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Objectives: To assess the feasibility, spectrum, outcomes, and challenges of delivering super-specialty consultations through telemedicine to remote areas of the Union Territory (UT) of Ladakh. Methodology: The authors report on a prospective, observational (descriptive), pilot study. Super-specialty medical teleconsultations were provided to healthcare providers in UT Ladakh by specialists in the Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India, from October 2021 to May 2022, employing the Hub-and-Spoke model of the Ayushman Bharat Digital Mission. Doctorto-doctor teleconsultations were initiated by treating doctors at healthcare facilities in UT Ladakh on the eSanjeevani™ platform. An audio-video model was used for teleconsultation, and digitally signed prescriptions were shared. The outcome measures included demand and spectrum of super-specialty teleconsultations, the outcome of consults (whether managed successfully at the teleconsultation level or required referral for in-person visits), and technical challenges faced. Results: A total of 26 super-specialty teleconsultations were provided: 14 (54%) were for women. Patient distribution was uniform across all age groups. The super-specialty-wise distribution of consultations was nine from endocrinology, nine from neurology, three from hepatology, two from cardiology, and three from neonatology. Reasons for seeking consultation were assistance in diagnosis (3, 12%), optimization of therapy (10, 38%), or both diagnostic evaluation and treatment optimization (13, 50%). Five cases (19%) were referred for physical visits to a higher center for advanced diagnostic testing like liver biopsy, brain biopsy, upper GI endoscopy, etc.; other cases were managed remotely. Problems with audio-visual connectivity were encountered in three patients. Conclusion: This pilot study demonstrates that telemedicine can effectively deliver complex, super-specialty medical consultations to remote areas. Future research should focus on assessing long-term outcomes, patient satisfaction, and cost-effectiveness to evaluate this model's impact better. [ABSTRACT FROM AUTHOR]

Fibromyalgia syndrome (FMS) is common in patients of psoriatic arthritis (PsA), but the magnitude of its impact is uncertain. This cross-sectional study evaluated the impact of FMS on health-related quality of life (HRQoL) and disease activity in PsA. Adults classified with PsA (CASPAR criteria) at the rheumatology and dermatology outpatient clinics of PGIMER, Chandigarh, India between January 2014 and June 2015 were recruited. All patients were assessed for FMS using the 2010 ACR criteria. Health-related quality of life was assessed using PROMIS-HAQ, HAQ-pain, HAQ-health and revised fibromyalgia impact questionnaire (FIQR). Disease activity measures (SJC, TJC, BASDAI, enthesitis, dactylitis, PASI) and PROMIS-HAQ were correlated with measures of FMS [FIQR, symptom severity scale (SSS) score and widespread pain index (WPI)]. Multivariate regression analyses were used to identify predictors of PROMIS-HAQ and FMS. Out of 106 PsA patients screened, 102 [50 (49%) females; mean age 43.8 (12.4) years] were included. 19 (18.3%) had FMS. Patients of PsA with FMS had significantly (p < 0.05) higher TJC (14 vs 7), SJC (10 vs 5), BASDAI (6.1 vs 4.1) and enthesitis (53 vs 33%), but no difference in dactylitis, severity of skin disease and disease duration. A significant positive correlation of measures of FMS (FIQR, SSS and WPI) with SJC, TJC and BASDAI was noted. PROMIS-HAQ, HAQ-pain and HAQ-health were significantly worse (p < 0.001) in patients of PsA with coexisting FMS. Presence of FMS was found to be an independent predictor of worse PROMIS-HAQ. Female gender and higher TJC independently predicted presence of FMS. To conclude, FMS is an important contributor towards poor HRQoL in patients of PsA and is associated with higher values of joint disease activity measures. [ABSTRACT FROM AUTHOR]