Evaluation of long term rheumatoid arthritis patients during the COVID 19 pandemic - Remission, treatment and follow up profile

Abstract

BACKGROUNDThe COVID-19 pandemic has caused both direct and indirect challenges to healthcare services worldwide. Decline in outpatient visits has been reported in the United States and across Europe. However, objective data in South America is still scarce on how the follow-up of chronic autoimmune diseases has been impaired. METHODSHere we evaluated the profile of rheumatoid arthritis (RA) outpatient care at the Rheumatology Department of a Brazilian university hospital during the COVID-19 pandemic. Through chart reviews of in-person and telemedicine visits between January 2020 and May 2022, we aimed to evaluate the follow-up of a long-term RA patient cohort, previously approved by national and local research ethics committees. Deaths were evaluated through the Brazilian National Death Registry website. RESULTSSince 2004, a cohort of 182 patients with RA was followed-up in our database. In 2022, they would have a mean age of 71.2 (± 0.7) years, with 29.5 (± 9.8) years of symptoms and 25.0 (± 6.7) years of treatment. In total, only 37 of those patients (20.32%) attended to at least one outpatient visit between January 2020 and May 2022, of which 1 was excluded due to change in diagnosis. There were 73 deaths (40.1%), of which 3 occurred during the pandemic. The remaining 72 patients (39.56%) were lost to follow-up by other causes. We further evaluated the 36 patients with regular follow-up. They had a mean age of 65.2 (± 8.8) years, with 27.4 (± 7.7) years of symptoms and 24.1 (± 6.3) years of treatment. Between 2004-2008, they had a mean disease activity by DAS28 of 3.94 (± 1.99) and only 4 patients (23.62%) achieved remission. In comparison, between 2020-2022, they had a mean DAS28 of 3.18 (± 1.49) and 14 patients (38.88%) achieved remission. CONCLUSIONWe evaluated a cohort consisting of several patients with long-term RA, not usually covered in studies. We observed many losses since the start of follow-up in 2006. Despite the long-term disease, the patients who maintained the follow up achieved better disease control, higher remission rates and optimized treatment (with an increase in the number of patients using immunobiological therapy). However, a limitation of the study was that we could not evaluate the causes of death. We intend to maintain the follow-up of the patients in the sample, focusing on the evaluation of disease progression and control in long-term RA.