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Dehghan Nayeri N, Fooladzadeh Dehghan M. Exploring the Experiences of Patients with Autoimmune Skin Diseases During the COVID-19 Pandemic. Adv Skin Wound Care 2024; 37:1-6. [PMID: 38506584 DOI: 10.1097/asw.0000000000000119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To explore the experiences of patients with an autoimmune disease during the COVID-19 pandemic. METHODS A total of 12 patients with autoimmune skin disease who were hospitalized in dermatology wards between 2021 and 2022 participated in this qualitative study. The researchers conducted in-depth, semi-structured interviews, which they analyzed using conventional content analysis. RESULTS Data analysis revealed three main themes: changes in mental/psychological status, social impacts and financial problems, and physical consequences. These patients reported changes in mental/psychological status as their most important experiences. CONCLUSIONS During a pandemic, it is important to manage the therapeutic course of patients who are at risk of infection, especially patients with autoimmune skin diseases, via appropriate planning.
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Affiliation(s)
- Nahid Dehghan Nayeri
- Nahid Dehghan Nayeri, PhD, is Professor, Nursing and Midwifery Care Research Centre, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Mohsen Fooladzadeh Dehghan, MSN, is Practical Nurse and PhD Candidate, Medical-Surgical Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Barber CEH, Lethebe BC, Szostakiwskyj JH, Barnabe C, Barber MRW, Katz S, England BR, Hazlewood GS. A population-based analysis of rheumatology care patterns for inflammatory arthritis during COVID-19 in Alberta, Canada. Semin Arthritis Rheum 2024; 65:152364. [PMID: 38237230 DOI: 10.1016/j.semarthrit.2024.152364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The aim of the study was to understand the impact of the COVID-19 pandemic on inflammatory arthritis (IA) rheumatology care in Alberta, Canada. METHODS We used linked provincial health administrative datasets to establish an incident cohort of individuals with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and Ankylosing Spondylitis (AS) seen at least once by a rheumatologist. We examined incidence rates (IR) per 100,000 population, and patterns of follow-up care between 2011 and 2022. In a subset of individuals diagnosed five years prior to the pandemic, we report on those lost to follow-up during the pandemic, and those with virtual care visits followed by in-person visit within 30 days. Multivariable logistic regression was used to examine patient characteristics associated with these patterns of care. RESULTS The IR for RA in 2020 declined compared to previous years (44.6), but not for AS (9.2) or PsA (9.1). In 2021 IRs rose (RA 49.5; AS 11.8; PsA 11.8). Among those diagnosed within 5 years of the pandemic, 632 (6.0 %) were lost to follow-up, with characteristics of those lost to follow-up differing between IA types. 1444 individuals had at least one virtual visit followed within 30 days by an in-person follow-up. This was less common in males (OR 0.69-0.79) and more common for those with a higher frequency of physician visits prior to the pandemic (OR 1.27-1.32). CONCLUSION Impacts of patterns of care during the pandemic should be further explored for healthcare planning to uphold optimal care access and promote effective use of virtual care.
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Affiliation(s)
- Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada.
| | - Brendan Cord Lethebe
- Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Megan R W Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Steven Katz
- Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Bryant R England
- VA Nebraska-Western Iowa Health Care System & University of Nebraska Medical Center, Omaha, NE, USA
| | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
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Hsieh E, Dey D, Grainger R, Li M, Machado PM, Ugarte-Gil MF, Yazdany J. Global Perspective on the Impact of the COVID-19 Pandemic on Rheumatology and Health Equity. Arthritis Care Res (Hoboken) 2024; 76:22-31. [PMID: 37277949 DOI: 10.1002/acr.25169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Abstract
Although the public health emergency associated with the COVID-19 pandemic has ended, challenges remain, especially for individuals with rheumatic diseases. We aimed to assess the historical and ongoing effects of COVID-19 on individuals with rheumatic diseases and rheumatology practices globally, with specific attention to vulnerable communities and lessons learned. We reviewed literature from several countries and regions, including Africa, Australia and New Zealand, China, Europe, Latin America, and the US. In this review, we summarize literature that not only examines the impact of the pandemic on individuals with rheumatic diseases, but also research that reports the lasting changes to rheumatology patient care and practice, and health service use. Across countries, challenges faced by individuals with rheumatic diseases during the pandemic included disruptions in health care and medication supply shortages. These challenges were associated with worse disease and mental health outcomes in some studies, particularly among those who had social vulnerabilities defined by socioeconomic, race, or rurality. Moreover, rheumatology practice was impacted in all regions, with the uptake of telemedicine and changes in health care utilization. While many regions developed rapid guidelines to disseminate scientific information, misinformation and disinformation remained widespread. Finally, vaccine uptake among individuals with rheumatic diseases has been uneven across the world. As the acute phase of the pandemic wanes, ongoing efforts are needed to improve health care access, stabilize rheumatology drug supplies, improve public health communication, and implement evidence-based vaccination practices to reduce COVID-19 morbidity and mortality among individuals with rheumatic diseases.
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Affiliation(s)
- Evelyn Hsieh
- Yale School of Medicine, New Haven, Connecticut, and VA Connecticut Healthcare System, West Haven, Connecticut
| | - Dzifa Dey
- Korle-bu Teaching Hospital and the University of Ghana Medical School, Accra, Ghana
| | | | - Mengtao Li
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, and Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Pedro M Machado
- University College London, NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, Northwick Park Hospital, and London North West University Healthcare NHS Trust, London, UK
| | - Manuel F Ugarte-Gil
- Universidad Científica del Sur and Hospital Nacional Guillermo Almenara Irigoyen - EsSalud, Lima, Perú
| | - Jinoos Yazdany
- San Francisco General Hospital and University of California, San Francisco
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Horton DB, Yang Y, Neikirk A, Huang C, Crystal S, Davidow A, Haynes K, Gerhard T, Rose CD, Strom BL, Parlett L. Impact of the COVID-19 Pandemic on the Management of Juvenile Idiopathic Arthritis: Analysis of United States Commercial Insurance Data. J Clin Rheumatol 2023; 29:388-395. [PMID: 37798830 PMCID: PMC10843854 DOI: 10.1097/rhu.0000000000002035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
BACKGROUND/OBJECTIVE Given limited information on health care and treatment utilization for juvenile idiopathic arthritis (JIA) during the pandemic, we studied JIA-related health care and treatment utilization in a commercially insured retrospective US cohort. METHODS We studied rates of outpatient visits, new disease-modifying antirheumatic drug (DMARD) initiations, intra-articular glucocorticoid injections (iaGC), dispensed oral glucocorticoids and opioids, DMARD adherence, and DMARD discontinuation by quarter in March 2018-February 2021 (Q1 started in March). Incident rate ratios (IRR, pandemic vs prepandemic) with 95% confidence intervals (CIs) were estimated using multivariable Poisson or Quasi-Poisson models stratified by diagnosis recency (incident JIA, <12 months ago; prevalent JIA, ≥12 months ago). RESULTS Among 1294 children diagnosed with JIA, total and in-person outpatient visits for JIA declined during the pandemic (IRR, 0.88-0.90), most markedly in Q1 2020. Telemedicine visits, while higher during the pandemic, declined from 21% (Q1) to 13% (Q4) in 2020 to 2021. During the pandemic, children with prevalent JIA, but not incident JIA, had lower usage of iaGC (IRR, 0.60; 95% CI, 0.34-1.07), oral glucocorticoids (IRR, 0.47; 95% CI, 0.33-0.67), and opioids (IRR, 0.44; 95% CI, 0.26-0.75). Adherence to and discontinuation of DMARDs was similar before and during the pandemic. CONCLUSIONS In the first year of the pandemic, visits for JIA dropped by 10% to 12% in commercially insured children in the United States, declines partly mitigated by use of telemedicine. Pandemic-related declines in intra-articular glucocorticoids, oral glucocorticoids, and opioids were observed for children with prevalent, but not incident, JIA. These changes may have important implications for disease control and quality of life.
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Affiliation(s)
- Daniel B. Horton
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | | | | | - Cecilia Huang
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
| | - Stephen Crystal
- Rutgers Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
- Rutgers School of Social Work, New Brunswick, NJ, USA
| | - Amy Davidow
- New York University School of Global Public Health, New York, NY, USA
| | - Kevin Haynes
- Janssen Research & Development, Titusville, NJ, USA
| | - Tobias Gerhard
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, New Brunswick, NJ, USA
| | | | - Brian L. Strom
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
- Rutgers Biomedical and Health Sciences, Newark, NJ, USA
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Striani G, Hoxha A, Lorenzin M, Cozzi G, Scagnellato L, Vangelista T, Frizzera F, De Sandre P, Simioni P, Doria A, Ramonda R. The impact of SARS-CoV-2 infection and vaccination on inflammatory arthritis: a cohort study. Front Immunol 2023; 14:1207015. [PMID: 37564642 PMCID: PMC10410443 DOI: 10.3389/fimmu.2023.1207015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
Objectives To investigate the effects of SARS-CoV-2 infection, as well as short- (within 48 hours) and long-term (within 30 days) adverse events (AEs) of SARS-CoV-2 vaccines, including arthritis flares in a large cohort of patients with inflammatory arthritis (IA). Methods A retrospective cohort study comprising 362 patients: 94 (26%) rheumatoid arthritis, 158 (43.6%) psoriatic arthritis and 110 (30.4%) ankylosing spondylitis; and 165 healthy controls (HC) to ascertain the prevalence and severity of SARS-CoV-2 infection in patients with IA, the rate of AEs associated with SARS-CoV-2 vaccines and disease flares within a month of the vaccination. All patients provided informed consent and data about SARS-CoV-2 infection and/or vaccination status. Results One-hundred-seventeen (32.3%) patients and 39 (23.6%) HC were affected by SARS-CoV-2 infection. Forty (34.2%) patients experienced an IA flare within one month of infection, of whom 3 (7.5%) needed to switch therapy. The prevalence of SARS-CoV-2 infection, disease severity, and hospitalization rate were not significantly different. At least one shot of SARS-CoV-2 vaccine was administered in 331 (91.4%) patients and 147 (89.1%) HC. Within 48 hours, 102 (30.8%) patients developed vaccine-related AEs; 52 (15.7%) patients with >1 vaccine dose experienced an IA flare-up, of whom 12 (23.1%) needed to switch therapy. Conclusions A significantly higher rate of IA flare was observed among patients who contracted SARS-CoV-2 infection vs. those without infection. Patients with IA experienced flares after SARS-CoV-2 vaccination, though it was not statistically significant.
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Affiliation(s)
- Giovanni Striani
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Ariela Hoxha
- General Internal Medicine and Thrombotic and Hemorrhagic Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Giacomo Cozzi
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Laura Scagnellato
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | | | - Francesca Frizzera
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Pierino De Sandre
- Internal Medicine Unit, Department of Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Hemorrhagic Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
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Ursini F, Ruscitti P, Addimanda O, Foti R, Raimondo V, Murdaca G, Caira V, Pigatto E, Cuomo G, Lo Gullo A, Cavazzana I, Campochiaro C, Naclerio C, De Angelis R, Ciaffi J, Mancarella L, Brusi V, Marchetti E, Motta F, Visentini M, Lorusso S, De Santis M, De Luca G, Massaro L, Olivo D, Pellegrini R, Francioso F, Luppino J, Di Cola I, Foti R, Varcasia G, Caso F, Reta M, Dagna L, Selmi C, Iagnocco A, Giacomelli R, Iannone F, Ferri C. Inflammatory rheumatic diseases with onset after SARS-CoV-2 infection or COVID-19 vaccination: a report of 267 cases from the COVID-19 and ASD group. RMD Open 2023; 9:e003022. [PMID: 37328292 DOI: 10.1136/rmdopen-2023-003022] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVES To better define the spectrum of new-onset post-COVID-19 and post-COVID-19 vaccine inflammatory rheumatic diseases (IRD) from a large multicentric observational study. METHODS Consecutive cases of IRD encountered during a 12-month period and satisfying one of the following inclusion criteria: (a) onset of the rheumatic manifestations within 4 weeks from SARS-CoV-2 infection or (b) onset of the rheumatic manifestations within 4 weeks from the administration of one of the COVID-19 vaccines ws recruited. RESULTS The final analysis cohort comprised 267 patients, of which 122 (45.2%) in the post-COVID-19 and 145 (54.8%) in the postvaccine cohort. Distribution of IRD categories differed between the two cohorts: the post-COVID-19 cohort had a higher percentage of patients classified as having inflammatory joint diseases (IJD, 52.5% vs 37.2%, p=0.013) while the post-vaccine cohort had a higher prevalence of patients classified as polymyalgia rheumatica (PMR, 33.1% vs 21.3%, p=0.032). No differences were detected in the percentage of patients diagnosed with connective tissue diseases (CTD 19.7% vs 20.7%, p=0.837) or vasculitis (6.6% vs 9.0%, p=0.467). Despite the short follow-up period, IJD and PMR patients' response to first-line therapy was favourable, with both groups achieving a drop in baseline disease activity scores of ~30% and ~70% respectively. CONCLUSION Our article reports the largest cohort published to date of new-onset IRD following SARS-CoV-2 infection or COVID-19 vaccines. Although causality cannot be ascertained, the spectrum of possible clinical manifestations is broad and includes IJD, PMR, CTD and vasculitis.
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Affiliation(s)
- Francesco Ursini
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Piero Ruscitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Olga Addimanda
- UO Interaziendale Medicina Interna ad Indirizzo Reumatologico, AUSL BO-IRCCS AOU BO, Bologna, Italy
| | - Rosario Foti
- Unit of Rheumatology, Department of Medicine, ARNAS Garibaldi Hospital, Catania, Italy
| | - Vincenzo Raimondo
- Rheumatology Unit, Rheumatology Hospital 'Madonna dello Scoglio', Cotronei, Italy
| | - Giuseppe Murdaca
- Department of Internal Medicine, Ospedale Policlinico San Martino, Genoa, Italy
| | - Virginia Caira
- UO Reumatologia, Ospedale di Castrovillari, Castrovillari, Italy
| | - Erika Pigatto
- Rheumatology Outpatient Clinic, Ospedale Villa Salus, Mestre, Italy
| | - Giovanna Cuomo
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Alberto Lo Gullo
- Unit of Rheumatology, Department of Medicine, ARNAS Garibaldi Hospital, Catania, Italy
| | - Ilaria Cavazzana
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Rossella De Angelis
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Ciaffi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luana Mancarella
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Veronica Brusi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elena Marchetti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesca Motta
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marcella Visentini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Sebastiano Lorusso
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research and Clinical Unit of Immunorheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico, Rome, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Laura Massaro
- Rheumatology Outpatient Clinic, ASP Cosenza, Scalea, Italy
| | - Domenico Olivo
- Rheumatology Outpatient Clinic, ASP Crotone, Crotone, Italy
| | - Roberta Pellegrini
- UOC Medicina Interna 'M.Valentini', Presidio Ospedaliero 'Annunziata', Cosenza, Italy
| | - Francesca Francioso
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Jessica Luppino
- Rheumatology Unit, Rheumatology Hospital 'Madonna dello Scoglio', Cotronei, Italy
| | - Ilenia Di Cola
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roberta Foti
- Unit of Rheumatology, Department of Medicine, ARNAS Garibaldi Hospital, Catania, Italy
| | | | - Francesco Caso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Massimo Reta
- UO Interaziendale Medicina Interna ad Indirizzo Reumatologico, AUSL BO-IRCCS AOU BO, Bologna, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - Roberto Giacomelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research and Clinical Unit of Immunorheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico, Rome, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Precision and Regenerative Medicine-Ionian Area, University of Bari "Aldo Moro", Bari, Italy
| | - Clodoveo Ferri
- Rheumatology Unit, Rheumatology Hospital 'Madonna dello Scoglio', Cotronei, Italy
- Rheumatology Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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Managing immunosuppression in vasculitis patients in times of COVID-19. Rheum Dis Clin North Am 2023. [PMCID: PMC10011035 DOI: 10.1016/j.rdc.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Mungmunpuntipantip R, Wiwanitkit V. Medication interruptions during the COVID-19 pandemic: comment on the article by Dharia et al. Arthritis Care Res (Hoboken) 2022; 74:2119. [PMID: 35970761 DOI: 10.1002/acr.24852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 02/05/2023]
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Shaw YP, Hustek S, Nguyen N, Starlin M, Wipfler K, Wallace BI, Michaud K. Rheumatic disease patient decision-making about COVID-19 vaccination: a qualitative analysis. BMC Rheumatol 2022; 6:76. [PMID: 36443813 PMCID: PMC9706890 DOI: 10.1186/s41927-022-00307-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although patients with rheumatic and musculoskeletal diseases (RMDs) are at increased risk for adverse outcomes of COVID-19 illness compared to healthy controls, they also have lower rates of willingness to be vaccinated. Previous research has identified reasons for vaccine hesitancy among patients with RMDs (such as concerns about side effects and flares), but little is known about what these reasons mean in the context of patients' lives, or how vaccine decision making is experienced from a patient perspective. Our objective was to describe decision-making about COVID-19 vaccination among RMD patients. METHODS Participants in a RMD registry were invited to complete monthly online surveys regarding COVID-19 vaccination from March-June 2021. We qualitatively analyzed comments from two open-ended survey questions reporting general experiences with vaccination and side effects. Comments were coded for attitudes towards COVID-19 vaccination, vaccine access, rheumatologic medication management around vaccination, and vaccine side effects. Themes were identified for the process and context of COVID-19 vaccine decisions, patient motivations for receiving or avoiding vaccination, and consistency of peri-vaccine medication management with current ACR guidelines. RESULTS We analyzed 710 comments from 537 respondents. Commenting respondents had a mean age of 64 years, were 87% female, 94% white, and 93% received/intended to receive ≥ 1 dose of a COVID-19 vaccine. Desire for protection and a return to normal routines motivated some commenters to get vaccinated, while concerns about vaccine side effects motivated others to delay or avoid vaccination. Several commenters reported disease flares following vaccination. Some commenters did not consult their providers about vaccination and failed to withhold immunomodulatory medications during vaccination, while others withheld medications more conservatively than recommended by current ACR guidelines, either on their own or directed by their provider. CONCLUSIONS While most commenters were vaccine-accepting, challenges to COVID-19 vaccine uptake in the RMD population may include fears of side effects, including worsened RMD symptoms, and perceptions that vaccination is unnecessary. Addressing these concerns and beliefs may be critical for promoting vaccination in this population.
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Affiliation(s)
- Yomei P Shaw
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | - Sara Hustek
- University of Michigan Division of Rheumatology, Ann Arbor, MI, USA
| | - Nina Nguyen
- University of Michigan Division of Rheumatology, Ann Arbor, MI, USA
| | | | - Kristin Wipfler
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | - Beth I Wallace
- University of Michigan Division of Rheumatology, Ann Arbor, MI, USA
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Kaleb Michaud
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA.
- University of Nebraska Medical Center, Omaha, NE, USA.
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10
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Belov BS, Egorova ON, Tarasova GM, Muravieva NV. Infections and systemic vasculitis. MODERN RHEUMATOLOGY JOURNAL 2022. [DOI: 10.14412/1996-7012-2022-5-75-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Infections and systemic vasculitis (SV) are characterized by mutual influence, which increases the risk of occurrence, aggravates the course and outcome of the disease. The review considers the issues related to both the trigger role of infections in the development of SV and comorbid infections (CI) that complicate the course of the disease. Recognition of the infectious etiology of SV is of great importance, since it requires a comprehensive examination and, if necessary, early and complete etiotropic treatment. Since SV per se and the use of both induction and maintenance immunosuppressive therapy are significant risk factors for secondary CIs, special attention should be paid to the prevention of the latter, including vaccination, primarily against influenza and pneumococcal infections.
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Affiliation(s)
- B. S. Belov
- V.A. Nasonova Research Institute of Rheumatology
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11
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Theofilis P, Vordoni A, Koukoulaki M, Vlachopanos G, Kalaitzidis RG. Overview of infections as an etiologic factor and complication in patients with vasculitides. Rheumatol Int 2022; 42:759-770. [PMID: 35165771 PMCID: PMC8853270 DOI: 10.1007/s00296-022-05100-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/29/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Panagiotis Theofilis
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece
| | - Aikaterini Vordoni
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece
| | - Maria Koukoulaki
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece
| | - Georgios Vlachopanos
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece
| | - Rigas G Kalaitzidis
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece.
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Di Iorio M, Cook CE, Vanni KM, Patel NJ, D’Silva KM, Fu X, Wang J, Prisco LC, Kowalski E, Zaccardelli A, Martin LW, Qian G, Hsu TYT, Wallace ZS, Sparks JA. DMARD disruption, disease flare, and prolonged symptom duration after acute COVID-19 among participants with rheumatic disease: A prospective study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.02.08.22270696. [PMID: 35169813 PMCID: PMC8845434 DOI: 10.1101/2022.02.08.22270696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To describe disease-modifying antirheumatic drug (DMARD) disruption, rheumatic disease flare/activity, and prolonged COVID-19 symptom duration among COVID-19 survivors with systemic autoimmune rheumatic diseases (SARDs). METHODS We surveyed patients with SARDs after confirmed COVID-19 at Mass General Brigham to investigate post-acute sequelae of COVID-19. We obtained data on demographics, clinical characteristics, COVID-19 symptoms/course, and patient-reported measures. We examined baseline predictors of prolonged COVID-19 symptom duration (defined as lasting ≥28 days) using logistic regression. RESULTS We analyzed surveys from 174 COVID-19 survivors (mean age 52 years, 81% female, 80% White, 50% rheumatoid arthritis) between March 2021 and January 2022. Fifty-one percent of 127 respondents on any DMARD reported a disruption to their regimen after COVID-19 onset. For individual DMARDs, 56-77% had any change, except for hydroxychloroquine (23%) and rituximab (46%). SARD flare after COVID-19 was reported by 41%. Global patient-reported disease activity was worse at the time of survey than before COVID-19 (mean 6.6±2.9 vs. 7.6±2.3, p<0.001). Median time to COVID-19 symptom resolution was 14 days (IQR 9,29). Prolonged symptom duration of ≥28 days occurred in 45%. Hospitalization for COVID-19 (OR 3.54, 95%CI 1.27-9.87) and initial COVID-19 symptom count (OR 1.38 per symptom, 95%CI 1.17-1.63) were associated with prolonged symptom duration. Respondents experiencing prolonged symptom duration had higher RAPID3 scores (p=0.007) and more pain (p<0.001) and fatigue (p=0.03) compared to those without prolonged symptoms. CONCLUSION DMARD disruption, SARD flare, and prolonged symptom duration were common in this prospective study of COVID-19 survivors, suggesting substantial impact on SARDs after acute COVID-19.
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Affiliation(s)
- Michael Di Iorio
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Claire E. Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Kathleen M.M. Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Naomi J. Patel
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Kristin M. D’Silva
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Xiaoqing Fu
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Jiaqi Wang
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Lauren C. Prisco
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Emily Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alessandra Zaccardelli
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Lily W. Martin
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Tiffany Y-T. Hsu
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Zachary S. Wallace
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey A. Sparks
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
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