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Background/Aims It is recognised that immunosuppressive medications, often relied upon in the management of autoimmune rheumatic disease, inhibit vaccine-induced immunity against the SARS-CoV-2 virus. A key challenge for rheumatologists is maximising immunity provided by the vaccine in their patients. Recent data has implicated methotrexate (MXT), a commonly used disease modifying anti-rheumatic drug (DMARD), in reducing patients' vaccine-induced immunity against the virus and studies have demonstrated the effectiveness of pausing MXT medication for 2-weeks after receiving the vaccine in boosting patients' immunity. There is a lack of data exploring the impact of concurrent biologic-DMARD (b-DMARD) use with MXT on COVID-19 infection rates in vaccinated individuals. This analysis forms part of a larger programme of research (clinicaltrials.gov NCT04542031) exploring COVID-19 in patients with rheumatic disease. Here we provide a comparative analysis of COVID-19 infection rates between patients taking MXT either with or without b-DMARD therapy and those on no immunosuppression. Methods We distributed two web-based questionnaires via SMS-messaging in April 2020 and December 2021 and two interim monitoring questionnaires in December 2020 and June 2021. All rheumatology patients with a valid mobile telephone number under follow up at the Royal Wolverhampton Trust were invited to participate in the study;those that consented received follow up questionnaires. We collected information on demographics, rheumatology diagnosis and treatment, vaccination status, and COVID-19 infection rates. Data were collected 7-days following questionnaire distribution. Results Initial questionnaires were sent to 7911 active follow up patients, 1636/ 7911 (21%) responded and consented to further follow up;906/1636 (55.4%) provided a complete response to the final survey which was subsequently linked to survey one enabling analysis. Responders were female (622/906, 68.7%), white (865, 95.5%), 60 years or above (519, 57.3%), and vaccinated (898/906;99.1%). Of those vaccinated significantly more patients that were on any immunosuppressive therapy compared to those on no immunosuppression (92/530 (17.4%) vs. 26/368 (7.1%);p<0.001), and more in the MXT monotherapy group compared to no immunosuppression (33/222 (14.9%) vs. 26/368 (7.1%);p=0.001) contracted COVID-19. Similar numbers in the MTX and b-DMARD and b-DMARD without MXT groups (23/140 (16.4%) vs. 36/168 (21.4%);p=0.23) contracted COVID-19. Conclusion Recent trial data from the VROOM study has demonstrated that omitting a patients MXT therapy for a 2-week period following administration of the COVID-19 vaccine doubles their antibody response. This data highlights that the risk of COVID-19 infection in vaccinated rheumatology patients is doubled in patients on any immunosuppressive medication compared to those on no immunosuppression, while there is no significant difference in infection rates between patients on MXT and a b-DMARD and b-DMARD therapy without MXT. Further work exploring the impact of different types of immunosuppression on COVID-19 vaccine-induced immunity and simple interventions to maximise this immunity in immunosuppressed individuals is required.
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Background: The COVID-19 pandemic has had disproportionate effects on the health and well-being of older adults. Little is known about the effects of isolation and social distancing measures on the mental health of older adults with cognitive impairment. Method(s): 194 participants from the Wake Forest Alzheimer's Disease Research Center (ADRC) Clinical Core cohort adjudicated as cognitively normal (CN, n = 129), and mild cognitive impairment (MCI, n = 65) were given questionnaires cross-sectionally measuring loneliness, perceived stress, well-being, and coping style. We created multivariable regression models (adjusted for age, sex, race, and education) to assess relationships among dependent variables, loneliness and perceived stress, and independent variables of interest, well-being and coping style (Table 2). Result(s): Overall, the mean age was 72+/-8 years. Table 1 lists baseline demographic and study measures for CN and MCI groups. Table 2 shows associations between dependent variables (perceived stress, loneliness) and independent variables of interest. Participants with MCI had significantly higher levels of loneliness (B = 3.30;p = 0.03) than CN participants. Participants who reported lower eudaimonic and hedonic well-being had higher levels of perceived stress and loneliness (p < 0.01), and those who endorsed using self-blame and behavioral disengagement to cope with stress had higher perceived stress (B = 3.06, = < 0.01) and loneliness (B = 7.84, p < 0.01). There was no interaction by cognitive diagnosis. Conclusion(s): Participants with MCI had higher levels of loneliness, but not perceived stress, than those with normal cognition. We found that participants expressing high feelings of well-being had significantly lower, and participants reporting a coping style with self-blame and behavioral disengagement had significantly higher perceived stress and loneliness. Next steps involve exploring associations of neuroimaging and Alzheimer's disease biomarkers with perceived stress and loneliness and evaluating transcriptional measures of stress measured concurrently. Copyright © 2022 the Alzheimer's Association.
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Background/Aims The UK coronavirus vaccination programme has been successful;by 8.10.21, 85% of those over 12 years had received the first dose of the vaccine and approximately 78% had received both doses. National guidance from British Society for Rheumatology recommends that all patients with rheumatic disease should receive a SARS-CoV-2 vaccine regardless of underlying diagnosis and treatment regime. Data highlight that in this group vaccine uptake can be significantly improved with physician recommendations and timely intervention. At the Royal Wolverhampton Trust (RWT, UK), we have previously described an innovative 8-minute web-based multimedia educational video sent via SMS-text messaging 21.12.20 to increase awareness of the recommendations and safety profile of the COVID vaccine in our cohort. A single-centre longitudinal study assessing the impact of COVID-19 on health-related quality of life (HRQOL) in our rheumatology patients is ongoing (NCT04542031), which we used to explore the impact of our intervention. Methods Existing study participants were sent a 6-monthly SMS text message containing a linked web-based survey. This collects demographic profiles, including gender, ethnicity, underlying rheumatological conditions;vulnerability, vaccination status, and HRQOL scores. Patients were asked to rate the impact of the video: more likely to be vaccinated;less likely;no impact. Responses were collected 7-days following distribution. Results Surveys were sent 9.06.21 to 1636 patients;there were 628/1636 (38.3%) complete responses. Responders were mostly female (69%), Caucasian (96%), mean age 63years, most had an autoimmune rheumatic disease (75%) and half were clinically extremely vulnerable (47%);623/628 (99%) were vaccinated and 45/628 (7%) had contracted COVID since the beginning of the pandemic. In total 424/ 628 (68%) reported watching the educational video;422/468 (99%) reported receiving the vaccination. Of these 138/424 (32%) reported they were more likely to get the vaccine as a result, 285/424 (67%) reported it made no difference, and one patient (1%) reported that the video made them less likely to have the vaccine. Of the 5/628 (1%) non-vaccinated patients, reasons for not having the vaccine were concerns over vaccine side effects (2/5), and personal reasons including awaiting further vaccine data and awaiting home visit (3/5);2/5 had watched the video, both reported the video made no difference to their decision and none had contracted COVID. Conclusion In a research cohort of patients with rheumatic disease, following a targeted COVID-19 vaccine education video 32% were more likely to get the COVID vaccine, and the vast majority went on to be vaccinated. Within the limitations of a research study, these data contribute to evidence supporting the use of SMS technology to communicate key healthcare messages and targeted educational materials. Further research exploring the use of targeted educational materials and communications via SMS-text messaging could support in tackling vaccine hesitancy in this population.
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Background/Aims COVID-19 has had severe consequences across the globe and the detrimental impacts are continually emerging. Recently it has been recognised that some patients develop persisting symptoms past the initial infection, termed 'long-COVID'. The prevalence of long-COVID in the general population is estimated to range from 2.3% to 37.7% and while risk factors in this group have been explored, there is a lack of data reporting prevalence and risk factors of long-COVID in patients with rheumatic disease (RD). This is an interim report of an ongoing study (clinicaltrials.gov NCT04542031) exploring COVID19 in patients with RD;we report risk factors for the development and impacts on health-related quality of life (HRQoL) of long-COVID in patients with RD to inform guidelines and target service provision as the pandemic continues. Methods We distributed three web-based surveys spanning 14 months, April 2020 to June 2021. Surveys were communicated via a linked SMS-text message;all patients with a validated mobile-number under rheumatology follow-up at the Royal Wolverhampton Trust were invited to participate in survey-1, those that consented were invited to participate in follow-up surveys. Patients reported a range of metrics including demographics, and self-reported COVID-status;on completion patients were asked to complete a validated HRQoL survey, the short-Form 12 encompassing physical (PCS), and mental component (MCS) scores. Data were collected 7-days following survey distribution. SPSS version-27 was used for comparative data analysis. Results Initial surveys were sent to 7911 active follow-up patients, 1636/7911 (21%) responded and consented to further follow-up;628/1636 (38%) responded to all surveys. 45/628 (7%) reported contracting COVID at any time (59years, female-80%, BAME-9%). 26/45 (58%) suffered acute-COVID (symptoms <4weeks), and 19 (42%) suffered long- COVID (symptoms 4 weeks or more);10/19 (53%) had post-COVID syndrome (symptoms 12 weeks or more). Compared to the acute- COVID group more in the post-COVID syndrome group were female (69% vs 100%), BAME (4% vs 20%), housebound due to prepandemic ill-health (5% vs 60%), and needed regular assistance (7% vs 60%). While baseline MCS did not differ, after 14months, compared to the acute-COVID group MCS was significantly worse in those that developed post-COVID syndrome (43.2 vs 35.8) and more in this group reported visiting their GP due to mental health concerns (7% vs 30%). Age, diagnosis, and PCS were similar across groups. Conclusion These data highlight that in RD patients those at risk of developing post-COVID syndrome are females, those with worse pre-pandemic health, and BAME-groups. While physical health remained stable, following infection the mental health of patients that developed post- COVID syndrome was significantly worse than those that suffered COVID acute-COVID. These data can be used to identify COVIDpositive patients at greater risk of developing post-COVID syndrome and suggest services need to adapt to support psychological wellbeing in these groups.
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The COVID-19 pandemic has resulted in huge disruption to healthcare provision, including to dual-energy X-ray absorptiometry (DXA) imaging. Increased waiting lists for DXA from the pandemic mean potential long and uncertain delays in treatment for osteoporosis. To address these increased waiting lists, we propose a rapid, simple, one-stop algorithm incorporating medication use (aromatase inhibitor, corticosteroid) and clinical risk stratification supplementing a standard FRAX assessment. Our pragmatic algorithm produces a recommendation to treat empirically, image with DXA, or observe. If applied, we model a significant reduction in DXA scan requirements with a corresponding reduction in treatment delays for those awaiting DXA. We estimate this will reduce DXA scan numbers by about 50%, whilst pragmatically ensuring those with the highest clinical need correctly receive treatment without delay. This algorithm will help many clinicians including general practitioners/family physicians prioritise DXA when they may not always have the expertise to make this judgement based on clinical information alone. Although we have used UK guidelines as an example, this approach is flexible enough for adaptation by other countries based on their local guidelines, licensing, prescribing requirements, and DXA waiting list times. There are some limitations to our proposal. However, it represents one way of managing the uncertainty of the current COVID-19 pandemic.
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Background: Worldwide the detrimental consequences of the COVID-19 pandemic on physical and psychological health have been recognised. Social distancing and isolation measures have negatively impacted physical functioning (PF) and mental health (MH), and are known to have reduced physical activity (PA) generally within the population. A significant proportion of patients with autoimmune rheumatic disease (ARD) are considered 'clinically extremely vulnerable' (CEV), at high risk from COVID19 and been advised to follow stricter social distancing precautions than the general population. Evidence in ARD patients highlights the importance of PA in maintaining physical and psychological wellbeing. Prior to the pandemic limitations in both PF and MH in patients with ARD were recognised and early in the pandemic MH was noted to be impacted by distancing measures in this population. Objectives: This is an interim report of a research study (clinicaltrials.gov NCT04542031) exploring the impact of the COVID19 pandemic on the physical and psychological wellbeing of patients with rheumatic disease, to inform guidelines and target service provision as the pandemic continues. Methods: We distributed two web-based surveys, eight months apart during the first (April-2020) and second wave (December-2020) of the pandemic. Surveys were communicated via a linked mobile-phone SMS message, to all rheumatology patients with a validated mobile number under follow-up at the Royal Wolverhampton Trust. We assessed patients using the Short Form-12 version 2 made up of mental (MCS) and physical component scores (PCS). For each survey, data were collected 4-weeks following distribution;comparative analysis was conducted using SPSS version-27. Results: Initial surveys were sent to 7911 active follow up patients;1694/7911 (21.4%) responded and consented for further follow up, of which 1636 were linked to a validated mobile number. 899/1636 (55.0%) responded to the second survey and 824/899 (91.7%) responses were linked across both surveys. These 824 patients were predominately female (69.5%), aged 61 years and 76.3% had an ARD;388/824 patients were CEV, 436 were in the comparator group. For the CEV group, scores remained significantly lower than the comparator for PCS (survey 1: 36.40 vs 39.61 [P<0.001], survey 2: 36.11 vs 38.66 [P<0.001]) and MCS (41.61 vs 43.44 P<0.001;41.19 vs 43.60 [P<0.001]);there was no deterioration in CEV scores. In the comparator group, while MCS did not differ in patients with ARD, PCS significantly decreased (1.39;95% CI: 0.69, 2.08;P<0.001);PCS in the non-inflammatory group did not significantly change (-0.23, P=0.65). Conclusion: These preliminary data suggest that while the physical and mental health of CEV patients is significantly lower in this cohort, surprisingly, neither aspects of health have been worsened by the impacts of the pandemic over an 8-month period. However, the physical functioning of patients with ARD significantly decreased in this time, which may reflect the reduction in PA faced by society, and reduced contact with secondary care services. These data suggest services need to adapt to provide additional support to patients with ARD to maintain physical functioning during the pandemic. Further work exploring the evolving pattern of the physical and psychological responses to the pandemic is ongoing.
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Background: There are reported concerns of patient misunderstanding of the COVID-19 pandemic and vaccination safety. It is particularly important that these are understood in patients taking complex immunusuppressive therapies. Rapid delivery of targeted and up-to-date video messages from clinicians sent directly to patients could address patient uncertainty, and improve COVID-19 vaccination uptake. Innovative SMS (short message service) based video message has already shown promise in delivering COVID-19 information to patients [1]. We present our experience in creating a tailored vaccine information video sent directly to our large cohort of patients in the UK with a range of rheumatic diseases and report on the learning points going forward. Objectives: Our three objectives were: (1) educate our patients using an interactive mobile video information resource outlining the safety of the COVID vaccination in these patient groups;(2) better understand our patients' views of the COVID-19 vaccine;(3) evaluate the patient experience of this approach. Methods: We designed and recorded an 8-minute interactive web-based video delivered education resource designed for mobile phones. This included: aims of the video;details of licenced vaccines;UK vaccination schedule;frequently asked questions;links to national charity resources;our clinician recommendations;a rheumatologist being vaccinated;case studies;and summary data. We produced a simple mobile phone web-based evaluation of the resource, including anonymised patient demographics, their understanding of the safety of the vaccine pre/ post video, and their user experience. Resource and evaluation were piloted by local healthcare professionals, our Patient Participation Group, a national charity, and approved by senior management. We distributed this to our follow-up patient cohort via our hospital SMS provider on 21.12.20, at the start of roll-out of UK vaccines, containing a link to the resource and evaluation. Results: Of a cohort of 10,981 patients, we had 8886 mobile phone numbers. At Day 14, we recorded 2358 video views (26.3%) and 664/2358 completed evaluations (28.1%). Only one person reported being unable to watch the video. Before watching the video, 348/664 patients (52.4%) were unsure if the vaccine was safe and/or recommended for them, rising to 626/664 (94.3%) post-video. Reasons for uncertainty after the video (38/664) included drug allergy and fertility concerns. Following the video, 509/664 patients (76.6%) reported that they were more likely to have the vaccination. The majority of the patients (614/660, 93.0%) agreed that the method was a helpful method to share such information.Age distribution of our whole cohort, patients with mobile phones, and responders were similar: Age >50 was 80.4%,76.3%,and 88.6% respectively. A large proportion was treated with immunosuppressive medication (61.3% conventional DMARD, 39.4% biological DMARD and 17.6% corticosteroids). Gender and case mix for responders were similar to published data from our cohort: female 74.0%;rheumatoid arthritis commonest disease (389/664, 58.5%). Conclusion: To our knowledge, this is the first study to show the potential for SMS linked interactive multimedia message for patient education. The multimedia component allows users to easily navigate to relevant sections, and access a choice of linked resources. We demonstrate this low-cost technology is simple, effective and well placed to assist physicians in educating patients during a time when face-to-face contact is proving to be difficult. We have shown high levels of patient satisfaction, reassurance, and self-reported behaviour change. Such technology has potential utility for national bodies, primary and secondary care groups, and merits further research.
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Background/AimsMedical students need to gain patient contact to develop their skills inhistory taking and examinations. In year three, undergraduate studentstypically rotate across various hospitals and specialties and areexpected to have dedicated rheumatology exposure for history andexamination competencies. Rheumatology as an out-patient specialtycan limit opportunities for medical students to have broad exposure torheumatological conditions.MethodsIn January 2018, we designed an annual rheumatology half-dayteaching workshop ('Rheumatology Carousel') using a combination oflecture-based teaching and small group based guided clinical historyand examination stations, aimed at third-year medical students fromthe University of Birmingham. This covered key presentations inrheumatology: axial spondyloarthropathy, rheumatoid arthritis, systemic sclerosis (connective tissue disease), osteoarthritis, and vasculitis. Each station required a Clinical Teaching Fellow or RheumatologyST trainee, overseen by one consultant facilitator. We designed patientproforma's incorporating consent, demographics, key clinical history, therapy, and examination findings. We produced a written patientguide, and consultants invited appropriate patients to volunteer for theday. We designed a one-hour lecture-based tutorial. A lesson plan andschedule were created outlining faculty requirements;including time, roles, and faculty numbers. We invited five to six patients to eachsession, with a plan of four to five focussed examinations. Wedesigned the carousel to accommodate up to 40 students, split intotwo groups running over a day. Focussed examinations involvedstudents in groups of four, with each student being a lead examiner inat least one station, each station lasting 20 minutes. Best practiceexamination techniques for each condition were assessed andemphasised. Following a debrief, we collected feedback fromstudents, faculty, and patients (online and written feedback), usingLikert scores for teaching content, and quality of the session delivery.ResultsThe carousel ran in February 2018, 19, and 20. The sessions werepositively evaluated by students, faculty, and patients. In total, 93students attended, 89/93 completed feedback. Satisfaction scores(mean;SD;range) were high (1-strongly disagree, 5-strongly agree) forcontent (4.8;0.49, range 3-5) and quality of delivery (4.7;0.54;3-5). Allpatients who participated volunteered to return for future teachingsessions, with several patients attending all three years. Free textfeedback indicated students valued structured exposure to coreconditions and called for more sessions of this nature.ConclusionThis sustainable reproducible intervention ensures students havestructured exposure to important rheumatological conditions. Themethodology allows reproducible sessions that are positively evaluated despite rotating clinical teaching staff. We have made all ourteaching materials, logistical plan, and scheduling tools available asopen access resources under a Creative Commons license for free reuse and adaptation by any healthcare professional, via a web link. Weplan to record an electronic version to distribute post the COVID-19pandemic.
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Background/AimsThe COVID-19 pandemic has resulted in a number of changes inpractice in the UK, including the reduction in routine day-caseattendances for intravenous rheumatology treatments. Due to redeployment and resultant staff shortages, we required alternatives to daycase attendance. The usual face-to-face education that normallysupports this was not possible.MethodsIn March 2020, we identified patients receiving monthly intravenoustocilizumab on our day-unit and planned a supported transition toweekly subcutaneous self-injection. We designed, planned, storyboarded, video-recorded, and piloted a 15-minute tocilizumab selfinjection interactive video resource, using evidence-based educationalmethodology. This included: an introduction;explanation of thechange and context;a one-minute video of our nurse specialist selfadministering a sample injection;a close-up injection video;locallogistical information and contact details, and a voluntary anonymousweb-based evaluation. The interactive resource was searchable andcontained links to supporting information, including a link tomanufacturer patient education material. The intervention receivedrapid institution and pharmacy approval for distribution. We sent it viaSMS message to our cohort of patients using a commercial partner(HealthComm UK) from 8.4.20, using an established method we haverecently described. Simultaneously, we made it publicly available onour departmental website. We collated feedback and usage metricsover an eight-week period (8.4.20 - 3.6.20).ResultsWe identified 69 patients eligible to switch to self-injection;all weresent the SMS link. Our resource was viewed by 39/69 patients (57%)via the unique SMS link, a total of 97 times (mean 2.5 views/patient).Others watched it on our website, 534 views, by 283 unique visitors(1.9 views/visitor). In total, 24/69 patients (35%) returned a completeevaluation of the video, 16/24 (67%) felt more confident injecting afterwatching the resource. Age ranges in deciles (number) was: 40-49, (5);50-59, (6);60-69, (8);>70, (5). Likert scores for satisfaction with theresource (1=strongly disagree;5=strongly agree) were as follows:video ease and playback (4.1);improved confidence of self-injection(4.0), usefulness of SMS methodology (4.3), usefulness of interactiveresource over video (3.7). A number (9/24, 38%) had never selfinjected any medicine. Most completing the evaluation (18/24, 75%)viewed the resource on mobile phones. Written feedback, wheregiven, was positive in 18/19 (95%) cases, one patient identified theycould not watch the video.ConclusionThe COVID-19 pandemic has increased the use of telerheumatologyresources. We have demonstrated that interactive video resources area rapid, acceptable, and useful method of delivering rheumatologyeducation. This intervention is low cost (£0.01 per SMS) and we usedexisting e-learning technology already licensed to our hospital at noadditional cost to the department, other than staff time. Our findingshave implications for other aspects of rheumatology self-care and wecall for further research in this area.
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Background/AimsThe COVID-19 pandemic is associated with significant levels ofpsychological distress, affecting both those with and without theCOVID infection. In the general population, COVID-19 has mostnotably affected those who are female, in younger age groups, blackAsian and ethnic minority groups (BAME). A significant proportion ofrheumatology patients are 'clinically extremely vulnerable', classed ashigh-risk of COVID under current national guidance. While it isrecognised that extra precautionary measures in this group, such asstringent social distancing (shielding), adversely impacts thesepatients mental health, other risk factors, for patients with rheumaticdisease whose health related quality of life (HRQoL) scores are mostimpacted, have not being explored. In our large cohort of rheumatology patients under secondary care follow up at the RoyalWolverhampton Trust we assessed HRQoL scores at the 4-weekpoint following the introduction of lockdown measures.MethodsWe distributed a web-based survey via a linked mobile-phone SMSmessage, to all rheumatology patients, with a validated mobilenumber, under follow-up at the Royal Wolverhampton Trust. Weassessed patient's HRQoL by Short Form-12 version 2 (SF12);datawere analysed using SPSS version 26.ResultsThere were 7, 911 active follow up patients with linked mobile numbers.Survey responses were received from 1, 828/7, 911 (23%) and of these1, 727 completed all aspects of the SF12. Responders were mostlywhite British 1, 711/1828 (94%) and female 1, 276 (70%);inflammatoryarthritis was the predominant diagnosis (1, 275, 70%). 858 (47%) wereat high-risk of COVID (advised to follow shielding guidance) and 72(4%) reported having suffered COVID-19 infection. Mental SF-12(MCS) component scores were significantly lower in: COVID vs nonCOVID patients (mean differences: -3.8, P < 0.001);BAME vsCaucasian patients (-1.5, P = 0.04);Females vs Males (-1.3, P = 0.001). Importantly, there were no differences in physical component scores (PCS) in these groups. Patients considered at high risk ofCOVID had lower MCS (-2.1) and PCS (-3.1) (both P < 0.001). Olderpatients had lower PCS (-2.7, P < 0.001) but not MCS.ConclusionWe found significantly worse mental health scores in female patients, BAME patients and those patients that had suffered the COVIDinfection. Clinically extremely vulnerable patients had worse mentaland physical health scores. There was no significant difference inmental health scores between patients in different ages groups, while, as might be expected, physical health scores were significantly worsein the older age groups. These data indicate a focus on adversepsychological consequences in specific patient groups may berequired for future increases in COVID infection rates. Further workon the evolving pattern of psychological responses to the pandemic inrheumatic disease is required.
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OBJECTIVES: We sought to gain insight into the prevalence of COVID-19 and the impact stringent social distancing (shielding) has had on a large cohort of rheumatology (RD) follow-up patients from a single large UK centre. METHODS: We linked COVID-19-related deaths, screening and infection rates to our RD population (1.2.20-1.5.20) and audited active rheumatology follow-up patients through survey data communicated via a linked mobile phone SMS message. We assessed epidemiology, effect of stringent social distancing (shielding) and quality of life (HRQoL) by Short Form 12 (SF12). RESULTS: There were 10,387 active follow-up patients, 7911 had linked mobile numbers. 12/10,387 RD patients died from COVID-19 (0.12%); local population 4131/7,415,149 (0.12%). For patients with mobile phones, 1693/7911 (21%) responded and of these, 1605 completed the SF12. Inflammatory arthritis predominated 1174/1693 (69%); 792/1693 (47%) were shielding. Advice on shielding/distancing was followed by 1372/1693(81%). 61/1693 (4%) reported COVID-19 (24/61 shielding); medication distribution was similar in COVID and non-COVID patients. Mental SF12 (MCS) but not physical (PCS) component scores were lower in COVID (60) vs. non-COVID (1545), mean differences: MCS, - 3.3; 95% CI - 5.2 to - 1.4, P < 0.001; PCS, - 0.4; 95% CI, - 2.1 to 1.3). In 1545 COVID-negative patients, those shielding had lower MCS (- 2.1; 95% CI - 2.8 to - 1.4) and PCS (- 3.1, 95% CI - 3.7 to - 2.5), both P < 0.001. CONCLUSIONS: Our full RD cohort had no excess of COVID deaths compared to the general local population. Our survey data suggest that shielding adversely affects both mental and physical health in RD. These data broaden our understanding of shielding, indicating need for further study.
Subject(s)
COVID-19/epidemiology , Data Collection/methods , Physical Distancing , Rheumatology , SARS-CoV-2 , Aged , COVID-19/mortality , COVID-19/prevention & control , Female , Humans , Male , Middle Aged , PrevalenceABSTRACT
The COVID-19 pandemic has resulted in huge disruption to healthcare provision, including to dual-energy X-ray absorptiometry (DXA) imaging. Increased waiting lists for DXA from the pandemic mean potential long and uncertain delays in treatment for osteoporosis. To address these increased waiting lists, we propose a rapid, simple, one-stop algorithm incorporating medication use (aromatase inhibitor, corticosteroid) and clinical risk stratification supplementing a standard FRAX assessment. Our pragmatic algorithm produces a recommendation to treat empirically, image with DXA, or observe. If applied, we model a significant reduction in DXA scan requirements with a corresponding reduction in treatment delays for those awaiting DXA. We estimate this will reduce DXA scan numbers by about 50%, whilst pragmatically ensuring those with the highest clinical need correctly receive treatment without delay. This algorithm will help many clinicians including general practitioners/family physicians prioritise DXA when they may not always have the expertise to make this judgement based on clinical information alone. Although we have used UK guidelines as an example, this approach is flexible enough for adaptation by other countries based on their local guidelines, licensing, prescribing requirements, and DXA waiting list times. There are some limitations to our proposal. However, it represents one way of managing the uncertainty of the current COVID-19 pandemic.