COVID-19 pandemic led to fewer initial rheumatology visits, autoimmunity lab tests
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The COVID-19 pandemic brought with it a significant decrease in autoimmunity laboratory testing, first rheumatology visits and diagnoses from 2019 to 2020, according to Italian data published in The Journal of Rheumatology.
However, the researchers also noted that the percentage of positive test results and new diagnoses related to more severe autoimmune rheumatic diseases increased during the pandemic, suggesting successful efforts to better prioritize laboratory tests and visits, they said.
“While volume increases for laboratory tests related to COVID-19 diagnostics were observed, autoimmunity testing volume decreased worldwide,” Teresa Carbone, PhD, of the Laboratory of Clinical Pathology at the Health Authority of Matera, in Italy, and colleagues wrote. “Autoantibodies are key serological markers to screen for and support the diagnosis of autoimmune rheumatological disease (ARD). Early diagnosis of ARD is important in order to improve long-term outcome. The situation was extremely challenging for laboratory staff, clinical rheumatologists and rheumatological patients themselves.”
“Data regarding the impact of the COVID-19 outbreak on the numbers of autoimmunity tests and on rheumatological diagnosis of ARD are lacking,” they added. “Understanding the impacts of the pandemic on specialistic activities is crucial for future planning in both the immediate and longer term.”
To analyze the pandemic’s impact on rheumatology clinic practices and autoimmunity testing demands, Carbone and colleagues studied data from the Regional San Carlo Hospital, in Potenza, Italy. According to the researchers, Regional San Carlo is the largest hospital in the Basilicata region and the leading center for autoimmune rheumatic disease in the area. Focusing on the period from January 2020 to December 2020, the researchers collected data on first rheumatology visits, new diagnoses and autoimmunity laboratory testing volumes, and compared them to those during 2019.
Diagnoses included in the analysis were rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, other SpA, systemic lupus erythematosus, systemic sclerosis, Sjögren's syndrome, polymyositis/dermatomyositis, undifferentiated connective tissue disease/mixed connective tissue disease, antiphospholipid syndrome, osteoarthritis, microcrystalline arthropathies, osteoporosis, fibromyalgia, juvenile idiopathic arthritis, polymyalgia rheumatica, Behçet's syndrome, vasculitis and other regional syndromes, skin diseases without systemic involvement and peripheral neuropathies.
Meanwhile, data on laboratory tests included anti-nuclear antibodies, anti-extractable nuclear antigens antibodies, anti-ds-DNA antibodies, rheumatoid factor, anti-citrullinated protein antibodies, and anti-neutrophil cytoplasmic antibodies, including myeloperoxidase and serine proteinase 3 antibodies.
According to the researchers, there were 9,912 autoimmunity laboratory tests performed in 2020, compared with 14,100 in 2019 (P < .05). The number of first rheumatology visits and diagnoses also decreased, from 2,336 in 2019 to 1,272 in 2020 (P < .05).
However, the hospital recorded an equivalent or higher percentage of positive autoimmunity tests from outpatient services during 2020 compared with 2019. The researchers also noted that the pandemic-related decline in new diagnoses primarily affected less severe cases. In contrast, autoimmune rheumatic disease cases with systemic involvement were diagnosed at similar levels before and during the pandemic.
“This study provides important insights regarding the appropriateness of autoimmunity laboratory testing and of outcomes of prioritization strategies with face-to-face rheumatological visits developed during the COVID-19 outbreak,” Carbone and colleagues wrote. “Our data could be also useful to better manage the inappropriateness of ARD diagnostic pathway in the daily clinical practice as well as in a future pandemic setting. In conclusion, although there were challenges for clinical practice during the COVID-19 pandemic, safe and high-quality health care was maintained for patients with severe ARD.”
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