Non-steroidal anti-inflammatory drugs during coronavirus 19 pandemic: What do tunisian rheumatologists think?

ABSTRACT

Background: Concerns over the safety of non-steroidal anti-inflammatory drugs (NSAIDs) use during severe acute respiratory syndrome associated with coronavirus 19 disease (covid-19) have raised. NSAIDs are one of the most commonly prescribed and used pain medications for acute and chronic rheumatic diseases such as spondyloarthritis (SpA) and osteoarthritis. Objectives: This study aimed to assess the impact of covid-19 pandemic on NSAIDs prescription. Methods: A cross-sectional web survey was disseminated to all Tunisian rheumatologists through a mailing system and social media. The French version was accessible on Google form. It included close-ended questions about the prescription of NSAIDs during covid-19 pandemic. Participation was anonymous. Data collection and analysis was performed between January the first and January 30, 2021. Results: Among one hundred and thirty Tunisian rheumatologists, thirty responded to the online questionnaire. Ninety percent of participants were women. The mean age of rheumatologists was 34 years [25-57]. The duration of practice was inferior to 5 years in 59.3%, between 5 and 10 years in 18.5%, and superior to 10 years in 22.2% of cases. Sixty-three percent of rheumatologists reported that their activity decreased during covid-19 pandemic. NSAIDs prescription was avoided as much as possible in 40.7% of cases. The participants indicated NSAIDs less frequently in 33.3% of cases, and as much as before the pandemic in one-quarter of cases. Rheumatologists believed that NSAIDs worsen the respiratory symptoms (67%), delay recovery (55%), and increase mortality (48%), hospitalization in intensive care (44%), and infectious complications (33%). The participants suggested that the most incriminated NSAIDs were Ibuprofen (7.4%), indomethacin (7.4%), celecoxib (7.4%), and diclofenac (3.4%). The majority of rheumatologists (74%) believed that all NSAIDs had a similar risk. For patients with osteoarthritis, rheumatologists replaced NSAIDs with paracetamol and corticoids in 78% and 11% of cases, respectively. If mandatory, reducing NSAIDs doses or duration was an option in 22% and 74% of cases. For patients with SpA, half of rheumatologists did not change the treatment. However, the participants limited the use of NSAIDs or discontinued the treatment in patients with comorbidities. More than 60% of rheumatologists didn't know the effect of NSAIDs in the post-covid-19 syndrome. Conclusion: Covid-19 pandemic has affected rheumatologists' practice. Rheumatic disease management during this pandemic may be challenging. More evidence is mandatory to standardize treatment prescription, especially with NSAIDs.