STRESS-ASSOCIATED INCREASES in RHEUMATOID ARTHRITIS DISEASE ACTIVITY and FLARES during the COVID-19 PANDEMIC

ABSTRACT

Background: The novel coronavirus disease 2019 (COVID-19) pandemic has spurred global action. Beginning in March of 2020, the Southern California COVID-19 pandemic response to limit virus transmission was characterized by mandated lockdowns and quarantines, resulting in signifcant stressors for rheumatology patients and potentially threatening their disease. Objectives: To examine factors associated with changes in rheumatoid arthritis (RA) disease activity and fares in the COVID-19 pandemic. Methods: RA patients identifed by ICD-9/10 codes and active email addresses within a University of California, Los Angeles (UCLA) Rheumatology database were sent surveys via email in July and November of 2020. The survey was UCLA Institutional Review Board approved and included electronic consent and questions related to perceptions of disease activity/remission via Routine Assessment of Patient Index Data 3 (RAPID3), fare frequency, RA fare questionnaire (RA-FQ), Perceived Stress Scale (PSS-4), and pandemic impact on stress (I.e. emotional state, apprehension, panic, helplessness, work, home, fnancial, and social distancing stress). Demographics were extracted from electronic medical records. Results were examined via descriptive analyses, Pearson correlations, and chi-square test for comparisons plus linear stepwise regressions where appropriate to evaluate the relationship between stress measures, RA disease activity, and fare frequency and severity. Results: Among 5037 patients surveyed, 361 in July and 4676 in Novem-ber,1128 (22.4%) responded. The study population demographics were mean age of 57.5 ± 15.1 years, 79.4% female, racially diverse (69.6% Caucasian, 13.7 % LatinX, 9.5 % Asian, and 4.9% Black), and 62% seropositive (CCP and/or RF). Perceived disease activity and remission remained stable in most patients with 719 reporting no fares, and 409 in current fares at the time of the survey (Table 1). A minority reported perceived increases in disease activity which were associated with multiple aspects of perceived stress. At survey completion, 346 had not experienced fares, 290 had experienced one fare, and 492 had experienced multiple fares. Use of DMARDs was associated with lack of fare versus current fare (77.8% versus 71.6%, p = 0.02). The use of conventional synthetic, biologic, or targeted synthetic DMARDs were not associated with fare while current corticosteroid use was associated with fare (9.3% without fare and 20.8% with fare, p < 0.0001). Current fare was associated with increased PSS-4 scores (odds ratio (OR) 1.17 (95% confdence interval 1.12-1.22, p < 0.0001). Figure 1 describes the odds ratio of experiencing aspects of stress with the presence of RA fare. Conclusion: In a large survey population of RA patients during the COVID-19 pandemic, multiple aspects of stress were found to correlate with RA disease activity and fare.