ABSTRACT
BackgroundIn inflammatory arthritis patients, the concomitant decline of their mental wellbeing is an increasing concern[1,2]. It is important to not only describe the trajectory of psychological distress in early disease stages, but also understand which clinical outcome measures are most associated with these changes.ObjectivesUsing data from the National Early Inflammatory Arthritis Audit (NEIAA), we assessed trends in psychological wellbeing over 12 months after initial diagnosis and mapped these against clinical outcomes to identify significant associations.MethodsNEIAA collects data from patients referred with suspected early inflammatory arthritis in rheumatology services in England and Wales. We used data provided by 20,472 patients eligible for follow-up (diagnosis of inflammatory arthritis) between May 1st, 2018, and April 1st, 2022. Data items included baseline demographics e.g., age and gender, and clinical variables e.g., rheumatic disease comorbidity index (RDCI), DAS28, and patient reported outcomes.Psychological distress was measured by the sum score of Patient Health Questionnaire Anxiety and Depression Screener (PHQ4ADS). Using mixed effects regression models, we analysed the co-variability of PHQ4ADS with demographic factors and clinical outcomes over 12 months. Time was included as a dummy-coded covariant.ResultsThe analysis included 36% of patients (7,378 out of 20,472) who completed the baseline patient outcome survey. In this cohort, PHQ4ADS scores decreased from a baseline average of 4.7 (CI: [4.6, 4.8]) to 2.62 (CI: [2.5, 2.8]) at 12 months post-diagnosis. The proportion of patients screening positive decreased from 50.0% (CI: [48.9, 51.1]) at baseline to 23.8% (CI: [21.8, 25.9]) at 12 months.At baseline, psychological distress correlated significantly with age, gender, ethnicity, RDCI, prior depression diagnosis, and baseline DAS28 (Figure 1). No significant correlations were found between psychological distress and working diagnosis, seropositivity, or the assessment being recorded after the start of the COVID-19 pandemic. Younger ages were nonlinearly associated with higher distress levels (coefficient per decade: -0.006;p<0.001;CI: [-0.009, -0.003]) (Figure 1a). Distress levels in females were higher than that of males (coefficient: 0.5;p<0.001;CI: [0.4, 0.7]) (Figure 1b). White patients reported lower PHQ4ADS scores compared to non-white patients (coefficient: -0.7;p<0.001;CI: [-1.0, -0.4]) (Figure 1c). Higher distress levels were also associated with higher RDCI (coefficient: 0.2;p<0.001;CI: [0.1, 0.3]) and prior diagnosis of depression (coefficient: 1.8;p<0.001;CI: [1.5, 2.2]) (Figure 1d, 1e). Furthermore, higher baseline DAS28 scores correlated with more severe psychological distress (coefficient: 0.8;p<0.001;CI: [0.7, 0.8]) (Figure 1f).By 12-months, psychological distress decreased significantly overall, which correlated significantly with ethnicity (coefficient: 0.8;p=0.005;CI: [0.3, 1.4]) and baseline DAS28 (coefficient: -0.5;p<0.001;CI: [-0.6, -0.4]). Compared to white patients, the reduction was significantly greater for non-white patients, but the level of distress was no longer different at 12 months (Figure 1c). While those with higher baseline DAS28 showed a greater reduction in psychological distress, the distress levels remained higher at 12 months (Figure 1f).Figure 1.Changes in psychological distress correlated with age, gender, ethnicity, RDCI, prior depression diagnosis, and baseline DAS28.[Figure omitted. See PDF]ConclusionIn this early inflammatory arthritis cohort, mental health burden was high. Age, gender, ethnicity, RDCI, prior depression diagnosis and baseline DAS28 significantly correlated with psychological distress at baseline. Supporting mental health should be a focus of clinical care for this population and it may be beneficial to use an approach that is culturally valid for non-white patients and accounts for multimorbidity.References[1]Euesden, J, et al. Psychosomatic medicine 79.6 (2017): 638.[2]Lwin, MN, et al. Rheumatology and therapy 7.3 (2020): 457-471.AcknowledgementsThe authors would like to thank the Healthcare Quality Improvement Partnership (HQIP) as the commisioner of NEIAA, British Society for Rheumatology as the audit providers, Net Solving as the audit platform developers, and the Wellcome Trust (ST12406) for funding to support L.Z..Disclosure of InterestsLucy Zhao: None declared, James Galloway Speakers bureau: Has received honoraria from AbbVie Celgene, Chugai, Gillead, Janssen, Eli Lilly, Pfizer, Roche, and UCB, Jo Ledingham: None declared, Sarah Gallagher: None declared, Neena Garnavos: None declared, Paul Amlani-Hatcher: None declared, Nicky Wilson: None declared, Lewis Carpenter Consultant of: Statistical consultancy for Pfizer, Kirsty Bannister: None declared, Sam Norton Speakers bureau: Has received honoraria from Janssen and Pfizer.
ABSTRACT
Rationale: Asthma morbidity and mortality are disproportionately high in African Americans, especially in emerging adult (AAEA) population (age 18 to 30 years) who are between adolescence and adulthood. Few studies have been done to identify unique challenges to asthma care in African American emerging adults. Methods: We conducted virtual focus groups consisting of African American young adults (n = 16) with a physician diagnosis of asthma. Discussion questions regarding asthma triggers, management, and challenges were used. Focus group discussions were recorded and transcribed verbatim. The transcripts were then coded by three coders using a thematic saturation approach. Results: Six major domains were identified: heightened awareness and anxiety around environment and triggers;increased autonomy from parents and resultant challenges;desire for technology to aide in asthma management;impact of asthma on social group settings;asthma interference with school and/or work;and concerns during the Covid-19 pandemic. Participants reported difficulty affording asthma medications, living in unsafe environments, trouble keeping up with their young children due to asthma, regular use of technology, and utilization of nonpharmacologic remedies. While wanting to take more responsibilities as grown-ups, many felt their asthma was better controlled when they were children because of their parents' involvement in asthma management. Conclusions: African American emerging adults with asthma have unique challenges due to age and race. To achieve optimal asthma control, physicians must address these challenges through innovative means such as using technology-based tools.
ABSTRACT
Background/AimsCOVID-19 lockdown affected access to clinical care for manyvulnerable patients, including those with inflammatory arthritis (IA). Italso had the potential to alter self-management behaviours. Thesechanges could in turn impact mental health, especially given that IApatients are already at higher risk of mental health disorders. Thus, theaims of this study were to determine how IA care and self-management were affected by lockdown and assess the impact of thesechanges on disease outcomes and mental health.MethodsOnline questionnaires were completed by 338 participants betweenJune and July 2020. The questionnaires assessed demographics, IAcondition, IA self-management, COVID-19 clinical information, qualityof life, and mental health. Visual analogue scale (VAS) scores forpatient global assessment (PGA) of disease activity, pain, fatigue, andemotional distress were completed relating to the previous week andretrospectively for pre-lockdown (March) and early-lockdown (April).Improvement/worsening in each VAS was considered as a change of10 points or more from pre-lockdown to the current rating. Linearregressions were conducted to determine factors associated withworse outcomes, controlling for potential confounders including selfreported pre-lockdown status.ResultsMean VAS scores worsened during lockdown for all outcomemeasures, with over half reporting a more than 10-point worsening(Table 1). Changes to clinical care affected 87% of patients. The mostcommonly affected services were hospital outpatient appointments(77%), GP appointments (59%), and blood tests (53%). Changes toclinical care were significantly associated with worse PGA (b = 8.95, p=0.01), pain (b = 7.13, p=0.05), fatigue (b = 17.01, p<0.00) andemotional distress (b = 12.78, p<0.01). Regarding self-management, 64% of patients reported changes to diet while 51% reduced physicalactivity. Change in diet was not significantly associated with any of theoutcomes, whereas physical activity was associated with PGA (b=-2.42, p<0.01), pain (b=-2.43, p<0.01), fatigue (b=-2.5, p < 0.01), andemotional distress (b=-2.41, p<0.01).ConclusionMost patients (87%) had at least one area of clinical care affected bythe lockdown. These changes in IA clinical care were associated withworse disease outcomes across all measures and greater emotionaldistress. In self-management, reduced physical activity was associated with worse outcomes in all physical and mental healthmeasures.
ABSTRACT
Background/AimsInflammatory arthritis (IA) patients have been identified as being atgreater risk of severe illness from COVID-19. It is likely that lockdownrestrictions enforced by the UK government in response to the COVID-19 pandemic, and subsequent changes made to healthcare provisions, could impact patients' abilities to effectively manage theircondition. The aim of this study was to qualitatively explore the impact of COVID-19 and lockdown on self-management behaviours andhealthcare provision in people with IA.MethodsSemi-structured interviews were conducted with 21 patients with IAfrom across the UK (as part of a larger longitudinal survey studyexploring the impact of COVID-19 on health-related quality of life forpeople with IA). Participants who gave consent for contact, followingthe completion of the baseline survey study, were approached to takepart in the qualitative interviews. The interview schedule wasdeveloped with a Patient Research Partner and consisted of eightmain questions to explore participants' experiences of the COVID-19pandemic, including the impact of COVID-19 on their self-management behaviours and access to healthcare services. The interviewswere conducted via telephone and were recorded and transcribedbefore being analysed using inductive thematic analysis.ResultsParticipants were aged between 24-72 (mean age 50.0, SD 15.6) andwere mostly female (71%) and White British (86%). Four main themeswere identified: impact of COVID-19 on medication adherence, impactof COVID-19 on physical activity, impact of COVID-19 on diet, andimpact of COVID-19 on healthcare access. Subthemes focused onpositive and negative changes made to these areas, as well asbehaviours which remained consistent. Some participants expressedthat the lockdown period had enabled them to increase their physicalactivity, improve their diet and maintain their usual medicationregimen, whilst others noted that lockdown had had a negativeimpact on their self-management behaviours. For example, somepatients decided to discontinue their medication during the pandemicdue to concerns that it would make them more susceptible to severeconsequences from COVID-19. In relation to healthcare provision, themost commonly reported change was the introduction of telephoneappointments to replace face-to-face consultations. Several patientsfound the telephone appointments ineffective, especially if theirdisease was relatively uncontrolled. Nevertheless, participants understood why a remote approach had been implemented during thepandemic.ConclusionCOVID-19 has had an impact on patients' abilities to manage their IA.Healthcare professionals need to recognise the impact of COVID-19on patient self-management and healthcare provision to ensure thatadequate understanding and support is available to patients who mayhave inadequate disease control as a result.
ABSTRACT
Background/AimsCOVID-19 lockdown has affected the mental health of many peoplearound the world. People with inflammatory arthritis (IA) are at a higherrisk of mental health and psychosocial consequences of the pandemiccompared with the general population, since they are potentially morevulnerable to COVID-19 and experience higher rates of existingcomorbid mental health disorder. Furthermore, vulnerable patientswere advised to self-isolate for 12 weeks, which could furtherexacerbate emotional distress. This study aimed to explore theimpacts of lockdown on mental health and wellbeing, and to determinewhich factors were associated with worse disease outcomes.MethodsAn online questionnaire was completed by 338 participants in the UKwith an IA condition between June and July 2020. The questionnaire, designed with input from a service user, assessed various aspects ofthe impact of the pandemic on the quality of life of people with IA, including their mental health. Self-reported visual analogue scales(VAS) for patient global assessment (PGA) of disease activity, pain, fatigue, and emotional distress were completed relating to theprevious week, and retrospectively for pre-lockdown (March) andearly-lockdown (April). Specific mental health outcomes were furthercaptured using the 8-item Patient Health Questionnaire (PHQ8) and theshort UCLA loneliness scale. Linear regressions were conducted todetermine mental health factors associated with worse outcomes onphysical health measures (PGA, pain, and fatigue), controlling for fearof COVID-19 and COVID-19 status.ResultsOverall, 49% of participants met the PHQ8 criteria for moderate tosevere depressive symptoms and 58% reported their mental healthhad worsened by more than 10 points on the emotional distress VASduring lockdown. Finally, 37% reported they were concerned aboutloneliness, with 26% indicating this had worsened during lockdown.Emotional distress VAS was significantly associated with PGA(b = 0.21, p< 0.01), pain (b = 0.24, p<0.01), and fatigue (b = 0.36, p<0.01). Similarly, depression was also associated with PGA (b = 0.95, p<0.01), pain (b = 0.92, p<0.01), and fatigue (b = 1.56, p<0.01).However, loneliness was not associated with any of the physicalhealth VAS scores but was associated with the emotional distress VAS(b = 1.83, p=0.00). These results remained consistent for emotionaldistress, depression, and loneliness as predictors when accounting forfear of COVID-19 and COVID-19 status.ConclusionThere has been a clear impact of the pandemic on the mental health ofpeople with IA, and this should be taken into consideration byclinicians, especially as it appears to be related to worse overallreported physical health. The mixed results for loneliness in comparison to other mental health measures may illustrate the interrelatedness of these aspects of mental and physical health, particularlyin the context of lockdown.
ABSTRACT
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes coronavirus disease of 2019 (COVID-19) and has been reported in > 98,000 children in the U.S (5% of reported cases) as of early June 2020. Most published literature focuses on adults with COVID-19, but little is understood on the impact of SARS-CoV-2 in children. We created a database for children with COVID-19 at Children's Hospital Colorado (CHCO), a large tertiary care pediatric hospital, to better understand the epidemiology and clinical outcomes of this disease in children. Methods: We retrospectively reviewed the medical records of all pediatric and youth patients with positive SARS-CoV-2 PCR test results from March-May 2020. Univariate logistic regression models were used to identify predictors of hospital admission, need for critical care, and need for respiratory support among symptomatic patients, with p-values < 0.05 considered statistically significant. Results: We identified 246 patients with SARS-CoV-2 (age range: 17 days- 25 years). We noted a Hispanic predominance with 68% of all patients with SARSCoV- 2 identifying as Hispanic or Latino, compared to 29% among all CHCO visits in 2019 (Figure 1). The most common symptoms at presentation were fever, cough, or shortness of breath in 94% of symptomatic patients. Sixty-eight patients (28%) were admitted, of which 7 (10%) required admission to the pediatric intensive care unit (PICU) for symptomatic COVID-19 disease (Figure 2). Age 0-3 months, certain symptoms at presentation, and several types of underlying medical conditions were predictors for both hospital admission and need for respiratory support (Figure 3). Initial and peak C-reactive protein (CRP) values were predictors for PICU admission with median peaks of 24.8mg/dL vs. 2.0mg/dL among PICU vs. non-PICU patients (OR 1.27, p=0.004). Conclusion: There is a wide spectrum of illness in children with SARS-CoV-2, ranging from asymptomatic to critical illness. Hispanic ethnicity was disproportionately represented in our cohort, which requires further evaluation. We found that young age, comorbid conditions, and CRP appear to be risk factors for severe disease in children.