The impact of the ongoing COVID-19 pandemic on the management of rheumatic disease: a national clinician-based survey.

This study aims to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the management of rheumatic diseases (RD). An online survey included 10 questions were designed to assess potential differences in rheumatology practice. The survey was conducted between March 2021 and June 2021. Marginal homogeneity test was used to compare frequencies of outpatient clinic patients between the pre-pandemic and pandemic. Other results were analyzed by descriptive statistics. One hundred three clinicians (75.7% in rheumatology practice for at least five years) responded to the survey. Almost 70% examined < 30 patients per day during the pandemic while nearly 70% examined ≥ 30 patients per day before the pandemic (p < 0.001). They indicated following reasons for decreasing outpatient clinic activity were concerns regarding COVID-19 transmission risk of the patients (95%) and the clinicians (53%), being able to supply chronic medications directly from the pharmacy (85%), lockdown (71%), limited outpatient appointments (64%) and using telemedicine (20%). The frequencies of rheumatology daily routine procedures were decreased as follows; patient hospitalization for diagnosing (80%) and treatment (78%), labial salivary gland biopsy (63%), Schirmer's test/salivary flow rate test (56%), nail bed video-capillaroscopy (52%), musculoskeletal ultrasonography (51%) and Pathergy test (50%). Clinicians hesitated to use rituximab (63%) mostly, followed by cyclophosphamide (53%), glucocorticoids (43%), tofacitinib (41%), mycophenolate mofetil (36%), and azathioprine (33%). In this first national survey, the prominent differences in the management of RD have decreased outpatient clinic activity, reduced rheumatology daily procedures, and hesitancy to use some rheumatic drugs.

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.

The impact of COVID-19 pandemic on rheumatology practice: a cross-sectional multinational study.

OBJECTIVE: To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on rheumatology practice. METHOD: A cross-sectional web survey was designed by the members of the Arab League of Associations for Rheumatology (ArLAR), validated by its scientific committee and disseminated through e-mail and social media. It included close-ended questions about the impact of the pandemic on the rheumatology activities, including outpatient visits and hospitalizations (in percentage, 100% corresponds to complete suspension) and open-ended questions about unmet needs. Univariate and multivariable logistic regression analyses were used to evaluate the predictors of impact. Suggestions were developed to improve the practice. RESULTS: A total of 858 rheumatologists were included in the analysis (27.3% of registered in ArLAR), 37% were 35-44 years old, 60% were females, and 48% worked in the private sector. The impact of COVID-19 was a decrease of 69% in hospitalizations, 65% in outpatient clinic, 56% in infusion centers, and 43% in income. It was associated with the region (highest in the Gulf), use of telemedicine, impact on income and practice sector (lowest in private). There was a hydroxychloroquine shortage in 47%. Telemedicine was mostly based on traditional telephone contacts and e-mails and reimbursed in 12%. Fifteen rheumatologists (1.8%) were infected and 156 cases of COVID-19 were reported among patients. The top-cited unmet needs in rheumatology practice were access to drugs and a telemedicine platform. CONCLUSIONS: The negative impact of the COVID-19 pandemic on rheumatology practice may compromise rheumatic diseases control. Better access to drugs and providing telemedicine platforms are recommended to improve the practice. Key Points • The COVID-19 pandemic had a significant negative impact on the rheumatology practice, including access to outpatient clinic, hospitalization, and to anchor drugs. • The compromised access to rheumatology care may jeopardize the control of chronic rheumatic diseases and the long-term prognosis. • Better access to drugs and providing telemedicine platforms are strongly recommended.