Impact of coronavirus disease 2019 (COVID-19) pandemic on attitude, behavior, and mental health of patients with rheumatic diseases

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has become a global health, social, and economic crisis. Healthcare professionals, patients, healthy individuals, and the whole community are under inevitable psychological pressure which may cause different psychological problems as fear, anxiety, depression, and insomnia. The aim was to assess the impact of the COVID19 pandemic on the attitude, behavior, and mental health of rheumatic patients and to compare them with healthy individuals. This is a case-control study, 360 participants were included and divided into a patient group composed of 180 patients with rheumatic diseases, and a control group composed of 180 healthy people. Data were collected via a self-administered structured questionnaire designed on Google forms. It was sent to participants via social networks and emails to different rheumatic patients and healthy individuals. Mental health was measured by the 5-item Brief Symptom Rating Scale (BSRS-5).ResultsThe mean age of cases and control were (35.05 ± 8.79 vs 34.56 ± 9.06) years. In comparing attitudes and behavior toward COVID 19, there was a statistically significant difference (p ≤ 0.05) between both groups regarding washing hands, going outdoors, wearing masks and gloves outdoors, and staying in their rooms. Patients depended mainly on telehealth more than usual where about 50% used either phone calls, internet or sent their relatives to their physicians;moreover, 20% did not contact their physicians at all the past few months. There was a statistically significant difference (p ≤ 0.05) between both groups regarding feeling angry/irritated, inferior and insomniac. The BSRS-5 total score and being defined as a psychiatric case (according to the BSRS-5 scale) also differed significantly between patients and controls. Systemic lupus erythematosus (SLE) patients showed more adherence to their medications and stayed mostly at home and they have higher BSRS scores.ConclusionPatients with rheumatic diseases show comparable degrees of anxiety and depression to healthy individuals, but higher distress symptoms and panic in the form of anger, irritability, and insomnia. They have a significantly higher sense of inferiority and a higher total BSRS compared to controls. SLE patients show more adherence to their medications and stay mostly at home as a reflection of feeling more vulnerable. Moreover, they have higher degrees of psychological affection in the form of higher BSRS scores. Abandoning drug purchasing without medical prescription is necessary in Egypt to protect our patients from unnecessary drug shortages adding to their fear and anxiety. Mental health should be addressed in the same manner we deal with the infectious disease itself, being of no less importance. Mental health professionals, social workers, and support groups need to provide psychological support to vulnerable populations, including patients with rheumatic diseases. Rheumatologists should be aware of the need for psychiatric consultation for their patients whenever necessary.

Attitudes of patients with a rheumatic disease on drug use in the COVID-19 pandemic.

BACKGROUND: Anti-rheumatic drugs can increase the predisposition to infection, and patients may be unaware of continuing their treatment during the COVID-19 pandemic. OBJECTIVE: This study aimed to assess whether patients maintain their treatment for rheumatic conditions during the pandemic period and determine the factors responsible for discontinuation. METHODS: Patients were randomly selected from the prospectively collected database of our tertiary referral center. The patients were interviewed by telephone through a standardized closed-ended questionnaire, which is targeting the continuity of the treatment plan and the considerations related to the individual choice. The patients were asked whether they hesitated to visit the hospital for follow-up or intravenous drug administration. RESULTS: A total of 278 patients completed the questionnaire. While 62 of the patients (22.3%) had reduced or interrupted the treatment, only 11 patients (3.9%) stopped the treatment completely. A significant difference was observed between the duration of illness and the discontinuation of treatment. (p = 0.023) There was a significant difference in disease activity between the group that stopped treatment and continued treatment. (p = 0.001) There was no statistically significant difference in other demographic characteristics. One hundred thirty-five patients (48.6%) made the treatment decision by themselves, and 80% continued the treatment. Reasons for stopping the treatment were anxiety (48.4%), not being able to go to the hospital for intravenous treatment (45.1%), and not being able to find the drug (6.5%). CONCLUSION: Since patients with long-term illnesses were found to be significantly more likely to stop their treatment, this group of patients should be monitored.

Risk of COVID-19 infection in patients with rheumatic disease taking disease-modifying anti-rheumatic drugs.

BACKGROUND AND OBJECTIVE: Patients with rheumatic disease taking long-term disease-modifying anti-rheumatic drugs (DMARDs) are expected to have a higher risk of infection due to the alterations in cellular immunity associated with these medications. However, the potential risks associated with these drugs remain unclear. This study aimed to estimate the risk of COVID-19 infection in patients with rheumatic disease taking disease-modifying anti-rheumatic drugs. METHODS: Patients with autoimmune rheumatic disease taking DMARDs with or without long-term (> 6 months) HCQ treatment prior to the COVID-19 outbreak were selected consecutively. The diagnosis of COVID-19 was made based on the history of symptoms suggestive of the disease and/or serum IgG positivity. During statistical analysis, the risk of COVID-19 infection was calculated in rheumatic patients taking DMARDs versus controls, as well as in patients taking HCQ versus those who are not. The ORs and 95% CIs were also calculated. The participants in the control group were selected from individuals without RD. RESULTS: A total of 800 patients with RD and 449 controls were analyzed. COVID-19 infection was detected in 16.8% of rheumatic patients versus 17.6% of controls (OR 0.95; 95% CI 0.7-1.28). The proportions of COVID-19 infection in HCQ users versus non-users were 15.3% and 18.1%, respectively (OR 0.87; 95% CI 0.61-1.26). These results remained unchanged after adjusting for all covariates using logistic regression analysis. CONCLUSION: These findings indicate that rheumatic patients taking DMARDs are not at a higher risk of COVID-19 infection, and that HCQ therapy has no influence on the risk of COVID-19 infection. Key points • The risk of COVID-19 infection is not higher in patients with RD on DMARD therapy. • The prevalence of COVID-19 infection in HCQ users has not significant difference relative to non-users. • Significant percent of RD patients taking DMARDs had asymptomatic infection. • There was a positive association between leflunamide therapy and the risk of COVID-19 infection.

A COVID-19 Outbreak in a Rheumatology Department Upon the Early Days of the Pandemic.

Objectives: To describe our experience with a coronavirus disease 2019 (COVID-19) outbreak within a large rheumatology department early in the pandemic. Methods: Symptomatic and asymptomatic healthcare workers (HCWs) had a naso-oropharyngeal swab for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and were followed clinically. Reverse transcription polymerase-chain reaction (RT-PCR) was repeated to document cure, and serological response was assessed. Patients with risk contacts within the department in the 14 days preceding the outbreak were screened for COVID-19 symptoms. Results: 14/34 HCWs (41%; 40 ± 14 years, 71% female) tested positive for SARS-CoV-2, and 11/34 (32%) developed symptoms but were RT-PCR-negative. Half of RT-PCR-positive HCWs did not report fever, cough, or dyspnea before testing, which were absent in 3/14 cases (21%). Mild disease prevailed (79%), but 3 HCWs had moderate disease requiring further assessment, which excluded severe complications. Nevertheless, symptom duration (28 ± 18 days), viral shedding (31 ± 10 days post-symptom onset, range 15-51), and work absence (29 ± 28 days) were prolonged. 13/14 (93%) of RT-PCR-positive and none of the RT-PCR-negative HCWs had a positive humoral response Higher IgG indexes were observed in individuals over 50 years of age (14.5 ± 7.7 vs. 5.0 ± 4.4, p = 0.012). Of 617 rheumatic patients, 8 (1.3%) developed COVID-19 symptoms (1/8 hospitalization, 8/8 complete recovery), following a consultation/procedure with an asymptomatic (7/8) or mildly symptomatic (1/8) HCW. Conclusions: A COVID-19 outbreak can occur among HCWs and rheumatic patients, swiftly spreading over the presymptomatic stage. Mild disease without typical symptoms should be recognized and may evolve with delayed viral shedding, prolonged recovery, and adequate immune response in most individuals.