Variables Associated With Perceived Risk of Contracting SARS-CoV-2 Infection During the COVID-19 Pandemic Among Patients With Systemic Rheumatic Diseases

Abstract

Objective The aim of this study was to assess patients' perceived risk of contracting SARS-CoV-2 at the peak of the pandemic in NYC in terms of their systemic rheumatic disease and medications. Methods With the approval of their rheumatologists, patients were interviewed by telephone and were asked about their perceived risk of contracting SARS-CoV-2 considering their rheumatic condition and whether medications increased this risk. Patients also completed surveys assessing beliefs about medication and multidimensions of physical/mental well-being. Information about current medications and rheumatologist-initiated changes in medications during the pandemic were reported by patients and verified from medical records. Results One hundred twelve patients (86% women; mean age, 50 years; 81% White, 15% Latino) with diverse diagnoses were enrolled. Fifty-four percent thought they were at “very much greater risk” of COVID-19 because of their rheumatic condition, and 57% thought medications “definitely” put them at greater risk. In multivariable analysis, the perception of “very much greater risk” was associated with greater belief that rheumatic disease medications were necessary, worse physical function, chronic pulmonary comorbidity, and more anxiety. In a separate model, the perception that medications “definitely” caused greater risk was associated with White race, not taking hydroxychloroquine, rheumatologists initiating change in medications, more anxiety, and taking biologics and corticosteroids. Conclusions Patients’ perceived increased risk of contracting SARS-CoV-2 was associated with beliefs about their rheumatic disease, medications, comorbidity, and anxiety. Clinicians should be aware of patients’ perceptions and foster self-management practices that will alleviate anxiety, minimize exposure to the virus, and optimize systemic rheumatic disease outcomes.

Perceived Risk and Associated Shielding Behaviors in Patients With Rheumatoid Arthritis During the Coronavirus 2019 Pandemic

“…Hypertension was the most common comorbidity (142; 29%) and the median (IQR) CCI was 1.0 (1.0‐2.0). The median (IQR) number of health care visits within the MGB system in the last 6 months of 2019 (July 1, 2019, to December 31, 2019), preceding the pandemic, was 16 ( 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ). At the time of the survey, the mean (SD) disease activity was 74.6 (19.9).…”

“…Although shielding practices are critical to reducing risks of COVID‐19 and controlling the ongoing pandemic, they do come at substantial personal and societal costs. Indeed, previous studies of the general population and participants with rheumatic diseases have established the negative impacts of the pandemic on mental health, including anxiety and depression, likely driven in part by the need for shielding practices, which contribute to social isolation ( 24 , 25 , 26 , 27 , 28 , 29 ).…”

Perceived Risk of SARS-CoV-2 at the Start of the COVID-19 Pandemic and Subsequent Vaccination Attitudes in Patients With Rheumatic Diseases

“…Patients with a rheumatologist-diagnosed rheumatic disease were eligible if they were taking immunosuppressive medications and had a telehealth visit during the study period or if they were recommended to the study by their rheumatologist. At enrollment, patients participated in a telephone interview, which asked about rheumatic disease medications, changes in medications due to the pandemic, psychosocial factors affected by the pandemic, and perceived risks of contracting the virus compared with the general population and due to immune-mediating medications (reported previously) 9–12 …”

“…At enrollment, patients participated in a telephone interview, which asked about rheumatic disease medications, changes in medications due to the pandemic, psychosocial factors affected by the pandemic, and perceived risks of contracting the virus compared with the general population and due to immune-mediating medications (reported previously). [9][10][11][12] For the follow-up, patients were interviewed again by telephone beginning in January 2021, coinciding with the initiation of SARS-CoV-2 vaccines for older patients and those with chronic conditions. This also coincided with the release of the American College of Rheumatology guidelines recommending vaccination for patients with rheumatic diseases.…”

“…At enrollment, patients participated in a telephone interview, which asked about rheumatic disease medications, changes in medications due to the pandemic, psychosocial factors affected by the pandemic, and perceived risks of contracting the virus compared with the general population and due to immune-mediating medications (reported previously). 9 – 12 …”