Brief halt on in-person visits did not adversely impact inflammatory arthritis
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Short interruptions in face-to-face rheumatology visits due to COVID-19 considerations resulted in no major negative effects for patients with inflammatory arthritis, according to findings published in Annals of the Rheumatic Diseases.
“The ongoing COVID-19 pandemic remains an important health care challenge,” Adrian Ciurea, MD, of Zurich University Hospital, in Switzerland, and colleagues wrote. “Data on the course of inflammatory rheumatic diseases during the pandemic are scarce. Partial or complete closure of rheumatology services was experienced in many countries as part of virus containment measures and transient lockdown of public life. It remains unclear whether remote consultation strategies might partly compensate for lower numbers of face-to-face visits to prevent a postponement of treatment decisions.”
“Additional factors may also potentially contribute to disease worsening during the pandemic,” they added. “Some patients may choose to preventively stop immunosuppression out of fear of complications. Moreover, the psychological stress (anxiety about a new disease, economic pressure, less recreational opportunities and so on) encountered during the pandemic should not be underestimated.”
To analyze whether the temporary halt in face-to-face rheumatology visits, imposed due to COVID-19 containment procedures, were linked with worsening disease among patients with inflammatory arthritis, Ciurea and colleagues examined three periods of time — before, during and after the pandemic’s wave through Switzerland. Each period was 2 months in duration, with the before phase defined as Jan. 1 to Feb. 29, and the “after” phase stretching from May 1 to June 30.
The researchers examined data on 666 patients with axial spondyloarthritis, rheumatoid arthritis and psoriatic arthritis from the Swiss Clinical Quality Management cohort. Patient-reported disease activity was assessed during the three study periods during face-to-face visits or through a smartphone application. Assessments included the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5) and the Patient Global Assessment (PGA) visual analogue scale for disease activity in PsA, both during in-person visits and for app entries.
According to the researchers, in-person visits decreased by 52% while remote assessments via the smartphone app increased 129%. The percent of patients who were noncompliant with drugs increased slightly during the pandemic, although the difference was statistically significant only in those with axial SpA — 19.9% compared with 13.2% prior to the COVID-19 wave (P = .003). Meanwhile, the rate of patients with disease flares remained stable, at less than 15%, and there was no increase in mean BASDAI, RADAI-5 or PGA values.
“The results presented here can only be interpreted in the context of a rather short first COVID-19 pandemic wave as encountered in Switzerland,” Ciurea and colleagues wrote. “A recent international survey in 35 EULAR (European League Against Rheumatism) countries found that a partial closure of rheumatology services of 5-8 weeks duration during the COVID-19 pandemic was reported by 81% of 1,428 respondents, underscoring the representativeness of our data.”
They added: “A temporary interruption of in person consultations during the COVID-19 pandemic had no major detrimental impact on the disease course of patients with inflammatory rheumatic diseases as assessed through patient-reported outcomes.”
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