Self-Reported Symptoms in a Cohort of Rheumatoid Arthritis and Systemic Lupus Erythematosus during the COVID-19 Quarantine Period

Abstract

Background: During the first three months of the COVID-19 pandemic in the Philippines, there was a supply shortage of hydroxychloroquine and methotrexate. Limited access to medication and the life changes resulting from the COVID-19 pandemic may predispose patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) to disease flares. Objective: This study aimed to investigate self-reported symptoms of disease flares among patients with rheumatoid arthritis or systemic lupus erythematosus during the COVID-19 pandemic. Methods: A total of 512 completed online surveys from patients with SLE or RA were collected. The data included sociodemographic characteristics, self-reported physical symptoms, health service utilization, and availability of hydroxychloroquine and methotrexate. Results: Seventy-nine percent of respondents had lupus, while 21% had RA. One-third of the cohort had contact with their attending physician during the two-month quarantine period prior to the survey. Eighty-two percent were prescribed hydroxychloroquine and 23.4% were prescribed methotrexate; but 68.6% and 65%, respectively, had “irregular” intake of these medicines due to unavailability. The current health status was reported as good by 66.2%; 24% had no symptoms during the two-week period prior to the survey. The most common symptoms experienced were joint pain (51%), muscle pain (35%), headache (26.8%), and skin rash (19.1%). Five percent had a combination of these four most common symptoms. Irregular supply of hydroxychloroquine among patients with SLE (n=323) was associated with more frequent occurrence of muscle pain (40.6% vs 27.9%, p=0.03) or rash (27.4% vs 11.7%, p<0.001). Irregular supply of methotrexate among RA patients prescribed hydroxychloroquine and methotrexate (n=36) was associated with more frequent occurrence of joint pains with or without swelling (73.9% vs 38.5%, p=0.04). Irregular supply of hydroxychloroquine was associated with less frequent occurrence of dizziness (0 vs 66.7%, p<0.001) among RA patients (n=18). Conclusion: In our cohort of RA and SLE, the majority reported at least one symptom that may indicate disease flare. There was a significant association between the irregular supply of hydroxychloroquine or methotrexate with the presence of muscle pain, rash, or joint pains during the 14-day period prior to the survey.

Systemic lupus erythematosus in the light of the COVID-19 pandemic: infection, vaccination, and impact on disease management

“…Interestingly, 61% felt confident of the correct management of disease during the lockdown by being associated with the cohort [ 72 ]. Another survey from the Philippines with 405 lupus patients reported similar findings, with two-thirds reporting their health status as good [ 73 ]. An irregular supply of HCQ resulted in increased frequency of myalgia and rash [ 73 , 74 ].…”

“…Another survey from the Philippines with 405 lupus patients reported similar findings, with two-thirds reporting their health status as good [ 73 ]. An irregular supply of HCQ resulted in increased frequency of myalgia and rash [ 73 , 74 ]. Similar results from Egypt, Poland, Saudi Arabia, and the GRA were observed (Table 4 ) [ 75 , 76 ].…”

Healthcare Encounters and Outcomes of Filipino Patients with Systemic Lupus Erythematosus Managed at a Tertiary COVID-19 Referral Center

“…This was significantly associated with an increased occurrence of musculoskeletal and cutaneous complaints among these patients. 13 This proves that those who are consistently maintained on this drug are less likely to experience a flare. 14 , 15 An important finding in our study was that after the first pandemic visit, there was a decrease in drug discontinuation rate (from 29.5 to 9.9).…”

Outcomes of Filipinos with inflammatory rheumatic diseases developing COVID-19 prior to vaccinations and new variants: a historical perspective

“…More than half (62%) of our patients were in remission or low disease activity when they got infected, but this is lower than in the overall GRA data (80%), reflecting limited access to, and cost of, second-line therapies in the Philippines, worsened by pandemic restrictions, and decreased availability of hydroxychloroquine and methotrexate in March to July 2020 [ 7 ].…”

“…Gout is the most prevalent inflammatory arthritis in the Philippines (0.5 to 1.6% of the population) [ 4 – 6 ]. RA and SLE are less common, affecting 0.6% and 0.03–0.05% of the population, respectively [ 6 , 7 ]. The high proportion of SLE in our study may reflect reporting bias since these patients were more likely referred to rheumatologists when hospitalized.…”