SEXUALITY, FAMILY PLANNING and MENTAL HEALTH among REPRODUCTIVE-AGE WOMEN with RHEUMATIC DISEASE during the COVID-19 PANDEMIC

Background: Women with rheumatic disease are more likely to suffer from sexual dysfunction, infertility, depression, and anxiety. The pandemic may have affected these constraints. Objectives: To investigate the effect of the Covid-19 pandemic on sexuality, family planning and mental health in a sample of women with rheumatic disease. Methods: Women aged 18-50 with a rheumatic disease and women in an age-matched healthy control group received questionnaires featuring: 1) demographic information, sexual frequency, family planning;2) the Female Sexual Function Index (FSFI);3) the Depression, Anxiety and Stress Scale (DASS-21);and 4) the Coronavirus Anxiety Scale (CAS). Recruitment took place 3/21-12/21. Patients with rheumatic conditions were recruited at the Vienna University Clinic (AKH) and the control group through social media. Parameters were compared between the patients and the healthy control group, and with data on sexuality from women with rheumatic disease from 2019. Results: A preliminary analysis was conducted with 83 patients with rheumatic disease and 124 healthy controls. The rheumatic disease group exhibited lower levels of stress (6.46 vs. 8.36 p<0.01) and Coronavirus Anxiety (6.27 vs 7.50 p<0.01) than the control group and was less likely to report that the pandemic led to a reduction of their sexual frequency (p<0.01). The control group cited 'stress' frequently the decrease of sexual frequency. The FSFI analysis revealed that patients with rheumatic disease experienced higher levels of pain (p<0.001) during sex than the control group but were more satisfed with their relationships (p<0.05). In comparison to 58 patients with rheumatic conditions, whose data was collected in 2019, the 2021 cohort reported reduced FSFI values in the domains of desire (p<0.01), arousal (p<0.05), lubrication (p<0.05), and orgasms (p<0.01). Conclusion: Consistent with research on female sexuality during the pandemic among healthy women, we found that patients with rheumatic conditions reported lower FSFI values in 2021, in comparison to 2019. Our fnding that the pandemic had less impact on the patient group than a healthy control group, is consistent with research on MS and IBD patients, who showed surprising resilience in the face of the Covid-19 pandemic.

Impact of Covid-19 pandemic on initiation of immunosuppressive treatment in immune-mediated diseases. -A nationwide, retrospective study

Background Immunosuppressive and biological medications are a mainstay in the treatment of immune-mediated diseases, such as inflammatory bowel diseases (IBD), rheumatic diseases, and psoriasis. However, the COVID-19 pandemic caused concerns over the safety of these drugs pertaining to risk and severity of infection with SARS-CoV2. Moreover, pandemic mitigation strategies may negatively impacted treatment start with immunosuppressive and biological treatment fostering worse long-term disease outcomes. The aim of this study was to examine the impact of the COVID-19 pandemic on new starts of immunosuppressive and biological treatment in Austria. Methods We conducted a retrospective analysis with a 4-year observation period from 2017 to 2020 on real-world data on prescriptions for immune-mediated diseases of the Austrian health insurance funds covering 98% of the Austrian population. Data from all patients with incident biologic or conventional immunosuppressive treatment (Table 1) were included. Incidence of biologic (including small molecules) and immunosuppressive therapy was defined as all first prescriptions of one of the listed substances from 2017. The incidence rate for biologic and immunosuppressive treatments was recorded monthly in 2020 and compared with the three previous years (2017 – 2019). Results During the first lockdown in Austria in spring 2020 (week 12 – week 20), there was a significant decrease in the overall starts of biologic (including small molecules) and immunosuppressive treatments (both p<0.0001), especially in April (Figure 1 and 2). After that lockdown, new starts of immunosuppressive and biological treatments rapidly re-achieved pre-lockdown levels despite higher infection rates with SARS-CoV-2 and subsequent lockdown periods (Figure 3). Independent from the COVID-19 pandemic, we observed a continuous increase of biological medication (bDMARDs) and small molecules (p<0.0001) and a decrease of conventional immunosuppressive medications (cDMARDS) (p<0.0120) during all observed years (Figure 1 and 2) Conclusion In patients with immune-mediated diseases in Austria the COVID-19 pandemic led to a significant decrease of newly started immunosuppressive and biological treatments only during the first lock-down. Over the last four years, we can observe a continuous increase of small molecules and biological medication as well as a continuous decrease of conventional immunosuppressive medication.

Mise à jour des recommandations EULAR sur l’utilisation des thérapies immunomodulatrices dans la prise en charge de la Covid-19

Introduction Les formes sévères de COVID-19 comportent à une hyperinflammation systémique intense ;ce qui a justifié des essais thérapeutiques avec des immunomodulateurs régulièrement utilisés chez les patients atteints de maladies systémiques auto-immunes ou inflammatoires Depuis février 2021 où les premières recommandations EULAR sur l’utilisation de thérapeutiques immunomodulatrices dans le COVID-19 ont été publiées [1], de nouveaux essais thérapeutiques ont été réalisés ce qui rend nécessaire une mise à jour ces recommandations. Matériels et méthodes Selon les procédures standardisées de l’EULAR [2], les résultats d’une revue de la littérature systémique réalisée jusqu’au 15 décembre 2020 puis mise à jour jusqu’au 14 juillet 2021 incluant tous types d’études ont été présentés à un groupe de travail multidisciplinaire composé d’experts internationaux comprenant des rhumatologues, des immunologistes translationnels, des hématologues, des pédiatres, des patients et des professionnels de la santé. La mise à jour des recommandations a été discutée et votée par l’ensemble du panel d’experts sur la base des résultats présentés, principalement des essais randomisés contrôlés (ECT) sur différents traitements immunomodulateurs. Résultats La mise à jour comprend deux principes généraux et dix recommandations. Les recommandations concernent uniquement la prise en charge des patients présentant des formes de COVID-19 modérées à sévères ou critiques, faute de preuves suffisantes avec très peu d’ECT concernant les patients asymptomatiques et ceux avec des formes légères de la maladie. Les molécules suivantes ont montré une efficacité dans le traitement de formes modérées à sévères ou critiques du COVID-19. L’association de glucocorticoïdes et de tocilizumab est bénéfique dans les cas de COVID-19 nécessitant une oxygénothérapie et dans les cas critiques de COVID-19. L’utilisation d’inhibiteurs de Janus kinase (baricitinib et tofacitinib) et peut-être d’Ac anti-GM-CSF est prometteuse dans les mêmes populations. Les anticorps monoclonaux anti-SARS-CoV-2 et l’utilisation de plasma convalescent pourraient trouver une application dans les phases précoces de la maladie et dans certains sous-groupes de patients immunodéprimés. D’autres immunomodulateurs comme l’hydroxychloroquine, la colchicine ou l’anakinra n’ont pas démontré leur efficacité sur la mortalité et ou sur l’aggravation clinique (évolution vers une détresse respiratoire), quel que soit le stade de la maladie. Conclusion Un nombre grandissant d’ECT soutiennent l’efficacité de l’association de glucocorticoïdes et d’autres agents immunomodulateurs tels que le tocilizumab dans le traitement de formes modérée à sévère et critique du COVID-19. De plus, certaines études en cours pourraient confirmer l’efficacité potentielle d’autres approches thérapeutiques comme les inhibiteurs de JAK ou les Ac anti-GM-CSF. L’implication des rhumatologues, en tant qu’experts des maladies inflammatoires et auto-immunes systémiques et des traitements immunomodulateurs est nécessaire dans le design des nouveaux essais cliniques et dans l’élaboration de nouvelles recommandations pour la prise en charge du COVID-19.

The impact of COVID-19 on rheumatology health care workers and their scientific output: Heavy lies the crown on female rheumatologists

Background: COVID-19 has changed daily practice in medicine and affected teaching as well as research activities of medical personnel. Meanwhile, the pandemic 's impact on private life and responsibilities for dependents also affected health care workers in rheumatology. Objectives: To examine the adaptability of clinician-researchers in rheumatology in a time of crisis focusing on academic output in the first six months of the COVID-19 pandemic and to investigate the professional and private burden experienced by health care workers in rheumatology. Methods: A systematic search in PubMed, medRxiv and bioRxiv for reports of rheumatic diseases and COVID-19/SARS-CoV-2 submitted (or published) from January 1 to June 30 2020 was carried out. As comparison, publications from April 6 to 13 2019 of the same rheumatic diseases without COVID-19 were analysed in terms of author characteristics and journal metrics. Additionally, a questionnaire was circulated via EULAR countries rheumatology societies and individual working group members. The participants were asked to answer 43 questions regarding their family situation, professional background, research output, changes in work and private responsibilities during the pandemic as well as the burden experienced. Responses were collected using an online survey tool and data analyses performed with SPSS Statistics 25;missing variable analysis was performed, excluding records with >15% missing responses. Descriptive and summary statistics were calculated for the entire dataset and split by gender. Results: Whereas the overall number of publications and authors was equal between 2020 and 2019, the portion of female first authors of review articles and original studies decreased substantially in the first phase of the pandemic (Table 1). The numerical contribution of female authors in highly ranked journals (impact factor>6) was comparable in 2019 and 2020, however, the percentage of female first authors dropped from 50% to 32% (P=0.07). In the survey, a total dataset was available for N=180 responders. On average, female respondents (52.5%) were younger, more likely to live alone (19,1% vs 10,5%) and have no caring responsibilities (51.1% vs. 36.3%) than male respondents. Male doctors were more often tenure-track/tenured or chairmen (31.4% vs 12.8% female) and worked less often part-time (9,3% vs. 19.1%). Unpaid overtime hours of all participants were striking with 46.3/44,2% (female/male) reporting to accumulate >10 hours/ week. Regarding gender differences in scientific output, male respondents more frequently revealed >20 publications as first (57,6% vs. 26,9%) or last authors (34.1% vs. 10,1%). Similarly, 44,7% of male respondents reported a last author publication during COVID-19 vs. 26,4% of female respondents. While female and male respondents reported similar experience of burden during the pandemic, more female respondents reported increased family care as a major source of this (38,2% vs. 22,2%). Both genders would like to see increased support from superiors and official institutions. Conclusion: In a time of acute crisis, the adaptability of scientifically active female health care workers in rheumatology is lower than that of their male counterparts. This is reflected in a lower scientific output, especially as first or last authors. However, the burden experienced in the current pandemic is similar between the genders. (Table Presented).