This may sound like a silly obvious question but I just had a bulb go off over my head. There is likely a huge perfromance difference between manipulating a local collection vs. patching / refreshing from an Azure SQL database right? Even if I essentially cache locally then write patches to SQL I am assuming it would be faster right? I don't know why I hadn't thought of this sooner, I have been almost always pulling a full table (or filtered one) from SQL rather than just write patch / remove from collection to maintain local copy.
The only issue with this is if you have more than one user acting upon a list at any given time, then you must always refresh from SQL to make sure data is up to date right?