What to Know About Telehealth for Gout

If you have gout, you may have concerns about scheduling visits with your healthcare professionals during the COVID-19 pandemic. While healthcare providers' offices are taking precautions to see patients safely in person, telehealth is a viable alternative to managing your health from home.

Telehealth is not a new concept, but it only recently has changed the patient-doctor dynamic. With the current global pandemic, telehealth is being used to prevent coronavirus spread, especially to vulnerable populations.

Gout is a common form of arthritis characterized by recurrent and sudden attacks of severe pain, swelling, and redness. It most usually affects the big toe, but it can affect other joints, including the knee, ankle, and elbow.

People with gout might be considered a higher risk group for COVID-19 complications, although the data is limited as to how this group would fare if they were to contract the coronavirus.

When to Use Telehealth for Gout

You need to stay in touch with your healthcare provider and remain on your medications even during the pandemic. This is especially important if you need ongoing gout treatment, such as medications that block uric acid production (like allopurinol) and those that improve uric acid removal (like Probalan).

For your gout care, telemedicine can be helpful for a variety of patient experiences. For example, if you are having a gout flare-up or experiencing severe pain.

Your healthcare provider can also see you for a telehealth visit to screen you to determine if you need an in-person visit. They will examine your swollen joints over the video call and make a decision.

After an in-person visit or a visit about a prescription review, follow-up visits can also be done with a telehealth visit.

Telehealth Doesn’t Work for Every Situation

Telehealth visits for gout work best for routine care, follow-up, and treatment changes. Things that might require you to go into your practitioner's office might include ongoing pain or recurrent flare-ups, serious symptoms or gout complications, a corticosteroid injection treatment, lab work, or other tests.

Ongoing pain/repeat flares: Your healthcare provider might want to physically examine an inflamed joint so they have a better idea of what you are experiencing. They might also want to examine the fluid in the affected joint. This means they will use a needle to draw fluid from the joint and then look for urate crystals within the fluid under a microscope.

Serious symptoms/complications: If your practitioner thinks you are experiencing serious symptoms or might have a complication, they will want to assess you in person. Complications associated with gout include tophi (clusters of urate crystals and inflammatory cells that form under the skin above the affected joint) or a bone fracture.

People with gout are more prone to osteopenia and osteoporosis fractures. Fracture risk is up to 23% in people with gout, according to a study reported in 2016 in the journal Medicine.

In-office injections: For gout attacks, corticosteroid injections are a safe and effective way to treat gout in a single joint. These injections cannot be accomplished during a telehealth visit, and you will need to go into your practitioner's office.

Lab work and other tests: Your healthcare provider will want lab work or other tests to determine if treatment is helping, if you are experiencing inflammation, or have high levels of uric acid in your blood. This follow-up testing will include joint fluid tests, bloodwork (such as uric acid testing), or imaging.

Benefits and Challenges

Rheumatology is one of the areas where telehealth visits far exceed other specialties. In a survey of 1,100 adults from the American College of Rheumatology, researchers found up to 66% of people with rheumatic conditions were using telehealth, mainly to avoid exposure to the coronavirus.

The American College of Rheumatology supports telemedicine and finds that it is an important “tool with the potential to increase access and improve care for patients with rheumatic diseases.” They add that telehealth should not replace in-person medical assessments.

Telehealth makes it easier for healthcare providers and their patients to connect. But unfortunately, not everyone has access to a computer, other smart devices, or even the Internet. A study from the Pew Research Center found that up to 10% of Americans do not have access to the Internet.

And even for people who have Internet access, telehealth works only if there is a good online connection. Depending on where you live or other factors, you might lose the connection, which means a longer appointment or a rescheduled one.

Telehealth also requires devices that support its use. Many people do not own smartphones, tablets, computers, or other devices because they can’t afford them or are older and don’t necessarily use technology. And without those devices, they won’t have access to telehealth services.

But for people who can take advantage of telehealth services, they can be quite beneficial. Advantages of telehealth include reducing the spread of illness, convenience, time savings, and fewer missed or canceled appointments.

Reduced spread of illness: A telehealth visit prevents exposure to germs and disease transmission compared with an in-person visit. Because people with gout may have a higher risk for coronavirus complications, they should limit their exposure.

Convenience: Telehealth is convenient because you don’t need to travel and can connect from anywhere. That means you are not taking time off from school or work or having to make child care arrangements. Telehealth is also helpful for people who are not feeling well or whose joint pain limits their mobility.

Time savings: In-person appointments take more time than telehealth visits, including travel and waiting time. A study from Harvard Medical School looked at how much time people were using for medical appointments. A typical visit took up 121 minutes of a patient’s day, with only 20 of those minutes spent with the healthcare provider.

Reduces missed and canceled appointments: Because telehealth visits are convenient, they are not canceled as often, and most people are likely to show up for their telehealth visit. A telehealth visit also means fewer hurdles that would cause a person to cancel or miss an appointment, such as an issue at work or with transportation or child care.

How to Prepare for a Telehealth Visit for Gout

The first thing you will want to do to prepare for your telehealth visit with your rheumatologist or other healthcare professional is to make sure you have access to the right technology. If the visit requires an exam by video, you will need a smartphone, computer, tablet, or another appropriate device.

Make sure the camera and microphone are enabled. You may also need access to a telephone, as you will likely be speaking with your practitioner’s receptionist or nurse before the start of the visit with your healthcare provider.

Your practitioner’s office staff will let you know what type of application is being used for the telehealth visit. It might be a specific application, or you might just be sent a link when your healthcare provider is ready to see you.

You should find a comfortable and private space for the visit. That way you can speak with your practitioner openly, and they will be able to do a visual physical exam and see your affected joints.

Before your appointment, you will want to prepare a list of all the medications, supplements, or vitamins you take. Have a list of all new symptoms, as well as your insurance card.

Any blood tests or imaging ordered by your healthcare professional should be completed before the telehealth visit. Blood work usually consists of a complete blood count (CBC), chemistry panel, uric acid level, and C-reactive protein (CRP).

Write down any questions so that you can remember to ask those during the visit. Last, keep a pen and paper handy to take notes on information and advice your healthcare provider has given.

What Happens During the Telehealth Visit

Your telehealth visit should be similar to an in-person visit with your healthcare provider. You may need to agree to consent to use telehealth via an online form or verbally at the beginning of the appointment.

Your healthcare professional will join you on the video call. They will ask you about current and new symptoms, how you are feeling currently, and if you feel your treatments are helping.

They might also do a visual exam to check your range of motion and the appearance of affected joints. You may be asked to show joints in which you are experiencing inflammation, swelling, or pain. They will want to know about symptoms that don’t appear to be related to gout, such as joint stiffness in another area or a skin rash.

As the visit ends, the healthcare professional will provide you with information about follow-up, referrals, prescriptions, and other things you need to do. You will also be allowed to ask questions about symptoms, treatment, or other concerns you have.

A Word From Verywell

COVID-19 has changed all of our lives and continues to cause worry and concern for people who are at a higher risk for complications. What hasn’t changed is that you still need to care for your physical and mental health as you do everything you can to stay healthy and prevent gout flares.

For now, that means practicing social distancing, continuing to maintain a gout-friendly lifestyle, keeping up with treatments, and staying in touch with your healthcare provider. 

Try not to let the technology intimidate you and keep you from getting the care you need. Your practitioner’s staff, a family member, or a friend can help you figure out what technology you need and how to connect.

Of course, telehealth is not your only option. You can still visit your healthcare provider in person and get the vital health care you need. Your practitioner’s office is doing everything they can to make sure their spaces are safe for people who visit them.