PSYCHOLOGICAL ASSESSMENT in PATIENTS with CHRONIC RHEUMATIC, SYSTEMIC AUTOIMMUNE, or AUTOINFLAMMATORY DISEASES PRESENTED with COVID-19: The MENTCOVRMD STUDY

ABSTRACT

Background: The COVID-19 pandemic has raised concerns about its psychological effects. Sleep disturbances, anxiety and/or depressive symptoms, post-traumatic stress symptoms have been reported in general population. Patients with chronic rheumatism, systemic autoimmune disease or auto-infam-matory disease, due to immunosuppression, are at risk of severe forms of infection. Currently, there is little information on psychological impact of the pandemic on the mental health of these more vulnerable patients. Objectives: To compare psychological assessment between patients with chronic rheumatic, autoimmune and/or autoinfammatory diseases who presented with COVID-19 infection between March and September 2020, frst wave of French pandemic, and patients with same diseases who did not presented with infection to date. Methods: The MentCOVRMD study was a multicenter descriptive study. Cases were patients with chronic rheumatic, autoimmune and/or autoinfammatory diseases from the French RMD cohort who presented COVID-19 infection between March and September 2020. Controls were patients with same diseases who did not develop infection. The study is registered in Clinical Trials under number 2020-A02058-31. For participants, following criteria were collected demographics (age, gender, smoking status);psychological assessment questionnaires Insomnia Severity Index (ISI);Post-traumatic stress disorder (PTSD) checklist;Patient Health Questionnaire (PHQ9) Depression;Generalized Anxiety Disorder (GAD7) Anxiety;Patient Health Questionnaire-15 (PHQ-15) and Somatic Symptom Disorder (SSD)-12. Results: Between February and December 2021, 60 cases (46 (76.7%) women), median age 52.0 (39.0;63.0) were included, of which 15 (25%) had been hospitalized during infection, and 169 controls (148 (87.6%) women), median age of 52.0 (38.0;63.0). There were more smokers in the group of cases 12 (20%) than controls 14 (9.1%) (p=0.028) as well as more cases on ARA2 treatment (8 (13.3%)) than controls (7 (4.5%)) (p=0.035) with no statistically signifcant difference in others comorbidities or treatments. There was no statistically difference concerning the ISI scores between cases (11.83 ± 7.31) of which 60% had sleep disorders and controls (11.64 ± 6.82) of which 70.4% had sleep disorders. There was no statistically significant difference in PTSD scores of 15.5 (5.0 to 28.0) for cases and 18.0 (8.0 to 35.0) for controls, of which respectively 12 (20%) had values indicating possible PTSD for cases and 50 (29.6%) for controls. There was no statistically significant difference in PHQ-9 scores (5.5 (1.5 to 11.0)) of which 50% had depressive symptoms and controls (6.0 (2.0 to 11.0)) of which 54.5% had symptoms. There was no statistically significant difference in GAD-7 scores (3.5 (0.0 to 8.0)) of which 40% had anxiety symptoms and controls (4.0 (0.0 to 8.0)) of which 43.2% had symptoms. There was no statistically significant difference in PHQ-15 scores (11.4 ± 6.7), 85% of whom reported presence of symptoms, and controls (10.9 ± 6.2), 82.3% of whom reported symptoms. There was no statistically significant difference in SSD scores between cases (17.7 ± 10.9) and controls (18.4 ± 10.9). There was a statistically signifcant difference in reported VAS scores of pain related to infammatory rheumatism in cases with a median of 4.5 (3.0 to 6. 0) compared to controls with a median of 4.0 (1.0 to 6.0) (p=0.011). There was no statistically signifcant difference in any of the psychological assessment scores between the inpatient and outpatient COVID cases. Conclusion: There was no statistically signifcant difference between COVID cases and controls in the evaluation of these psychological parameters. Prevalence of all these variables were high in the whole study population, testifying to the need to manage these psychological aspects for patients with chronic rheumatisms, autoimmune and/or autoinfammatory diseases.