Impact of COVID-19 pandemic on rheumatoid arthritis from a Multi-Centre patient-reported questionnaire survey: influence of gender, rural–urban gap and north–south gradient

Abstract

During the coronavirus disease-2019 (COVID-19) pandemic there were several barriers to treatment access and medication adherence in rheumatoid arthritis (RA) patients. There is no information regarding the RA patient health status in Egypt during the COVID-19. Thus,the aim of this work was to study the impact of the pandemic on RA patients through a patient-reported questionnaire and to determine the influence of gender, geographic regions. This multi-centre study initiated by the Egyptian College of Rheumatology (ECR) was conducted on 1037 RA patients attending rheumatology clinics from 10 governorates. The questionnaire provided covered socio-demographic data, health/disease status, information/knowledge about COVID-19 and medical/family history of the infection. Patients mean age was 44.2 ± 12.3 years;855 females and 182 males; 539(52%) from rural and 497(48%) from urban areas. 41.8% reported a striking difficulty to obtain hydroxychloroquine during the pandemic. The majority (70%) considered maintaining a regular visit to the rheumatologist in addition to remote contact mainly by phone (44.4%) or via WhatsApp (33.1%), in particular among male and urban patients. Urban patients were more likely to be infected by COVID-19 (12.9% vs 6.2%; p < 0.0001) than rural. Northern cities had more patients with suspected COVID-19 (13.9% vs 6.1%; p < 0.0001); was significantly associated with more disease flares (30.8% vs 5.8%) with subsequent change in the RA treatment (20.9% vs 6.4%; p < 0.0001). Patients with RA faced remarkable difficulty to obtain their medications with subsequent change in their disease status. The challenges of the pandemic have hastened changes in the way we deliver health care. Electronic supplementary material The online version of this article (10.1007/s00296-020-04736-9) contains supplementary material, which is available to authorized users.

Clinical and bioethical implications of health care interruption during the COVID-19 pandemic: A cross-sectional study in outpatients with rheumatic diseases

“…(Long) disease duration, substantial disease activity level previous HCI, need for rheumatic care, and NP with (rheumatic disease-related) treatment were associated with clinical deterioration. Hassen et al [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] surveyed 3000 rheumatic patients during the current pandemic in Saudi Arabia, with the aim to capture patients' experiences. Among the 637 respondents, patient perception of worsened disease activity was correlated to unplanned healthcare visits (which might be considered a surrogate for the need for rheumatic medical care), medication non-adherence (a surrogate for NP with treatment), and difficulty in accessing medication, which was in fact the main reason for treatment discontinuation among our patients.…”

“…The authors reported that up to 41% of the patients referred difficulty in obtaining hydroxychloroquine and 40.7% of the patients referred disease flare. Non-adherence to treatment has been extensively described in patients with rheumatic diseases during the COVID-19 pandemic and has been attributed to limited access to medications as well as to patients' fears related to immunosuppressive drugs [3,13,19,25,26,28,[30][31][32].…”

A novel multi-omics-based identification of symptoms, comorbid conditions, and possible long-term complications in COVID-19

“…According to rank (with a cut off score 4), the enriched known or reported comorbid conditions or long-term complications are lupus erythematosus (Rank-1) [100], depressive disorder / mental depression (Rank-2) [30, 101], hepatitis C (Rank-3) [102], breast cancer (Rank-4) [75], arthritis (Rank-5) [103], asthma (Rank-6) [10, 77], liver cancer (Rank-6) [78], tuberculosis (Rank-7) [104, 105], diabetes (Rank-8) [82], myocardial infarction (Rank-9) [35, 106], macular degeneration (Rank-9) [80], chronic kidney disease (Rank-9) [56, 57], arteriosclerosis (Rank-10) [107], ulcerative colitis (Rank-10) [108], liver cirrhosis (Rank-11) [12, 109], sepsis / septicaemia /septic shock (Rank-11) [60, 81], other autoimmune diseases (Rank-12) [49, 50], cerebrovascular accident / stroke (Rank-13) [110], congenital anemia (Rank-13) [111], COPD (Rank-13) [86], multiple myeloma (Rank-14) [112], hypertensive disease (Rank-14) [9, 113], dyslipidemia (Rank-15) [93], metabolic syndrome X (Rank-15) [51, 114], osteoporosis (Rank-16) [91], prostate cancer (Rank-17) [115], psoriasis (Rank-17) [116], leukemia (Rank-18) [117, 118], long QT syndrome (Rank-18) [119], dementia (Rank-18) [120], schizophrenia (Rank-18) [121], intellectual disability (Rank-18) [122, 123], diabetic kidney disease/ diabetic nephropathy (Rank-18) [124]etc.…”

“…Literature suggests that lupus (Rank-1) patients are more vulnerable to COVID-19 [100] and breast cancer (Rank-2) patients infected with COVID-19 show 13% mortality rate [75]. Arthritis that came at Rank-3 is reported to increase risk and severity of COVID-19 [103]. Although asthma came at Rank-4 and a comorbid condition, it may not increase the mortality rate [10, 77].…”

Microscopic polyangiitis associated with coronavirus disease-2019 (COVID-19) infection in an elderly male

“…Interestingly, the association between viral infections and rheumatic diseases is already well-recognized. In fact during the pandemic, rheumatic disease patients faced remarkable difficulty to obtain their medications with subsequent change in their disease status [4] with a negative impact on their quality of life [5] . There is an agreement to the key emerging frontline role of rheumatologists in treating COVID-19.…”