Patients with autoimmune rheumatic disease less likely to avoid office visit due to COVID-19
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Patients with autoimmune rheumatic diseases are less likely to avoid an office visit or laboratory tests due to COVID-19 and were more likely to have telehealth visits, according to a speaker at ACR Convergence 2020.
“As the pandemic ramped up, we launched the Autoimmune COVID‐19 Project for patients with arthritis, vasculitis, multiple sclerosis, Crohn’s and colitis, to track the evolving impact of COVID‐19,” Michael George, MD, MCSE, an assistant professor of medicine and assistant professor of epidemiology at the University of Pennsylvania, and medical advisor to CreakyJoints, told Healio Rheumatology.
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“This project has and continues to collect data from patients who are part of online patient registries or patient communities as well as patients in a large community rheumatology practice network,” he added. “We knew that both doctors and people living with autoimmune conditions had concerns about how autoimmune disease and immunosuppressive medications might affect susceptibility to COVID‐19 and wanted to better understand the impact of the pandemic on patients.”
To examine COVID-related concerns and behaviors among patients with autoimmune rheumatic conditions, compared with those with non-autoimmune rheumatic conditions, George and colleagues conducted an online survey of adults across a multi-state rheumatology provider network. Conducted from April 22 to May 27, the survey was able to link with respondents’ demographic and diagnosis data from electronic health records.
The researchers limited their analyses for the autoimmune population to patients with a primary diagnosis of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis or systemic lupus erythematosus. The non-autoimmune population, meanwhile, included patients with osteoarthritis or osteoporosis, with no autoimmune rheumatic disease diagnoses or DMARD use. Comparisons between the two patient groups were performed using logistic regression, adjusting for demographics, rural residence and zip-code based measures of COVID-19 activity, income, and education.
A total of 18,219 respondents completed the survey, of whom 9,004 met the diagnosis criteria for study inclusion. Among these included patients, 7,176 had autoimmune rheumatic disease while 1,828 had non-autoimmune disease. In all, 353 included respondents reported respirator illnesses and 66 were diagnosed with COVID-19.
According to the researchers, patients expressed similar concerns regarding COVID-19, and similar social distancing behaviors, regardless of autoimmune status. Older age, female sex, Black race, urban residence and higher county COVID-19 cases per capita were associated with higher levels of concern (P < .001). Patients with autoimmune disease did however have greater concerns related to their specific rheumatic condition (P < .001). Among these patients, those with lupus, as well as those treated with biologics, JAK inhibitors or glucocorticoids, reported greater COVID-related concerns (P < .01).
Among the 5,543 patients who reported receiving a DMARD, 10.3% stopped a medication due to COVID-19 concerns. Patients with autoimmune disease were less likely to avoid an office visit or laboratory tests and were more likely to have had a telehealth visit (P < .01), compared to those with non-autoimmune disease.
“Our studies show that many patients living with autoimmune disease reacted to the ongoing pandemic by stopping one of their medications,” George said. “At the same time, routine health care visits were interrupted for many patients making it harder for patients and providers to communicate.”
“While guidance from the American College of Rheumatology has emerged recommending that medications not be interrupted if patients are well, many patients may not be aware of these recommendations,” he added. “Rheumatologists need to actively engage with their patients to ensure adequate follow‐up and address concerns specific to patients with autoimmune disease as the pandemic continues.”
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