ABSTRACT
Background: People with infammatory arthritis (IA) treated with conventional or biological immunosuppressive disease-modifying anti rheumatic drugs (DMARDs), were initially considered to have an increased risk of severe illness from SARS-CoV-19 (COVID-19) infection compared to the general population. Although resent studies have not confrmed this, people with IA have reported high level of anxiety and self-isolation during the pandemic (1). Only few studies have qualitatively explored how people with IA experience the impact the COVID-19 pandemic and the SARS-CoV-19 vaccinations. Objectives: To explore how people with IA experienced restrictions during the COVID-19 pandemic and the possible impact of vaccination on their protection against COVID-19 and their everyday lives. Methods: Semi-structured in-depth interviews were conducted via telephone or video with 19 people with IA in May-August 2021, shortly after they were enrolled in the national COVID-19 vaccination programme (all Danish citizens >18 years of age invited for SARS-CoV-19 vaccination, free of charge, with timing depending on age and comorbidities). At the same time, society gradually reopened after a complete lock-down. Qualitative content analysis, inspired by Graneheim and Lundman (2), was applied to analyse the data. Two patient research partners were involved in development of the study protocol, an interview guide and in the interpretation of fndings. Results: The participants' age ranged from 21 to 64 years, median 50 years. 7 male and 12 female, all diagnosed with IA (Psoriatic arthritis n=4, Axial Spondyloarthropathy n=4, Rheumatoid arthritis n=9, and Juvenile arthritis n=2) and 14 were treated with DMARDs. Two had not accepted vaccination. The analysis derived five themes: 1: 'Changing and divergent information'. The participants experienced there was an overload of general information to the public, while targeted information on the specific risk for people with IA was lacking;2: 'Individual interpretation of own risk', refilecting that participants had to find their own level of daily-life restrictions, a task they found to be very difficult;3: 'Impact on everyday life'. They took self-imposed precautions to protect themselves and their families from attracting COVID-19;4: 'Position in society and the vaccination programme', emphasizing that participants were affected by the inconsistent announcements from authorities whether they were considered to be in particular risk or not, and some expressed concerns regarding the DMARDs influence on the effect of the vaccine and 5: 'Reopening is somehow harder than lock down'. A societal spirit of being 'in this together' emerged through the lock-down and some were concerned that fewer restrictions during reopening of the society would put them in higher risk of a COVID-19 infection and force them to continue self-isolation. Conclusion: The COVID-19 pandemic affected the everyday lives of people with IA due to the authorities' restrictions and further self-imposed precautions throughout lock down and reopening of society. People with IA experienced a lack of consistent information and felt alone to assess their own SARS-Cov-19 infection risk.