Objective. Due to concerns of infection and medication disruptions during the COVID-19 pandemic, rheumatology patients at the pandemic epicenter were at risk of distress and poor health outcomes. We sought to investigate medication disruptions and COVID-19-related distress in the Bronx, New York shortly after the peak of the pandemic and determine whether factors related to the pandemic were associated with flares, disease activity, and overall health.Methods. In the month following the epidemic peak, we surveyed adult patients and parents of pediatric patients from rheumatology clinics in the Bronx regarding medication access, medication interruptions, COVID-19 infection, COVID-19 hospitalization, and COVID-19-related distress. We examined which factors were associated with patientreported flares, disease activity, and overall health scores in regression models accounting for sociodemographic characteristics and rheumatologic disease type.Results. Of the 1,692 patients and parents of pediatric patients that were contacted, 361 (21%) responded; 16% reported medication access difficulty, 14% reported medication interruptions, and 41% reported experiencing flare(s). In a multivariable logistic regression model, medication access difficulty was associated with increased odds of flare (odds ratio [OR] 4.0 [95% confidence interval (95% CI) 1.5, 10.4]; P = 0.005), as was high COVID-19-related distress (OR 2.4 [95% CI 1.2, 4.6]; P = 0.01). In multivariable linear regression models, medication access difficulty and high COVID-19-related distress were associated with worse disease activity scores, and high COVID-19-related distress was associated with worse health scores.Conclusion. Medication access difficulties and flares were common among rheumatology patients from the Bronx, New York in the month following the peak of the epidemic. Medication access difficulty and COVID-19-related distress were highly associated with flare and disease activity. COVID-19-related distress was associated with overall health scores.

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BACKGROUNDIdiopathic inflammatory myopathies (IIMs) are chronic systemic autoimmune diseases defined by symmetrical, proximal muscle weakness, dysphagia, and interstitial lung disease (ILD). 1 Patients with IIM are predisposed to proinflammatory states, often immunocompromised by both their disease and medication regimens, and may have preexisting pulmonary conditions. Given these factors, it is imperative to review the outcomes of IIM patients with COVID-19 infections to anticipate the COVID-19 prognoses and complications of these patients. This can be difficult in rare diseases such as IIM, which is only found in 10 per 100,000 people. 1 In this report, we analyze the clinical characteristics and patterns noted in 8 cases of COVID-19 in patients with preexisting IIM. To our knowledge, this is the first publication to examine COVID-19 exclusively in the IIM population. METHODSA registry of Montefiore Medical Center patients that met the 2017 EULAR/ACR classification criteria for IIM was created. It included demographics, IIM subtype, clinical manifestations, comorbidities (including hypertension, diabetes mellitus, osteoporosis, gastroesophageal reflux disease), and treatment history. Interstitial lung disease presence, progression, and severity were determined by computed tomography and pulmonary function tests. The medical charts of this myositis cohort were then reviewed for patients that had been tested positive for COVID-19 on PCR tests and/or IgG antibodies.At our medical center, the qualitative detection of nucleic acid from SARS-CoV-2 was detected using the Cepheid Xpert Xpress Flu/RSV/SARS-CoV-2 real-time PCR assay or the Hologic Aptima SARS-CoV-2 Transcription Mediated Amplification assay. IgG antibody positivity was detected with Abbott's Architect SARS-CoV-2 IgG. All 3 assays have received Emergency Use Authorization from the Food and Drug Administration. 2 Eight of the 141 patients in the myositis cohort had a positive result in 1 of the 3 assays listed previously. The medical records of these 8 patients were reviewed further to determine COVID-19 disease course. Symptoms documented included shortness of breath, loss of smell, and nonspecific viral infection symptoms, such as fever, myalgias, headache, sore throat, and sneezing. Hospital admission for COVID-19 symptoms, inflammatory markers, and requirement of supplemental oxygen and/or intubation were recorded as well. Any changes in steroid or biologic medications 6 weeks before COVID-19 were noted. COVID-19 sequelae, such

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