbidity and mortality (early death), and provide continuous treatment and care, while keeping patients and health providers safe and healthy.

Routine tele-rheumatology care can help your doctor to:

  • Assess daily symptoms and determine how you are feeling day-to-day
  • Examine your ability to complete activities of daily living
  • Determine how well treatments are working and if you are experiencing side effects
  • Discuss the results of bloodwork and imaging to measure disease activity and progression
  • Answer and address any new concerns you have about managing your AS

Your doctor or their staff are in the best position to determine whether telehealth is an option for you based on your unique health needs. 

Why Switch To Telehealth

Telehealth is a good option for people who have ongoing health conditions like AS because these visits offer an easier option for frequent check-ins. In addition, telehealth practices can also lower healthcare costs, give better access to healthcare, and reduce the number of hospitalizations in people with rheumatic diseases.

Cost-Effective

Research shows telehealth options are cost-effective, especially for diagnosing and ongoing management. A systemic review of studies reported in 2017 in the journal Arthritis Care and Research looked at several telemedicine studies that included some type of cost analysis. All cost-analysis studies found telehealth to be a cost-effective option.

Telehealth visits can also reduce transportation costs, childcare costs, and lost income should you have to miss work.

Accessible

Telemedicine is “accessible, convenient, and patient-centered,” according to a 2016 report in the Journal of Medical Internet Research. Telehealth is especially helpful to people who live in remote locations, who cannot take time off from work, and who are homebound.

Reduced Hospitalizations

When you are able to communicate with your doctor in a timely and convenient way, problems can be addressed in advance and hospitalizations can be reduced.

A study reported in 2015 in The American Journal of Managed Care finds people who took advantage of telehealth options had 38% percent fewer hospitalizations and 31% fewer readmissions. Additionally, they were 63% less likely to have fewer days in the hospital.

If you're ready to make a telehealth appointment, call your doctor’s office and ask if they are providing virtual visits. You will need an internet-enabled device like a personal computer, smartphone, or tablet with a microphone and webcam to get started.

Prepare for a Telehealth Visit

Telehealth remote visits can be a safe and effective way to manage your AS care during the current pandemic. You should do what you can to make the most out of your virtual health appointments.

Know Your Technology

Even if you are not technology savvy, most telehealth options involve one click or simply signing into a downloaded app and you’re in. It is a good idea to test in advance the platform being used by your doctor’s office so you can address technical issues ahead of your appointment.

Make sure you attend your telehealth visit in a quiet and well-lit area of your home or office. A strong internet connection is helpful in ensuring your telehealth appointment is not interrupted by a dropped signal.

If you have technical problems or don’t have access to an internet-enabled device, a simple phone call with your doctor's office can suffice. While your doctor prefers using video to better exam your range of motion, affected joints, or skin issues, if you are in a pinch or if you live in a remote area, a phone call can be a viable option.

Gather Everything You Need

Make sure you have all the information you usually would take with you to an in-person appointment, including a driver’s license or another form of identification, your insurance card, a medication list, and a list of symptoms. You should also have a pen and paper handy to jot down instructions for follow-up, bloodwork, or future appointments.

Be Prepared

Write down two or three things in advance you want to discuss during your appointment. You can always schedule a follow-up visit for anything that doesn’t get covered or comes up later.

Your doctor will have questions for you during your telehealth visit. Be prepared to answer questions about:

  • How long you are stiff or in pain in the morning and what joints are involved
  • How you have been feeling since your last visit
  • If any new issues have arisen
  • If treatments are helping and if you are experiencing side effects
  • If you are running low on your medications
  • If you have gotten lab work done recently

Your doctor’s office may have their own guidance for managing telehealth visits, so be sure to ask what this might entail.

For more help with preparing for your telehealth visit, use our downloadable Doctor Discussion Guide below. It'll help you learn about relevant terminology for ankylosing spondylitis, and suggest questions that you may want to bring up to your doctor during your session.

Ankylosing Spondylitis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Old Man

Barriers and Solutions

Telehealth for ankylosing spondylitis care works best for routine, follow-up visits, and medication changes. But not everything part of your AS treatment and care can take place virtually.

Things requiring an in-person visit include issues related to ongoing pain, serious symptoms or disease complications, breathing problems, needed infusions and injections, and lab work or other testing. Technology problems or the lack of technology equipment can also limit telemedicine.

  • Ongoing pain: Your doctor cannot examine pain from tenderness and swelling virtually. An actual in-person physical exam is needed, and you will need to go in for an in-office visit.
  • A serious symptom or complication: If your doctor thinks you are experiencing a serious AS symptom or a complication of AS, they will want to assess you in person. This may include things like eye inflammation or a compression fracture that cannot easily be identified in a video conference.
  • Fluid in the lungs: If you are having breathing problems, your doctor will want to figure out the source and determine if you have fluid in our lungs or are wheezing. To do so, they will need to listen to your lungs.
  • Infusions and in-office injections: Biological infusion therapy for managing AS and corticosteroid injections cannot be accomplished during a virtual visit. In some cases, infusion centers may not be available due to the pandemic. However, doctors now have the option of providing infusions at patients’ homes if alternative sites of care are not available or if someone cannot leave their home. You should not stop taking your biologic without first talking to your doctor. Your doctor can provide instructions on how to stay safe during infusion visits.
  • Lab work and other testing: Lab tests, imaging, and vaccinations require in-person visits to your doctor’s office or a testing facility. There is currently no alternative to these methods of testing.
  • Technology limitations: Limited access to high-speed internet and/or smartphones or other telecommunications devices can restrict the ability for some people to participate in telehealth visits. One solution might be a program available to those in rural areas or with low incomes that provides equipment for participating in mobile health. Ask your doctor if this is something you might qualify for.

Office Visits

Your healthcare and safety still remain a priority to your doctor and their staff and they are taking every precaution during this unprecedented time.

This includes limiting the number of people in their offices, practicing proper masking and physical distancing, implementing screening measures for COVID-19, promoting handwashing, providing hand sanitizers for patient and staff use, and disinfecting frequently touched surfaces.

You can further reduce your risk by:

  • Calling your doctor’s office beforehand and following any provided safety instructions
  • Covering your mouth and nose with a mask
  • Not touching your eyes, nose, or mouth
  • Staying at least 6 feet away from others while inside and waiting in lines
  • When paying, use touchless payment options like tap to pay or contactless credit card
  • If you cannot use touchless payment methods, sanitizing your hands after paying with cash, credit card, or check
  • Washing your hands with soap and water as soon as you get home

A Word From Verywell

This is definitely an unusual time. Whether you are doing a telehealth visit or going into a medical or dental office, a specialty center or hospital, don’t delay time-sensitive treatment because of COVID-19 fears.

Your doctor and their staff will make sure all your ankylosing spondylitis healthcare needs are still met and you are provided with the safe and correct healthcare and treatment options.

The role that telemedicine plays in your healthcare will continue to improve as states reopen up and COVID-19 rates start to decrease. What that role might be is unknown, but anything that keeps you safe from COVID-19 and gives your doctor an opportunity to stay in touch and manage your care during a global health crisis is a good thing.

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Article Sources
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