ABSTRACT
Background: The COVID-19 pandemic has brought challenges especially for people with rheumatic and musculoskeletal disease (RMD). The COVID-19 Global Rheumatology Alliance reported patients with RMD had higher rates of COVID-19 infection and mortality compared with general population. The data regarding the prevalence, clinical characteristics, and outcomes of COVID-19 infection among RMD patients in Malaysia are limited. Objective(s): This study describes the clinical characteristics and outcomes of COVID-19 infection on RMD patients (including factors associated with poor outcomes) at Hospital Tuanku Jaa'far Seremban (HTJS), Malaysia. Method(s): This is a retrospective cross-sectional study. All RMD patients who confirmed COVID-19 infection either with COVID-19 PCR or RTK from 1st January 2021 to 28th February 2022 were identified. Data were collected from patients' clinic notes, hospital admission notes and electronic records. Data on RMD diagnosis, comorbidities, disease activity, medication, vaccination status, clinical staging of COVID-19 infection, outcomes including hospitalization, complications from COVID-19 infection and RMD disease flare within 1 month following COVID-19 infection were analyzed. Result(s): From the 2746 patients with RMD seen from 1st January 2021 to 28th February 2022, 2.8% (n = 77) patients were reported positive for COVID-19 infection. The most common underlying RMD were rheumatoid arthritis 35.1% (n = 27) followed by systemic lupus erythematosus 22.1% (n = 17) and psoriatic arthritis 13% (n = 10). Majority of the patients had mild COVID-19 infection symptoms which categorized into stage 2 (46.8%, n = 36). 53.2% (n = 41) patients were hospitalized, and 2.6% (n = 2) patients died of severe COVID-19 pneumonia. 13% (n = 10) developed complications from COVID-19 infection in which 6 patients complicated with organizing pneumonia, 2 with pulmonary embolism, 1 with cytokine release syndrome and 1 with acute respiratory distress syndrome. 16% (n = 10) patients reported flare of RMD within 1 month post COVID-19 infection in which 6 had arthritis flare, 5 mucocutaneous flare and 1 had renal flare. Hypertension (P = 0.021) and diabetes mellitus (P = 0.005) were associated with higher rate of hospitalization. Patients who received 3 doses of COVID-19 vaccination had lower rate of hospitalization compared with those without vaccination (P = 0.026). Patients with age more than 50 years old were associated with higher rate of complications from COVID-19 infection (P = 0.037) and flare of RMD (P = 0.038). Interestingly, RMD disease activity was not associated with poorer outcome of COVID-19 infection (P > 0.05). Conclusion(s): This single center experience on RMD patients with COVID-19 infection showed co-morbidities, no vaccination, age 50 and above were associated with poorer outcomes which was consistent with previous studies. In contrary, RMD disease activity was not associated with poorer outcomes of COVID-19 infection.
ABSTRACT
Background: Patient-reported outcomes (PROs) have become an essential component of patients' assessment in the management of Rheumatoid Arthritis( RA).They have been reported to be at least as informative if not more than physician assessed outcomes. MyRA Touch was pioneered by the Rheumatology Unit of Hospital Tuanku Jaa'far in Seremban Malaysia in March 2018,to engage and empower all RA patients on their own disease activity monitoring. It is an electronic platform, designed to enhanced the application of electronic patient reported outcomes (ePROs) among RA patients where they examine and record their own painful and/or swollen joints for DAS28 calculation and report their health assessment through Routine Assessment of Patient Index Data with 3 Measures (RAPID 3).MyRA Touch is an applications (App) that is user friendly and available in four major spoken languages (English, Chinese, Malay and Tamil) with an animated version for patients who are illiterate. Objectives: The objectives of this study are to determine the correlation between: I)Patient-reported and physician reported DAS28 ESR/CRP II)RAPID3 and Clinical Disease activity Index (CDAI) III)RAPID3 and DAS28 ESR/CRP assessed by physician and patient IV)RAPID3 and inflammatory markers ESR/CRP. Methods: This was a cross-sectional study carried out in the Rheumatology Unit of Hospital Tuanku Jaa'far. All data entered through MyRA Touch App from April 2018 till April 2020 was analysed. Results: There were a total of 562 patients who entered the data in the App, 87.9% were women. The ethnic compositions of the study subjects comprised of Indians (36.7%) followed by the Malays (34.7%),Chinese (26.3%) and other ethnics (2.3%). About half of patients (59.8%) were in the 51-70 age group whereas 22.9%,1.8% and 15.5% were in the 31-50,18-30 and above 70 age groups respectively. The majority of our patients (96%) were literate. A total of 54.3% of them received secondary education, 27% primary, 12.2% tertiary and 6.6% did not receive any formal education. There was a high level of correlation between DAS28 ESR/CRP performed by patient and DAS28 ESR/CRP assessed by physician, (r=0.808 for DAS28 ESR and r=0.804 for DAS28 CRP). RAPID3 also showed high level of correlation with CDAI and DAS28 CRP assessed by patient (r=0.700 and r=0.718 respectively). There was a moderate correlation between DAS28 ESR/CRP done by physician with RAPID3 (r=0.656 and r=0.696 respectively).RAPID3 demonstrated little correlation with inflammatory markers ESR and CRP (r=0.141 and r=0.171 respectively). Conclusion: PROs via DAS 28 (ESR/CRP) and RAPID3 showed moderate to high correlation with disease activity assessed by physician. We can empower patients to perform their own disease assessment by using the MyRA Touch App before seeing their physician and the information provided in the App, can help to reduced consultation time. During the COVID-19 pandemic, telemedicine is very much encouraged. By using the MyRA Touch, patients can assess their own tender and swollen joint count on a homunculus, evaluate their own physical function, health and pain using the RAPID3 parameters. The information obtained from the PROs in the MyRA touch App enables the physician to make a more comprehensive virtual assessment of the patient's condition which helps in treatment decision making. In conclusion, MyRA Touch is an useful tool for disease activity measurement by patient.