THE IMPACT of LOCKDOWN in PATIENTS with RHEUMATOID ARTHRITIS

ABSTRACT

Background: The COVID-19 pandemic has impacted on face to face assessments of patients with rheumatic diseases, including rheumatoid arthritis (RA) and telemedicine has offered a valid opportunity to follow these patients. DEDI-CARE is a Patient Support Program (PSP) which has been active at our center since 2016, which allows the telemonitoring of PROs (Patient Reported Outcomes) for patients being treated with abatacept. Since 2016, 98 RA patients followed at out Unit entered the DEDICARE program. During COVID19 pandemic these patients continued their monitoring using this PSP. Objectives: To evaluate the impact of the frst COVID wave on PROs and CROs (Clinical Reported Outcomes) in patients with RA included in the DEDICARE programme Methods: Data collected in the dedicated platform three months before (from December 2019 to February 2020, pre-lockdown), during (from March 2020 to May 2020, lockdown) and after (from June 2020 to August 2020, post-lockdown) the frst lockdown period in Italy were compared. In detail DAS28 (CRP, ESR), CDAI and SDAI were evaluated before and after the lockdown period;while VAS-pain, Global Health (GH);Patient Global Assessment of Disease Activity (PGA);Health Assessment Questionnaire (HAQ);Functional Assessment Chronic Illness Therapy (FACIT) were evaluated pre, during e post lockdown with the DEDICARE platform. Results: 36 RA patients, all females, were included in the study;mean age was 62.4 (32-85) years;mean disease duration 15.5 (5-38) years;18 were ACPA and RF+. All patients were treated with abatacept, 13 as monotherapy and 23 in association with csDMARDs. No patients had COVID19 disease during the evaluated period. A signifcant worsening of global health and patient global assessment of disease activity was observed;while no differences were observed regarding the CROs and other PROs (Figure 1) Conclusion: In the present study we were able to compare PROs in patients with RA before and after the frst COVID wave in Italy. While no signifcant changes in disease activity were observed, patients experienced an increased perception of disease activity and a decline in their overall health status which began during the lockdown and continued over the following 3 months. This may highlight a discordance between the patient and the physician perception of the disease, which may partly due to the psychological impact of pandemic on the general perception of health particular in patients with chronic diseases. Since this discrepancy may have consequences on disease management, and particularly on treatment adherence, there is a need to promote studies to better understand the reasons for these discrepancies and to improve the patient perception of their disease particularly in difficult situations such as COVID 19 pandemic.