Factors Related to Experiencing Pain in Patients Affected by Chronic Inflammatory Rheumatic Disease During the COVID-19 Pandemic

Objective: To evaluate the effects of the COVID-19 pandemic on the pain experienced by patients with CIRD and to analyze the associated factors. Method(s): A cross-sectional study was conducted amongst patients with rheumatic diseases using a questionnaire providing information on patients and disease characteristics. Patients were asked to assess the level of pain they had experienced before and during the pandemic, using a single Visual Analogue Scale (VAS) ranging from 0 (no pain) to 10 (greatest pain). Statistical Analysis System IBM SPSS Statistics V20.0.0 was used to analyze the study data. We performed univariate multivariate analysis to search for any related factors to pain perception during the COVID-19 pandemic. Qualitative values were analyzed by the chi2 test. Quantitative values were analyzed by the Student test when the measures were normally distributed or by nonparametric tests (Mann-Whitney U) when the measures were not normally distributed (the Kolmogorov-Smirnov test was used to test normality). Result(s): Amongst the 350 patients who answered the questionnaire online, rheumatoid arthritis represented 62.3%, spondyloarthropathy 34.3%, and undifferentiated CIRD 3.4%. CIRD-related pain was reported by 79.1% of the patients The level of pain, using the VAS of Pain, increased significantly during the COVID-19 pandemic (4,6 +/- 2,8 and 5,4 +/- 3 before and during the pandemic;p<0.001). In the multivariate analysis, the factors causing the pain were: the negative impact of the coronavirus on accessing rheumatology care, the discontinuation of treatment, the disturbed sleep, and the negative psychological impact. Conclusion(s): This survey showed that the COVID-19 pandemic had increased CIRD-related pain in patients. Factors influencing this pain should be considered to help patients cope with their chronic rheumatism in this global health crisis. Copyright © 2022, Bentham Science Publishers. All rights reserved.

Prévalence du COVID-19 chez les patients atteints de rhumatismes inflammatoires chroniques traités par biothérapies, données du registre marocain des biothérapies (RBSMR)

Introduction L'objectif de ce travail était de déterminer la prévalence du coronavirus 2 du syndrome respiratoire aigu sévère (SARS-CoV-2) 2019 (COVID-19) chez les patients adultes atteints de rhumatismes inflammatoires chroniques traités par biothérapies. Matériels et méthodes Les données ont été recueillies à partir du registre RBSMR, un registre historico-prospectif multicentrique de patients adultes (> 18 ans) ayant une polyarthrite rhumatoïde (PR) ou une spondyloarthrite (SpA), traités par des médicaments biologiques dans les 10 services universitaires de rhumatologie du Maroc. Les patients ont été évalués tous les six mois et chaque fois qu'ils subissaient un événement indésirable ou un changement de traitement, avec un suivi programmé de 3 ans. Un questionnaire électronique a été complété à chaque visite par l'investigateur. L'inclusion a débuté en juin 2017 et s'est terminée en janvier 2019, date du premier gel de la base de données. Résultats Le nombre de patients inclus était de 441, dont 419 patients validés. 225 patients étaient atteints de PR et 194 étaient atteints de spondylarthrite. L'âge moyen des patients suivis pour PR était de 51,9 ± 11,3 ans, dont 197 femmes (87,1 %). La durée moyenne de la maladie était de 11,8 ± 8,3 ans et la durée médiane du traitement était de 125 semaines dont 42 % en initiation. L'âge moyen des patients ayant une SpA était de 40,4 ± 13,8 ans, 123 patients étaient des hommes (63,4 %), la durée médiane du traitement biologique en cours était de 84 semaines. Dix patients (2,38 %) ont été touchés par le COVID-19, dont 5 suivis pour PR et 5 pour SpA. La prévalence du COVID-19 chez les patients atteints de PR était de 2,2 % et de 2,6 % chez les patients atteints de SpA. Chez les patients suivis pour PR ayant été testés positifs au COVID 19, l'âge moyen était de 51,2 ± 7,56 ans, tous de sexe féminin, aucune n'était tabagique, 3 patients (60 %) étais sous rituximab, 1 sous tocilizumab et 1 sous infliximab. 2 patients (40 %) étaient sous CsDMARDs concomitant ;MTX 15 mg/s. Quatre patients (80 %) étaient sous corticothérapie à des doses allant de 5–10 mg équivalent de prédnisone/jour. Chez les patients suivis pour spondylarthrite touchés par le COVID-19, l'âge moyen était de 50,40 ± 19,16 ans, le sex-ratio H/F était de 0,66, aucun patient n'était tabagique, 2 patients (40 %) étaient sous etanercept, 2 (40 %) sous adalimumab et 1 patient sous secukinumab. Deux (40 %) patients étaient sous CsDMARDs concomitant ;Sulfasalazine 2 g/j. Trois patients (60 %) étaient sous corticothérapie à des doses allant de 5–15 mg équivalent de prédnisone/j. Discussion La prévalence du COVID-19 au sein de la population suivie pour un rhumatisme inflammatoire chronique sous biothérapie était faible, cela étant probablement dû à la prudence de ces patients quant aux mesures préventives contre le COVID-19 (gestes barrières, isolement social) compte tenu de leur immunosuppression. Conclusion Les données relatives à la prévalence et au risque de COVID-19 chez les patients atteints de rhumatismes inflammatoires chroniques traités par biothérapies sont encore rares mais rassurantes, d'où l'intérêt d'encourager ces patients à poursuivre leur traitement tout en respectant les mesures de prévention et de protection contre le COVID-19.

Quels sont les facteurs liés au vécu douloureux des patients atteints de rhumatisme inflammatoire chronique pendant la pandémie de la COVID-19 ?

Introduction La pandémie de Coronavirus a entraîné de nombreuses conséquences sur le bien-être, l'accès aux soins et le maintien thérapeutique chez les patients atteints de maladies chroniques. L'objectif de cette étude est d'évaluer l'impact du confinement sur le vécu douloureux des patients atteints de rhumatisme inflammatoire chronique (RIC) et les éventuels facteurs associés. Patients et méthodes Une étude transversale a été menée auprès de patients atteints de RIC à l'aide d'un questionnaire en ligne fournissant les caractéristiques des patients et de leur maladie et la douleur globale qu'ils avaient ressentie avant et pendant la période de confinement, en utilisant l'échelle visuelle analogique (EVA). Système d'analyse statistique IBM SPSS Statistics V20.0.0 a été utilisé pour analyser les données de l'étude. Nous avons effectué une analyse univariée puis multivariée pour rechercher les facteurs liés à la perception de la douleur pendant le confinement. Les valeurs qualitatives ont été analysées par le test du Chi2. Les valeurs quantitatives ont été analysées par le test de Student lorsque les mesures étaient normalement distribuées ou par un test non paramétrique (Mann-Whitney U) lorsque les mesures n'étaient pas normalement distribuées (le test de Kolmogorov-Smirnov a été utilisé pour tester la normalité). Résultats Parmi les 350 patients ayant répondu au questionnaire, la polyarthrite rhumatoïde représentait 62,3 %, la spondylarthropathie 34,3 % et le RIC indifférenciée 3,4 %. La douleur causée par le RIC pendant le confinement a été rapportée par 79,1 % des patients. L'EVA de la douleur a augmenté de manière significative pendant la pandémie (4,6 ± 2,8 et 5,4 ± 3 avant et pendant le confinement ;p < 0,001). En analyse multivariée, les facteurs impliqués dans la douleur étaient l'impact négatif du Coronavirus sur l'accès aux soins rhumatologiques, la mauvaise observance thérapeutique, la qualité du sommeil perturbée et l'impact psychologique négatif. Discussion Cette étude montre les difficultés rencontrées par les patients pour assurer un suivi régulier auprès de leurs rhumatologues et la forte prévalence de l'arrêt des traitements. L'expérience de la douleur pendant la pandémie serait déterminée par des facteurs liés aux patients eux-mêmes et à l'interruption du suivi de leur RIC. La plupart des patients ont réclamé des difficultés à consulter leur rhumatologue pour plusieurs raisons : les problèmes de transport et la crainte de contracter le Coronavirus sur le chemin de l'hôpital et une peur générale d'attraper la COVID-19 à l'hôpital même. Ce constat est alarmant et laisse craindre des poussées de RIC plus fréquentes en période post-pandémique. Conclusion L'enquête a montré que cette pandémie a augmenté l'expérience douloureuse chez les patients ayant un RIC. Les facteurs influençant le vécu douloureux doivent être pris en compte pour aider les patients à faire face à leurs RIC et à cette crise sanitaire mondiale.

COVID-19 pandemic: Knowledge, believes and fears in patients with chronic inflammatory rheumatic diseases in a developing country

Objectives: To investigate the knowledge, believes, and fears of patients with Chronic Inflammatory Rheumatic Diseases (CIRD) in Morocco regarding the Covid-19 pandemic. Methods: COVID-19 related knowledge was evaluated through following items: clinical presentations, age of infection, transmission routes, self-reported preventive behaviors, patient's approach in case of suspicion of being infected by COVID-19 and vaccination. We also investigated the source of the patients' information. Believes and fears of patients regarding COVID-19 was assessed using 2 items that explored participant's perception of the degree of threat to public health and their individual infection susceptibility compared to the general population. Results: A cross-sectional study was conducted among patients with rheumatic diseases using a questionnaire providing information on patients and disease characteristics. 350 patients had participated in this online survey (mean age of 46,1 ± 14,4, 68% were women, 15.7% were illiterate, 45.7% were unemployed, rural residence in 11.7% of cases). The correct answer rates of the 6 questions of the knowledge section of the questionnaire were 53.4-100% with an average mean of 90.7%. The mean COVID-19 knowledge score was 5,43/6 (SD:0,48). Most participants (96.6%) correctly identified the age group concerned about Covid-19 infection. Remarkably 92.3% of the participants recognized 3 clinical features when 97.7% and 72.3% of the sample recognized perfectly modes of transmission and disease prevention measures. 87.4% of patients knew the recommended course of action to do if they have fever or cough and have recently been in contact with an infected patient. 64% of the study population thought that there was no vaccine available yet. The sources of information on COVID-19 were in descending order: rheumatologist (56.6 %), personal research (on the internet or other) (43.4%), video broadcasts on national television channels (28%), other Awareness Video (24.2%). Regarding the patients believes and fears toward COVID-19, 81.7% of patients believed that the pandemic is a serious threat for the public health and 80.6% thought that their CIRD makes them more exposed to the risk of contamination than general population. Conclusion: The results of this survey show a high prevalence of patient concern about COVID-19. However, the majority of patients responded correctly on the mode of transmission and the means of protection for the COVID-19 infection. Those results could be explained by enormous awareness-raising efforts carried out by our differents departments of our government.

Social and psychological impact of the containement during COVID-19 pandemic on patients with chronic inflammatory rheumatic diseases

Background: Covid-19 pandemic had a worldwide impact on the population, global economy and health care systems. Objectives: To evaluate the psychological state and social impact of patients with Chronic Inflammatory Rheumatic Diseases (CIRD) during this pandemic in order to understand how to optimize their quality of life. Methods: It's a cross-sectional survey, where the data were collected through the online survey tool google forms. A pilot test were conducted with the study committee members who analyzed the apparent validity of the questionnaire and identified issues that could lead to misunderstandings, and their suggestions were refined by a retest reliability until general agreement. The social and psychological impacts were evaluated by 14 questions exploring the different effects of the containment on negative feelings, interest in the family, changes in daily activities and plans, quality of sleep, practice of physical activity before and during containment, as well as the impact of the Coronavirus on psychological health. Statistical Analysis System IBM SPSS Statistics V20.0.0 was used to analyze the survey data. Results: 350 patients had participated in this online survey (mean age of 46,1 ± 14,4, 68% were women, 15.7% were illiterate, 45.7% were unemployed, rural residence in 11.7% of cases). Patients reported that their mental health has been negatively affected by Coronavirus in 59.1% of cases. Table 1 summarizes the psychological events during the containment. Patients reported that they paid more attention to their family in 87.1% during containment. Their daily lives and their life plans had changed because of Coronavirus(in 89.7% and 81.4%). Sleep during the pandemic has been negatively affected in 72.6% of patients. Physical activity practice had significantly decreased during containment (26.6% vs 51.7%) Conclusion: This study illustrates the social and psychological impact of COVID-19 pandemic on patients with CIRD. In the light of those results, we have lunched an awareness campaign to reinforce psychologic and social support of patients with CIRD during this global health crisis.

The impact of coronavirus (COVID-19) pandemic on therapeutic maintenance in patients with chronic inflammatory rheumatic diseases

Background: The Coronavirus pandemic caused many consequences on well being, access to care and therapeutic maintenance in patients with chronic diseases. Objectives: To assess the impact of COVID-19 on therapeutic maintenance of patients with Chronic Inflammatory Rheumatic Diseases (CIRD) and to identify related factors to difficulties in access to rheumatologist care during the COVID-19 pandemic. Methods: A cross-sectional study was conducted among patients with rheumatic diseases using a questionnaire providing information on patients and disease characteristics, impact of COVID-19 on access to rheumatologist care and therapeutic maintenance during the confinement. Reasons of therapeutic interruption and of diificulties in access to healthcare were precised. Results: We received answers from 350 patients (female sex of 68%, mean age of 46,1 ± 14,4 years) suffering from Chronic Inflammatory Rheumatic Diseases (CIRD):rheumatic arthritis (RA) (62.3%), spondyloarthropathies (34.3%), and undifferentiated CIRD (3.4%). The global average disease evolution was 12,1 ± 9,7 years. The patients were treated with conventional Disease-modifying anti-rheumatic drugs (cDMARDs) and biologic Disease-modifying anti-rheumatic drugs (bDMARDs) in respectively 67.4% and 30.6% of cases. Corticosteroids and Nonsteroidal Anti-Inflammatories (NSAIDs) intake was noted in 39.1 and 33.7% of patients. Difficulties to access to rheumatologist care appointments were reported in 82.9% of the participants. Reasons of thoses difficulties are summurized in Figure 1. Half of patients declared that the pandemic had affected their therapeutic compliance. Discontinued drugs were in decreasing order: Synthetic antimalarials (68.4%), NSAIDs (45.8%), Methotrexate (43.8%), bDMARDs (25.2%), Sulfasalazine (18.2%) and Corticosteroids (10,2%). Causes of treatments interruption are summarized in Table I. Conclusion: The COVID-19 pandemic impacted heavly on therapeutic maintenance in CIRD patients in our country. Patients expressed many difficulties in access to appropiate management. Facing to all thoses consequences, we need to devolopp as soon as possible adequate solutions adapted in such health crisis, especially therapeutic education and telemedecine.

Wich factors are related to painful experience in patients affected by chronic inflammatory rheumatic disease during the COVID-19 pandemic

Objectives: To evaluate the effect of containment, during the Covid-19 pandemic, on the pain of patients with CIRD, and to analyze the factors associated with the experience of pain. Methods: A cross-sectional study was conducted among patients with rheumatic diseases using a questionnaire providing information on patients and disease characteristics. Impact of COVID-19 on This is a cross-sectional study that consecutively included Patients were asked to assess the global pain which they had experienced before and during the containment period, using a single Visual Analogue Scale (VAS) ranging from 0 (no pain) to 10 (greatest pain). Statistical Analysis System IBM SPSS Statistics V20.0.0 was used to analyze the study data. We performed univariate then multivariate analysis to search any related factors to pain perception during to quarantines. Qualitative values were analyzed by the chi2 test. Quantitative values were analyzed by the Student test when the measures were normally distributed or by nonparametric test (Mann-Whitney U) when the measures were not normally distributed (Kolmogorov-Smirnov test was used to test normality). Results: Among the 350 patients who answered to the questionnaire online, rheumatoid arthritis represented 62.3%, spondyloarthropathy 34.3% and undifferentiated CIRD 3.4%. Pain experience caused by the CIRD during the containment was reported by 79.1% of patients. The level of pain, using the VAS of Pain increased significantly during the COVID-19 pandemic (4,6 ± 2,8 and 5,4 ± 3 before and during the containment;p<0.001). In multivariate analysis, the factors implicated in pain were the negative impact of Coronavirus on access to rheumatologic care, discontinuation of therapeutic adherence, the disturbed quality of sleep and the negative psychological impact (table 1). Table 1: Summarize multivariable analysis of factors associated with painful experience related to CIRD during containement. Conclusion: This survey showed the that the COVID-19 pandemic have incresed painful experience in CIRD patients. Factors influencing painful experience should be taken into account to help patients to cope with their chronic rheumatism and this global health crisis.