Telemedicine in Rheumatology in the United States: A Scoping Review of Modalities, Outcomes, and Costs in Support of a Hybrid Model of Care

BACKGROUND: Shortages and geographic maldistribution of rheumatologists limit access to rheumatology care in the United States. Tele-rheumatology grew from targeted rural and Veterans Affairs programs into mainstream practice during the coronavirus disease 2019 pandemic, and its postpandemic role remains unsettled. OBJECTIVE: To map the modalities, settings, and reported outcomes of telemedicine in US rheumatology. DESIGN: Scoping review following Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (Supplemental Digital Content 1, https://links.lww.com/RHU/A996) reporting. SETTING: MEDLINE/PubMed, the Cochrane Library, and Scopus were searched. PARTICIPANTS: Sixty US reports from 48 programs involving adults and children with rheumatic diseases, caregivers, and rheumatology clinicians. INTERVENTION: Video and telephone visits, clinic-to-clinic telemedicine, electronic consultation (eConsult), remote monitoring, and hybrid care. MAIN OUTCOME MEASURES: Access, clinical effectiveness, patient and clinician experience, cost, safety, and equity. RESULTS: Telemedicine reduced travel and patient-borne costs, improved appointment completion, and shortened the path to specialist input through eConsult triage. Disease activity was comparable to in-person care in established patients, and structured telephone and e-visit programs improved gout treatment targets. In the largest randomized trial, satisfaction and medication toxicity monitoring were lower with telemedicine; remote joint assessment remained unreliable; and uptake was lower among older, non-English-speaking, Black, and low-income patients. Health-system savings are unproven. LIMITATION: Predominantly observational, pandemic-influenced evidence. CONCLUSION: Telemedicine complements rather than replaces in-person rheumatology care. A hybrid model anchored by face-to-face evaluation, with structured visit selection and safety monitoring, should be tested in pragmatic trials with full economic and equity evaluation.