Objectives To determine the psychological impact of the COVID-19 pandemic on people with and without an inflammatory rheumatic disease and establish whether psychological flexibility buffers this impact. Methods From online surveys in the general Dutch population in 2018 and during the peak of the COVID-19 pandemic in 2020, we analysed data of people with (index group, n = 239) and without (control group, n = 1821) an inflammatory rheumatic disease. Worry, stress, mental well-being (SF-36) and psychological flexibility levels were subjected to covariate-adjusted analyses of variance or linear regression analyses. Results During the peak of the COVID-19 pandemic in 2020, as compared with the control group, the index group was more worried about getting infected with the virus (partial η 2 =0.098; medium effect) and more stressed (partial η 2 = 0.040; small effect). However, as compared with data acquired in 2018, the level of mental well-being during the COVID-19 pandemic peak was not lower in both groups. Levels of psychological flexibility did not moderate associations of group or year with mental well-being. Conclusions Although patients with an inflammatory rheumatic disease were more worried and stressed during the peak of the COVID-19 pandemic, their level of mental well-being was not reduced, which may have prevented us from finding a buffering effect of psychological flexibility. Overall, our results suggest that the psychological impact of the COVID-19 pandemic in patients with inflammatory rheumatic disease is modest, which could imply that common education and health care will do for most patients.

Multiple overlapping and complementary theoretical arguments suggest that the COVID-19 pandemic could worsen health in fibromyalgia. The aim of this study was to determine mental and physical health in women with fibromyalgia before and during the pandemic. In a 3-sample, repeated cross-sectional design, we analyzed questionnaire data from Dutch women with fibromyalgia, collected in three independent samples: before the COVID-19 pandemic (2018; n = 142) and during the first acute (2020; n = 304) and prolonged (2021; n = 95) phases of the pandemic. Eight dimensions of mental and physical health were assessed using The RAND 36-Item Short Form Health Survey (RAND SF-36). Compared to norm group data, both before and during the pandemic, women with fibromyalgia showed high levels of fatigue and pain and low levels of general health, social functioning, physical functioning, role physical functioning (d > 1.2, very large effect sizes), role emotional functioning, and mental health (0.71 < d < 1.2, medium to large effect sizes). Contrary to theoretical expectation, levels at five health variables before vs. during the pandemic did not differ (p > 0.05), and levels of pain (p < 0.001), role physical functioning (p < 0.001), and physical functioning (p = 0.03) (0.014 ≤ pη2 ≤ 0.042, small effect sizes) reflected a healthier status during than before the pandemic. These findings indicate a somewhat better but persistently low health status in women with fibromyalgia during the pandemic. This suggests that the pandemic may include changed circumstances that are favorable for some women with fibromyalgia.

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Background:Stress might augment pain in people with fibromyalgia, possibly through sensitization of the central nervous system. The COVID-19 pandemic offers a unique opportunity to examine this mechanism. If it holds, the link between COVID-19 stress and pain would be stronger in people with fibromyalgia than in people without it. Additionally, psychological flexibility might act as a resilience factor, reducing pain severity. If psychological flexibility buffers the impact of stress on pain in people with fibromyalgia, then enhancing psychological flexibility may be of value.Objectives:To determine the association between COVID-19 stress and pain severity in people with fibromyalgia, as compared to people without fibromyalgia, and whether psychological flexibility buffers the impact of stress on pain severity.Methods:In a repeated cross-sectional design, we analysed questionnaire data from two independent surveys. The data collection has been described in a previous study of mental well-being in people with inflammatory rheumatic diseases.[1] The current study analysed data from people with and without fibromyalgia. Data were collected before the COVID-19 pandemic (2018; fibromyalgia: n=145, no fibromyalgia: n=386) and at the first peak of the pandemic in the Netherlands (2020; fibromyalgia: n=270, no fibromyalgia: n=1259). Stress due to the pandemic, psychological flexibility, and pain were subjected to regression analyses. Two operationalisations of stress were analysed: self-reported stress levels during the peak of the pandemic in 2020, and a comparison of assessments in 2018 and 2020 (assuming higher stress levels during the pandemic peak in 2020).Results:In regression analyses, stress during the pandemic (p<.001), having fibromyalgia (p<.001), and lower psychological flexibility (p<.001) were all associated with more severe pain, but the interactions showed that the strength of the association of stress with pain was not different in people with fibromyalgia compared to people without fibromyalgia (p=.76 and p=.28 for the two operationalization of stress, respectively). Another interaction indicated that psychological flexibility was a potential buffer against the association between self-reported stress and pain in the first operationalisation of stress (p=.04), but not in the second (p=.44). The significant but small interaction is shown in the Figure 1. It suggests that pain is higher in people with low psychological flexibility and higher stress levels during the pandemic. This effect was not specific to fibromyalgia.Conclusion:Overall, the significant main effects show that negative states, such as stress related to the pandemic and low psychological flexibility, are associated with another negative state: pain. A small interaction effect suggests that psychological flexibility may protect against the impact of COVID-19 stress on pain, both in people with and without fibromyalgia. However, the analyses reject our hypothesis that COVID-19 stress would augment pain especially in people with fibromyalgia.References:[1]Koppert TY, Jacobs JWG, Geenen R. The psychological impact of the COVID-19 pandemic on Dutch people with and without an inflammatory rheumatic disease. Rheumatology (Oxford) 2020; keaa842. doi: 10.1093/rheumatology/keaa842.Pain (standard deviation from the norm) as a function of low (-1 SD) and high (+1 SD) psychological flexibility and low (-1 SD) and high (-1 SD) self-reported stress levels during the first peak of the pandemic in 2020, while controlling for gender, age, education level, and number of diseases.Disclosure of Interests:Tim Koppert: None declared, Johannes W.G. Jacobs: None declared, Mark Lumley Consultant of: Paid research consultant to Cognifisense, LLP, which studies virtual reality treatments for chronic pain., Rinie Geenen Speakers bureau: Sanofi Genzyme paid for a lecture and worshop on depression and fatigue in RA.