Rheumatic patients often avoided office visits in early months of COVID-19 pandemic
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Patients with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and lupus often avoided office visits and lab testing in the early months of the COVID-19 pandemic, according to data published in The Journal of Rheumatology.
In addition, patients who avoided visits commonly ceased disease-modifying antirheumatic drug treatments without the advice of a physician. These interruptions were associated with lower socioeconomic status, no office visits and limited telehealth availability, the researchers wrote.
“In this study, we were interested in understanding how the COVID-19 pandemic has affected people with autoimmune conditions, especially how it has led to disruptions in healthcare and medication interruptions,” Michael D. George, MD, MSCE, of the University of Pennsylvania, told Healio Rheumatology.
To examine the concerns and health-related behaviors of patients with rheumatic autoimmune diseases throughout the early days of the COVID-19 pandemic in the United States, George and colleagues surveyed individuals from the ArthritisPower Patient-Powered Research Network and the CreakyJoints patient community. According to the researchers, the ArthritisPower Patient-Powered Research Network is an online registry of patients with inflammatory arthritis and other rheumatic conditions, created through a partnership between the Global Healthy Living Foundation, the advocacy group CreakyJoints and the University of Alabama at Birmingham.
All participants were asked to complete an online survey. For this study, the researchers analyzed responses from 1,517 adults with RA, PsA, AS or systemic lupus erythematosus who completed the survey from March 29 to May 26. Question topics included concerns and behaviors, DMARD use and demographic measures, such as income, education, COVID-19 activity and geographic location.
According to the researchers, concerns regarding COVID-19 were similar across the country but were generally higher among biologic users (P < .001). In addition, avoiding office visits (56.6%) and laboratory testing (42.3%), as well as using telehealth (29.5%), were more common in urban areas. Among patients without COVID-19 or other respiratory illness who were prescribed DMARDs, 14.9% ceased DMARD use. In all, 78.7% of DMARD interruptions were not recommended by a physician.
Ceasing DMARDs was more common among patients with lower socioeconomic status and those who avoided an office visit (OR = 1.46; 95% CI, 1.04-2.04), as well as participants without telehealth availability (OR = 2.26; 95% CI, 1.25-4.08).
“Many patients avoided office visits and routine testing, and patients who avoided office visits or who did not have telehealth available to them were much more likely to stop one of their medications,” George said. “We also found that lower socioeconomic status was associated with more medication interruptions. Our findings show how important it is for clinicians to physicians to communicate with patients, especially patients who have missed visits and vulnerable populations who may be disproportionately affected by the pandemic.”
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