Using Node.js with Twilio can make building SMS and telephony apps easy and efficient. Node.js is a fast, event-based, async server-side JavaScript engine that provides simple evented IO, making it an ideal choice for handling HTTP requests and view rendering. Express is a popular web framework that works well with Twilio, allowing developers to receive SMS messages, extract their content, and respond. To get started, developers need to create an Express project, set up a Twilio account, and deploy the application using Nodester, which provides a Git repository and CLI toolkit for easy deployment and management of applications. With these tools, developers can quickly build and test SMS apps, and eventually, connect their public Nodester app URL with their phone number to send and receive SMS messages.