Interruptions to In-Person Visits During Pandemic Did Not Negatively Impact Patients With Inflammatory Arthritis

During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, patients with axial spondyloarthritis (axSpA), rheumatoid arthritis (RA), and psoriatic arthritis (PsA) didn’t see any increase in disease activity despite an interruption in in-person interactions, according to research published in Annals of Rheumatic Diseases.

The researchers analyzed patients in the Swiss Clinical Quality Management cohort to understand how partial or complete closure of rheumatology services impacted disease activity as remote consultations were used to partly compensate for the reduced in-person interaction.

“Additional factors may also potentially contribute to disease worsening during the pandemic,” the authors explained. “Some patients may choose to preventively stop immunosuppression out of fear of complications. Moreover, the psychological stress (anxiety about a new disease, economic pressure, less recreational opportunities and so on) encountered during the pandemic should not be underestimated.”

The researchers defined 3 study periods: a pre–COVID-19 phase from January 1 to February 29, 2020; a COVID-19 phase from March 1 to April 30, 2020; and a post–COVID-19 phase from May 1 to June 30, 2020. Patients who had at least 1 patient-reported disease activity measure in each of the study periods were included.

A few disease activity assessments were used: the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for axSpA; the Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5) in RA; and the Patient Global Assessment (PGA) visual analogue scale for disease activity in PsA. The researchers used the following to define a clinically important worsening:

• BASDAI: increase of 2 points
• RADAI-5: increase of 1.4 points
• PGA: increase of 1.2 points

The study looked at 287 patients with axSpA, 248 with RA, and 131 with PsA. The number of visits dropped 52% from 543 in February to 262 in April; however, there was a 129% increase in web-based application entries (521 to 1195) during this time.

In the pre­­–COVID-19 phase, 15% of patients were nonadherent to their medication. While there was a slight increase in nonadherence during the COVID-19 phase, the researchers noted the increase only reached statistical significance among patients with axSpA.

“Adherence returned to prepandemic levels in the post–COVID-19 phase,” they wrote.

Over the first half of 2020, patient-reported disease activity outcomes were stable. There was a slight decrease during the COVID-19 phase; the decrease was only statistically significant for patients with axSpA (mean BASDAI 3.40 before the pandemic and 3.23 during the pandemic; P = .02). There was disease flare in less than 15% of patients for all 3 diseases, which was not statistically different from the pre–COVID-19 phase.

The authors noted that the fact they could only evaluate patients with regular disease activity assessments was a limitation.

“This subset using the smartphone app is probably more invested in disease management and the non-compliance figures might be under-represented,” they wrote.

Reference

Ciurea A, Papagiannoulis E, Bürki K, et al. Impact of the COVID-19 pandemic on the disease course of patients with inflammatory rheumatic diseases: results from the Swiss Clinical Quality Management cohort. Ann Rheum Dis. Published online September 22, 2020. doi:10.1136/annrheumdis-2020-218705