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Objectives: To evaluate vaccination among patients with inflammatory rheumatic diseases initiating disease-modifying antirheumatic drugs (DMARD) Methods: Data from the real-world life PANLAR's register of consecutive patients diagnosed with RA, PsA, and axSpa (2010 ACR-EULAR /2006 CASPAR-2009 ASAS) from Dec 2021 to Dec 2022 were analyzed. Prevalence of recommended vaccinations were compared between different inflammatory rheumatic diseases. Categorical variables were expressed as %. Tables were analyzed with chi2 or Fisher tests, continuous variables (median, IQR)with the Kruskal-Wallis test, according with the variables type. A p value <=0.05 was considered significant. Result(s): 608 patients were included. Among patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial Spondyloarthritis (axSpA) are presented in the table. RA and axSpA seemed to have lower vaccination rate of pneumococcal vaccines than PsA. (p = 0.045 for conjugate anti pneumococcal vaccine in RA vs PsA). A large percentage of the population was vaccinated against COVID-19. There was a high rate of influenza vaccination in all three diseases. Conclusion(s): In Latin America, anti-pneumococcal vaccination is low, especially in patients with RA and axSpA. For other vaccines there was an acceptable level of vaccination without differences between diseases.
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Objectives: To assess the immunological [Lymphocyte populations (LP) and Autoantibodies (Ab)] and clinical profile of rheumatoid arthritis (RA) patients who suffered from COVID-19 compared with non-COVID-19 RA patients. Method(s): A nested case-control study of RA patients treated under a strict follow-up model. RA patients and confirmed COVID-19 infection (last 24 months) and RA patients without the infection were included. Subgroups of cases: Long COVID (LC): symptoms after infection for >=4 weeks;Post COVID syndrome (PCS): symptoms for >=12 weeks;and patients with symptoms alpha4 weeks. Sociodemographic, clinical, and paraclinical variables of RA and COVID-19 infection (in cases) were captured. Antinuclear antibodies (ANA), anticardiolipin antibodies, lymphocyte populations (BD FACSDuetTM-BDFACSLyricTMmultiparameter flow cytometry) T cells, B cells, and NK were evaluated. Univariate and bivariate analyzes (STATA 17) were done. Result(s): 300 patients were included (148 cases/152 controls;87.3% women). Median age 59 years (IQR 11). 71.86% were in low disease activity. There were no significant differences in sociodemographic and clinical characteristics between cases and controls. Cases had a time since infection of 18.5 months (IQR 7). Of the total cases, 69%presented LC and 63%PCS.No significant differences were found between cases and controls in the lymphocyte population nor in the antibodies evaluated. There were no differences in the immune profile when comparing patients with LC and PCS with those with symptoms alpha4 weeks after COVID-19 infection. Conclusion(s): No differences were found in the behavior of the immunological profile (independent of symptoms of LC and PCS) in RA patients under strict follow up, evaluated long-term after infection with those who did not have COVID-19. This suggest that patients returned to their baseline homeostatic state, something that has not yet been reported up to now. These results should be replicated in populations with different RA characteristics.
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Background: Many measurement tools are designed to assess disease activity for Rheumatoid Arthritis (RA) patients. One of the most used tools is the Disease Activity Score-DAS28 which assesses the number of painful joints, erythrocyte sedimentation, and a patient's global assessment. The assessment is performed by a clinician and requires laboratory exams. Unfortunately, from March to August 2019, Colombia had one of the strictest responses to the COVID-19 pandemic according to the COVID-19 stringency Index(1). One of the main restrictions was the preventive isolation of older populations, especially those with comorbidities. These restrictions challenged the rheumatology practice because face-to-face consultations were not possible. Due to the above, measurements like the PAS-II score should be used to assess disease activity during the pandemic. Objectives: To describe disease activity according to the Patient Activity Score-PAS-II score patients with RA and compare its results to the most recent DAS28 assessment before the COVID-19 pandemic. Methods: We conducted a descriptive study;patients were followed during the COVID-19-lockdown in a video consultation. The PAS-II score was applied to assess disease activity as an alternative to the DAS28 assessment. The patients were part of an educational program, clinical charts were reviewed to collect the study variables. We collected demographic data and DAS28 before the pandemic started. We present a descriptive analysis of DAS28 severity and the results obtained by the PASS-II score. Results: The educational program enrolled 250 participants;196 patients had complete data. 93% of participants were women, mean age was 64 years IQR (54-67). 43% of participants were married or had a civil union, 26% were single, 20% divorced, and 11% were widowed. Regarding educational level, 25% had fnished elementary school and 39% high school;the remaining 36% had higher education. When we compared the last DAS28 assessed by a rheumatologist between January, and March 2019, 67% of patients were in remission, while in July 2019, the PASS-II score reported that 7% of patients were in remission and 75% had low or minimal activity. Figure 1-Table 1. Conclusion: The PASS score is a helpful tool to assess disease activity in patients with RA, especially in situations where the patient cannot see a rheumatologist in a face-to-face consultation;however, patients in severe disease activity should not delay the consultation with a clinician. As other studies have demonstrated, patient-reported outcome measures should be adopted in clinical practice as an alternative for treat-to-targe strategies(2). Further studies should be conducted to assess the impact of the pandemic in countries with high levels of restrictions in the course of RA.
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Background: COVID-19, rheumatoid arthritis (RA) and osteoarthrosis (OA) are diseases characterized by the secretion of cytokines related to the stimulation of the infammatory response. Objectives: To identify the differences in the cytokine and matrix metalloprotein-ases (MMP) profile within one acute infectious disease and two chronic infam-matory rheumatic diseases. Methods: Analytical cross-sectional study. RA patients under a strict follow-up program (T2T evaluated every two months), OA patients without strict clinical follow-up, evaluated once or twice a year, and Severe (mortality) COVID-19 patients were included. Eleven proteins (cytokines, MMPs and its tissue inhibitors) were quantifed through Luminex multiplex assay in serum samples. Univar-iate and bivariate analyzes were performed. Approval of Ethics Committee and informed consent were obtained. Results: A total of 108 patients with RA and OA were compared with 20 severe COVID-19 patients. There were no signifcant differences through the method of Kruskall-Wallis, between RA and OA patients. IL1-B and MMP-2 were signif-cantly lower in COVID-19 patients. Levels of IL-10, IL-1RA, IL-6, MMP-1, MMP-9, and TIMP-1 were signifcantly higher in COVID-19 patients. There were no differences in TNF-A, TIMP-2 and INF-G. (Table 1) Conclusion: Compared with RA and OA patients, severe COVID-19 patients have a great impact on the cytokines and MMPs addressed in this study, proving that COVID-19 patients suffer from a cytokine storm [1] when severely infected.
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Introduction: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation, causing pain and stiffness in the joints. SARS-CoV-2 increases the clinical vulnerability of the population with RA and has led to the implementation and/or development of telemedicine. Objective: To describe changes in level of therapeutic adherence, quality of life and capacity for self-care agency, during the follow-up period of a group of patients linked to a non-face-to-face multidisciplinary consultation model during the SARS-CoV-2 pandemic. Methodology: Descriptive cohort study (July to October 2020). Description of the level of therapeutic adherence (Morisky Green Test), quality of life (EuroQOL-5-Dimensions-3-Level-version) and self-care capacity (ASA-R Scale) in the context of a telehealth model. A univariate and bivariate analysis was performed (Stata Software, Considered p-value <.05) Results: Of 71 patients treated under the telehealth model, 85.9% were women, the age range was between 33 and 86 years with a median of 63. The most prevalent comorbidity was arterial hypertension (35.2%). Quality of life did not change during follow-up nor did adherence to treatment, apart from in one item [the patients did not stop taking the medication when they were well (P=.029)]. In self-care capacity, there were significant improvements in five dimensions (P<.05), without significant differences in the global score. Conclusion: Patients with RA evaluated in the context of telehealth in a period of pandemic did not present significant changes in quality of life, adherence to treatment, or capacity for self-care, and remained close to baseline values when they attended a traditional face-to-face assessment.
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Objectives: The new coronavirus disease became a public health emergency that has not been seen for generations. The COVID-19 disease leads to an excessive immune activation and cytokine response and constitutes a considerable risk and a challenge for patients with inflammatory conditions such as rheumatic diseases. Patients with rheumatoid arthritis (RA) due to their age and comorbidities were the first to be in continuous lockdown due to their risk and current circumstances. This new normality has caused barriers to accessmedical care and a radical change in their daily life, especially during the beginning of the pandemic. The aim of this study is to describe the practices and behaviors of patients with rheumatoid arthritis during the first lockdown due to the COVID-19 pandemic in Bogotá, Colombia. Methods: In this study, we conducted a telephone survey.We included respondents who participated in an educational program for patients with rheumatoid arthritis. We asked about their behaviors around COVID-19 during the first lockdown established in Colombia, adherence to pharmacological treatment and compliance to a newly implemented telemedicine model. We also asked about COVID-19 related symptoms two weeks before the survey. Results: We included 296 participants. The mean age of the respondents was 60 years IQR (54-66), 95% were female. 86% of patients were receiving more than one conventional DMARD. See Table 1. Although the telemedicine model was entirely new to them, 75% participated in a tele rheumatology consultation. In general, at the beginning of the pandemic, patients were compliant with the COVID-19 prevention measurements. However, we found that 3.5% of patients reported having been less adherent to pharmacological therapy due to information received through media or social networks. Only one patient tested positive for having SARS-COV-2 and reported only flu symptoms without any complications. Patients reported the need to have information and education about the relationship between rheumatoid arthritis and COVID-19. Conclusion: Patients with rheumatoid arthritis have experienced drastic changes in their lives and adapted to new ways to receive medical care. Patients with RA need support and education. As other forms of education, for example, for college students new teaching methods have been implemented, programs for patients should follow the same model.
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Objectives: Rheumatoid arthritis (RA) is a disease highly vulnerable to COVID-19, a factor that caused an impact on everyday practice and the implementation of tele care assistance. Our goal was to understand the experiences of RA patients and health care professionals (HCP) in the implementation of a non-face-to-face multidisciplinary consultation model in the health emergency caused by COVID-19. Methods: Qualitative descriptive exploratory study. Semi-structured interviews (telephone or video-based depending on the participant preferences) were carried out that analyzed the experiences of RA patients and HCP who cared for them in a specialized center in Bogotá (Colombia). All interviews were audio-recorded, with prior informed consent of the participants, and were conducted by researchers trained in qualitative designs. Inclusion criteria: Adult RA patients evaluated in the tele consultation modality on at least two occasions, patients treated in the face-to-face consultation modality on at least two occasions and health professionals who have carried out at least 25 tele consultations, in the context of the health emergency due to COVID-19. It was analyzed following the Taylor-Bogdan proposal. Results: 36 interviews were conducted, 29 (80.5%) corresponded to RA patients (69% were attended by tele consultation and 31%, through face-toface consultation);and 7 (19.4%) corresponded to HCP. Characteristics of participants are shown in table 1 and 2. Four categories emerged configuring the experience of the subjects (patients and professionals) in a scenario of high vulnerability and uncertainty derived from the COVID-19 pandemic: Factors present in communication, information and communications technology (ICT) management, family support and interaction, and adherence to treatment. In patients, mental health, pain, functional dependence, and quality of life, were the most affected dimensions. Resilience mechanisms such as adaptation and self-care measures emerged to minimize risks from pandemic. Conclusion: Clinical and social conditioning factors were identified, which may determine the relevance of tele consultation. The implementation of tele consultation should be accompanied by the training of HCP, digital literacy and investment in technological infrastructure to overcome barrier access. It is important to promote assertive communication processes in the professional-patient relationship mediated by ICT.
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Objectives: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic joint inflammation, causing intense pain and stiffness. SARS-CoV-2, as the main pathogen of the current pandemic emergency, increases the clinical vulnerability of the population with RA and led to the implementation of tele consultation. Our objective was to analyze the changes in the level of therapeutic adherence, quality of life and the capacity for self-care agency during the follow-up period of the group of patients linked to the non-face-to-face multidisciplinary consultation model during the SARS-CoV-2 pandemic. Methods: A longitudinal analytical cohort observational study in adult RA patients evaluated in a specialized center under a tele care model in Bogotá, Colombia was carried out. Three instruments: EuroQoL-5 Dimensions (EQ 5-D-3 L), Morisky Green Test and The Appraisal of Self-care Agency Scale (ASA-R), to measure quality of life, adherence to treatment and self-care agency respectively, were administered. Data was collected by telephone interview between a three-month period (baseline and third month measurement). Ethical approval was granted. A quantitative comparison between follow up and baselines measurements was done (p-value<0.05 was considered significant) Results: Of 71 patients included and evaluated in tele consultation modality, 85.9% were women, with an age range of 90 years (Table). The most prevalent comorbidities were musculoskeletal (14.1%). Regarding the variables analyzed, the quality of life, pain/discomfort, anxiety/depression, and mobility were the variables most affected. In the 3-month follow-up period, no differences in EQ 5-D-3 L score and dimensions were found (p = 0.659). During follow-up, in adherence to treatment, patients did not stop taking medication when they were well (p = 0.029);As well, in the self-care agency, they took measures to guarantee their safety and that of their family (p = 0.000), they changed life habits to improve their health (p = 0.004) and they looked for betterways to take care of themselves (p = 0.026). Conclusion: The teleconsultation implemented in patients with RA during the SARS-CoV-2 pandemic had a high degree of acceptability, found significant changes in the variables of adherence to treatment and self-care agency and without significant changes in quality of life. This study provides new findings in the evaluation of the tele-assisted monitoring model in the context of a health emergency due to COVID-19 in Latin-American RA patients.
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Objectives: The COVID-19 pandemic has impacted everyday practice pattern of health care in rheumatoid arthritis (RA) patients. The objective was to evaluate the implementation of a tele-consultation program in an adult population with RA Methods: Analytical observational study longitudinal cohort (Clinical trials NCT04768413) that evaluated the effectiveness of a tele consultation model compared with a face-to-face consultation model in adult RA patients. Patients were followed 12 weeks (Jul-Oct 2020) at an RA center of excellence in Colombia. Simple random sampling was done. Two groups were included: Group A, patients who were cared for by tele-consultation care and Group B, thosewho wished to continue with the usual face-to-face consultation. Data regarding activity of disease (Week 0,6,12) [Patient Activity Scale (PAS) in both groups and DAS28 in group B], and Quality of life [EQ-5D-3L], disability [Health Assessment Questionnaire (HAQ)], therapeutic adherence [Morisky-Green Adherence Scale (MGLS)] and self-care capacity [Appraisal of Self-care Agency Scale -Revised (ASA-R)] were evaluated (weeks 0-12). Outcomes regarding COVID-19 were evaluated. Bivariate analysis was done (StataV-13;P-value<0.05). Results: 218 adults were included: (109/Group A-109/Group B). The groups did not differ in general characteristics (Table). Group A: (n = 71), no statistically significant differences were observed in the median scores of VAS global, VAS pain, PAS, HAQ, EQ-5D and ASA-R while increase in adherence was demonstrated (MGLS, without statistical significance). Group B: (n = 18), a significant increase in adherence (MGLS, p = 0,019) and in self-care (ASA-R, p = 0,0077) were found, no other differences were found (including DAS-28). A third group was constituted by patients that transited between the two models (figure). An increase in ASA-R was demonstrated in this group presential >remote>presential (p = 0,0001);the same result was documented in the group presential>remote>presential, with an increase in adherence (p = 0,033). 7 patients developed COVID-19 (one patient hospitalized/group A and one patient died/mixed model) Conclusion: In the tele consultation model patients remained adherent to their RA treatment, without major differences compared to the face-to-face model. It is important to know these results due to the impact they have, given the changes that will follow in the care of RA patients due the current pandemic. Studies with a longer follow-up period are required to corroborate these results.
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Background: The Covid-19 pandemic has generated restrictions in the mobility of people, affecting the face-to-face care of patients with chronic diseases, including autoimmune. The health emergency has created the need to establish follow-up alternatives, giving rise to telemedicine. Objectives: To evaluate the level of attendance to teleconsultation and the faceto-face usual care in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who underwent to a developed innovative telemedicine program after the declaration of quarantine due to the Covid-19 pandemic. Methods: The present cross-sectional descriptive study reports retrospective data collected from patients with RA and SLE from March to June, 2020;. Since the beginning of March 2020 when Covid-19 was declared in Colombia as a health emergency establishing specific standards for outpatient care, our center has made the necessary legal and technical adjustments to develop an innovative telemedicine service to prevent the epidemiological risk. To all contacted patients were offered the option of teleconsultation or face-to-face consultation;a standardized protocol was set with clinimetry measures evaluated in both groups. Continuous variables were described using mean and standard deviation, and categorical variables were described using numbers and percentages. We performed chi-square tests of independence to determine differences between teleconsulting and conventional face-to-face consultation. Results: A total of 5745 RA patients were followed-up, 5292 (92.1%) by teleconsulting and 453 (7.9%) by conventional face-to-face consultation;among the group of SLE patients, a total of 646 were assessed, of which there were 386 (60%) by teleconsultation and 260 (40%) by face-to-face consultation;this highlights an important difference in the level of acceptance of the teleconsultation between patients with RA and SLE, being much lower in patients with SLE (p value< 0.0001). Regarding gender differences, in men, there were 33 (12.7%) SLE and 89 (19.6%) RA face-to-face consultations, while in women there were 227 (87.3%) SLE and 364 (80.4%) RA in a face-to-face consultation. Regarding patients who were attended through telemedicine, 45 (11.7%) SLE and 966 (18.3%) RA were men, while 341 (88.3%) SLE and 4326 (81.7%) RA were women;that means, in the RA cohort, a greater number of men prefer the faceto-face consultation than in the SLE cohort (p value< 0.0185). 10 RA patients were diagnosed with the Covid-19 in teleconsultation;in all cases, close contact with infected relatives was verified as the probable cause. Conclusion: Telemedicine may provide a viable option for the follow-up of patients with rheumatological diseases even beyond the pandemic. But unexpectedly, data showed an important difference in the acceptance of teleconsultation between patients with RA and SLE, being much higher in older and/or male patients with RA compared to patients with SLE;however, further studies are needed to support this conclusion.
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Background: The new coronavirus disease has become a public health emergency that has not been seen for generations. Covid-19 disease leads to an extreme immune activation and cytokine response and constitutes a big risk and a challenge for patients with inflammatory conditions such as rheumatoid arthritis (RA). During the Covid-19 pandemic, rheumatologists and health-care professionals have faced many challenges to provide an adequate follow-up and treatment to RA patients;one of them, has been the establishment of lockdown for populations older than 60 years and the limitation of having face-to-face consultations, moving us to telemedicine activities. On the other hand, in our center an education program for patients with RA had been established in the second semester of 2019, which due to the epidemiological risk control measures, it was necessary to interrupt when we only had 5-6 months of a project that was planned for 2 years;it was mandatory to pause it and implement virtual education alternatives;this educational program for RA patients was also moved to virtual mode later. Objectives: To describe possible changes in the practices and behaviors of patients with rheumatoid arthritis (RA) during the lockdown that started in March 2020 in Colombia due to the Covid-19 pandemic, who previously partially attended to an educational program on RA. Methods: We included patients who attended previously a face-to-face educational program, that aims to teach and empower patients in all aspects related to RA. After the lockdown, the educational program had to stop abruptly while an online strategy was developed later;meanwhile the patients did not have any educational activity for 3-4 months. For this study, patients answered to a telephonic survey in July 2020;the survey included questions about their practices related to the Covid-19 pandemic, SARS-Cov-2 symptoms, adherence to rheumatoid arthritis treatment, virtual rheumatology consultations compliance and, the influence of news on their adherence. Results: A total of 260 patients took part in the survey;mean age of the respondents was 60 years IQR (54-66), 93% were female. In July 2020 88% of patients had accessed a telemedicine-based and 12% a face-to-face rheumatology consultation;only 3.5% of patients reported having been less adherent to pharmacological therapy due to information received through media or social networks. Regarding the prevention measures taken during the pandemic, 98% reported to have stayed in their houses since the lockdown was stablished in Colombia, and have implemented or increased hand washing from one or none to more than three times per day. Also 8% of respondents lived with people who were at bigger risk of having SARS-CoV-2 (i.e. health care professionals, workers at public transportation, and supermarkets among others), the main measurement taken was to be completely separate from the person at risk to avoid contagion and maintaining hygiene measures and physical distancing (Fig 1). Only one patient was positive for SARS-CoV-2, due to a possible contagion from a relative at home and reported only flu-like symptoms without any complications. Patients highlighted the necessity to return to the educational on RA program agreeing to attend to an online modality. Patients highlighted the need for educational sessions focused on the relationship between rheumatoid arthritis, its treatment, and Covid-19. Conclusion: An educational on RA program shows to be helpful tool to maintain high adherence rates to the RA treatment despite of the new challenges associated to the pandemic and despite being incomplete due to lack of time;patient-centered education programs should continue to address the patient's concerns and beliefs about their disease and the Covid-19 issues.