The impact of COVID-19 on clinical care, self-management, and mental health of patients with inflammatory arthritis

ABSTRACT

Objectives The COVID-19 lockdown and ongoing restrictions in the UK affected access to clinical care, self-management, and mental health for many patients with Inflammatory Arthritis (IA). This study aimed to determine the impact of lockdown on IA clinical care, self-management, disease outcomes, and mental health. Methods In total, 338 people with IA participated in a prospective study completing a series of online questionnaires. The questionnaires assessed demographics, IA condition and management, clinical care, quality of life, and mental health. Visual analogue scales (VAS) were completed at each assessment. Linear regression, controlling for confounders, was conducted to determine factors associated with physical and mental health outcomes. Results Over half of participants reported worsening VAS by more than 10 points for Patient Global Assessment (PGA), pain, fatigue, and emotional distress during the initial lockdown. Changes in clinical care were associated with worse PGA (b = 8.95, p = 0.01), pain (b = 7.13, p = 0.05), fatigue (b = 17.01, p < 0.01) and emotional distress (b = 12.78, p < 0.01). Emotional distress and depression were also associated with worse outcomes in PGA, pain, and fatigue, while loneliness was not. In contrast, physical activity seemed to mitigate these effects. Loneliness did not show any associations with outcomes. Over time, these effects decreased or disappeared. Conclusions Changes to clinical care due to lockdown were associated with worse disease outcomes in patients with IA. There has been a clear impact on mental health as well, with possibly complex relationships between mental health and psychosocial factors. Physical activity emerged as a key influence on disease outcomes and mental health.