ABSTRACT
Background: A major concern across rheumatology in recent years is how contracting COVID-19 may impact the control of rheumatic diseases. Objectives: To quantify any difference in rheumatic disease control between those who did and did not contract COVID-19 between March and December 2020 and whether rheumatic disease control changed after COVID-19 was contracted. Methods: Adults with rheumatic diseases recruited to the COVID-19 European Patient Registry, a patient-led, online, self-referred prospective cohort recruiting participants from around the globe, were included if enrolled between March and December 2020. Rheumatic disease control was self-reported weekly on a scale of 0 (very poor) to 10 (very well). Dates of contracting COVID-19 were self-reported. Differences in rheumatic disease control trends between those who did and did not contract COVID-19 over the study period were tested via multilevel linear regression. Within those who contracted COVID-19, differences in rheumatic disease control trends were tested via segmented multilevel, multivariable linear regression, adjusting for month of COVID-19 contraction and with the interruption point set at the point of COVID-19 contraction. Results: Of 3646 adults with rheumatic diseases, the majority were female (89%), most commonly from the UK (82%) and the most common rheumatic disease diagnosis was RA (63%). Between March and December 2020, 3% of the cohort contracted COVID-19 (n=103). Over the study period, rheumatic disease control for adults who did not contract COVID-19 decreased weekly by 0.01 points (95% CI 0.01, 0.02, p<0.001). In those who contracted COVID-19, rheumatic disease control decreased weekly by 0.03 points (95% CI 0.2, 0.05, p<0.001), with a significant weekly difference of 0.86 points between groups (95% CI 0.28, 1.44, p=0.004) (Figure 1a). Within those that contracted COVID-19, there were signifcant differences in rheumatic disease control trends before and after contracting COVID-19 (p=0.001). In the run up to contracting COVID-19, rheumatic disease control signifcantly decreased weekly by 0.03 points (95% CI 0.02, 0.04, p<0.001), dropped signifcantly by 0.53 points (95% CI 0.23, 0.83, p=0.001) at the point of COVID contraction and then stabilised with no further reductions or improvement in rheumatic disease control for the remainder of follow-up (p=0.831) (Figure 1b). Conclusion: People who contracted COVID-19 had initial decreases in rheumatic disease control before contracting the virus, after which their disease control stabilised at a lower level. Those with disease flares should consider increased screening for COVID-19 and COVID-19 mitigation measures. The stabilising lower disease control post-COVID is concerning and should prompt further work into restoring disease control pre-COVID-19 levels.
ABSTRACT
Background: People with rheumatic diseases may be at increased risk of contracting COVID-19 due to their rheumatic disease or immunosuppressive treatments. It is currently unclear what the COVID-19 disease burden is for these people and whether any of their personal or disease characteristics are associated with contracting COVID-19. Objectives: To explore the proportion of, and characteristics associated with, contracting COVID-19 in children and young people (CYP) with rheumatic diseases and adults with rheumatic diseases from March 2020 to December 2020 during the COVID-19 pandemic. Methods: CYP and adults recruited to the international COVID-19 European Patient Registry, a parent-led, online, self-referred prospective cohort recruiting participants from around the globe, were included in current study if enrolled between 20th March 2020 and 30th December 2020. Demographic information was collected at enrolment and rheumatic disease, diagnoses of COVID-19 and lifestyle factors were collected at weekly intervals. The proportion of CYP and adults diagnosed with COVID-19 were assessed separately. Associations between contraction of COVID-19 at any point over follow-up and participant demographics, rheumatic disease and lifestyle factors at enrolment were assessed descriptively and via Mann-Whitney U-tests, Chisquared tests and Fisher's exact tests. Results: Within 642 CYP and 3646 adults, the majority were female (67%, 89%) and most commonly from the UK (43%, 82%), respectively. The most frequent diagnoses were polyarticular JIA (37%) in the CYP cohort and RA in the adults (63%). Comorbidities were common (45%, 61%) and the majority were taking one or more immunosuppressive therapies (88%, 92%), respectively. At the time of enrolment, 51% and 54% were practising social distancing, respectively. In both cohorts ∼3% contracted COVID-19 at some point during follow-up (n=18 (2.8%) in CYP and n=103 (2.8%) in the adult cohort). In CYP, those who contracted COVID-19 were older (no COVID, median: 10, IQR: 7, 13, vs COVID, median: 14, IQR: 12, 16, p<0.001) and less often had oligoarticular JIA (no COVID: 31%, COVID: 22%) or polyarticular JIA (No COVID: 38%, COVID: 11%). Systemic JIA (no COVID: 7%, COVID: 11%) and enthesitis-related JIA (no COVID: 5%, COVID: 22%) were more common in those who contracted COVID. No other differences between those with and without COVID-19 were observed with respect to country of residence (p=0.335), gender (p=0.624), control of rheumatic disease (p=0.459), comorbidities (p=0.752), immunosuppressive medication (p=0.713) or social distancing (p=0.729). In the adult cohort, those contracting COVID-19 were more commonly from Russia (no COVID: 2%, COVID: 14%) and less commonly from the UK (no COVID: 82%, COVID: 71%, p<0.001). There was greater female representation in those that contracted COVID-19 (no COVID: 88%, COVID: 93%, p=0.022). Although there were no differences in overall presence of comorbidity (p=0.923), kidney disease was overrepresented in those that had contracted COVID-19 (no COVID: 2%, COVID: 8%, p<0.001). Finally, there were lower levels of social distancing in those who contracted COVID (no COVID: 54%, COVID: 44%, p=0.047). There were no significant differences in age (p=0.203), BMI (p=0.617), smoking status (p=0.120), rheumatic disease (p=0.181) and its control (p=0.218) or immunosuppressive use (p=0.208) between those who did and did not contract COVID-19 in the adult cohort. Conclusion: A low proportion of CYP and adults with rheumatic diseases contracted COVID-19 in the 9 months since March 2020. However, given the self-reported nature of the survey and limited testing available across many countries, this study may underestimate the true burden of COVID-19 in the rheumatic disease community. Factors associated with COVID-19 differ between CYP and adults, with age and type of rheumatic disease associated in CYP and gender, kidney comorbidity and social distancing associated in adults.
ABSTRACT
Background/AimsYounger and older people with rheumatic diseases may experienceincreased anxiety during the COVID-19 pandemic, due to theuncertainty regarding their likelihood of contracting the virus, itscomplications alongside their existing condition and whether theirimmunosuppressive treatments pose additional risks. This studyexplored trajectories of anxiety in parents of children and youngpeople (CYP) with rheumatic diseases and adults with rheumaticdiseases in the six months following March 2020 during the COVID-19pandemic.MethodsCYP and adults recruited to the international COVID-19 EuropeanPatient Registry, a parent-led, online, self-referred prospective cohortrecruiting participants globally, were selected if enrolled within 20thMarch to 17th April 2020. Anxiety scores (0-10, 10=Highest anxiety)were collected weekly for up to 28 weeks and denoted parent anxietyin the CYP cohort and self-reported anxiety in the adult cohort.Group-based trajectory models explored anxiety clusters usingcensored-normal models in the CYP and adult populations, separately.Linear, quadratic and cubic polynomials were tested within 1 to 10clusters and optimal models selected based on a combination ofmodel fit (BIC), parsimony and clinical plausibility. Demographic(country, age, gender) and clinical (diagnosis, disease control, respiratory comorbidity, immunosuppressive therapy) informationand COVID-19 mitigation behaviours (isolation, distancing, none)were collected at initial enrolment and compared between clustersusing Chi-squared, Fisher's exact and Kruskal-Wallis tests.ResultsAmong 498 CYP and 2640 adults, most were female (65%, 89%) andfrom the UK (50%, 84%), respectively. The most common diagnoseswere polyarticular JIA (37%) and oligoarticular JIA (29%) among CYPand RA among the adults (63%). Respiratory comorbidities wereuncommon in the CYP (10%) and adult (17%) cohorts, and most weretaking any immunosuppressive therapies (85%, 87%), respectively. Asof March 2020, 88% and 79% were self-isolating, respectively. In boththe parents of CYP and adult cohorts, four trajectory clusters wereidentified with similar patterns: Persistent extremely high anxiety (32%, 17%), persistent high anxiety (43%, 41%), high anxiety that marginallyimproved (25%, 32%) and moderate anxiety that improved (11%, 10%). Among CYP, few characteristics distinguished the clusters.However, in the adult cohort, clusters with greater and more persistentanxiety were associated with higher levels of respiratory comorbidities, higher use of immunosuppressive therapies, higher initial levels of selfisolation and slightly older age than those with lower or improvinganxiety over time.ConclusionThis study reports four trajectories of anxiety during the COVID-19pandemic that are consistent across parents of CYP with rheumaticdiseases and among adults with these conditions. Despite relativelylower risks for CYP, parental anxiety regarding COVID-19 was highand not associated with characteristics of their child or of their child'sdisease. Among adults with rheumatic diseases, greater anxiety wasassociated with risk factors potentially associated with COVID-19morbidity and mortality.