The Impact of COVID-19 on Self-Management of Inflammatory Arthritis

The COVID-19 pandemic has affected many patients’ abilities to manage their inflammatory arthritis (IA), which may ultimately cause inadequate disease control, according to a study published in BMC Rheumatology.¹Physicians must recognize the importance of providing additional support to their patients during this time.

“The unprecedented nature of the COVID-19 pandemic provided a unique opportunity to explore how people living with IA (eg, rheumatoid arthritis, psoriatic arthritis, spondyloarthritis, connective tissue disease-related arthritis) are able to manage their condition whilst also observing lockdown restrictions,” investigators stated.

This qualitative sub-study conducted semi-structured telephone interviews between June 19, 2020, and July 22, 2020, with the option of a follow-up interview in November 2020. Of the 21 patients, 9 participated in the follow-up.

Eligible patients were aged 18 years or older, living in the United Kingdom, and had a diagnosis of an IA condition.

Questions focused on mental and physical health during the lockdown period, guidance received by healthcare providers, and the impact of COVID-19 on healthcare access and self-management behaviors.

Data was analyzed with inductive thematic analysis.

The mean age of participants was 50.1 years, 71% were female, and 86% were White British. IA conditions included rheumatoid arthritis (n = 3), psoriatic arthritis (n = 8), spondyloarthritis (n = 7), and connective tissue disease-related arthritis (n = 3) with a median disease duration of 7 years. Most patients (n = 19) were prescribed conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) (21%), biologic DMARDS (bDMARDs) (31.6%), or a combination (47.4%).

Four themes were identified:

1: Impact of COVID-19 on Medication Adherence

While most participants were adherent to their medications, those who were in contact with someone who had COVID-19 symptoms or those who experienced symptoms themselves were more likely to pause their immunosuppressant therapy for a short time. A smaller percentage of patients believed their medication would make them more susceptible to COVID-19, so they stopped taking their medicine without alerting their physician. Interestingly, patients with no concerns about medication usage reported that it was due to advice from their healthcare team. Data suggest that information and reassurance greatly reduced any worries about continuing medication during the pandemic. However, many patients felt they did not receive adequate information during the first lockdown.

2: Impact of COVID-19 on Physical Activity

Some patients reported that the lockdown had a positive effect on their exercise habits, and many were able to maintain this through the second lockdown. For these patients, the fewer work commitments meant they had more time to exercise and an opportunity to prioritize themselves. However, most patients indicated physical activity levels decreased during the lockdown, due in part to government restrictions that limited outside activity. Weather changes during the second lockdown may have contributed to further complications as patients were unable to exercise outdoors.

3: Impact of COVID-19 on Diet

While the diet of some participants remained consistent through both lockdown periods, some reported improved diet. For those who increased healthy eating habits, they noted having more time to plan and prepare meals. For most participants, however, the type and amount of food consumed had been worse during the first lockdown period in an attempt regulate their emotional responses to the pandemic through eating.

4: Impact of COVID-19 on Healthcare Access and Delivery

Most patients noted telemedicine was the biggest change to healthcare access, as well as having secondary care and blood tests cancelled or postponed until after the lockdown. Positive effects included participants reporting that their physicians seemed more receptive during telemedicine consultations and that telephone consultations saved time and may have long-term economic benefits for the healthcare system. Conversely, some patients had increased anxiety due to postponed blood monitoring and “unhelpful” virtual appointments. Additionally, the absence of a physical examination made certain patients feel uneasy.

A lack of ethnic diversity in the study may impact generalizability, especially when considering that Black, Asian or Minority Ethnic (BAME) groups are disproportionately affected by COVID-19. The lack of geographical diversity also limits the study, as particular parts of England have had higher infection rates and more lockdown restrictions. Lastly, only a small number of patients with rheumatoid arthritis (RA) were included in the study, even though RA is the most common IA. However, including patients with PsA strengthens the study, as little research has been done examining how this patient population has fared during the pandemic.

“Findings from this study suggest that COVID-19 had a substantial impact on patients’ abilities to manage their IA condition,” investigators concluded. “Future research would need to consider the longer-term impact of these behaviour changes on the health and wellbeing of IA patients and the impact this may have on public health services.”

Reference:

Caton E, Chaplin H, Carpenter L, et al. The impact of COVID-19 on self-management behaviours and healthcare access for people with inflammatory arthritis. BMC Rheumatol. 2021;5(1):58. Published 2021 Oct 18. doi:10.1186/s41927-021-00231-1