Mental health and quality of life for people with rheumatoid arthritis or ankylosing spondylitis in Aotearoa New Zealand following the COVID-19 national lockdown

Evaluation of Depression and Anxiety in Rheumatoid Arthritis Patients During COVID-19 Pandemic

Background

Rheumatoid arthritis (RA) disease activity, associated comorbidities, and therapy-related side effects impair the physical, social, and emotional dimensions of the patient's health. Presently, the ongoing COVID-19 pandemic has been associated with a broad range of psychosocial disorders in various populations. Patients with RA are especially vulnerable to such effects.

Objectives

Detect the prevalence of recent COVID-19 infection among patients with RA, assess depression and anxiety in these patients and their associated factors during the COVID-19 pandemic and their potential relation to disease activity.

Design and Methods

This is a cross-sectional study conducted on 120 adult Egyptian patients diagnosed with RA during the COVID-19 pandemic. The prevalence of recent COVID-19 infection among the patients was evaluated. The patients underwent psychological assessment using the Hamilton Depression Rating Scale (Ham-D) and the Hamilton Anxiety Rating Scale (Ham-A) to measure levels of depression and anxiety levels. The RA disease activity was assessed using Disease Activity Score (DAS) Das-28-ESR.

Results

This study encompasses a total of 120 RA patients. The prevalence of patients with a recent history of COVID-19 infection was 40.8%. Both groups exhibited significantly elevated mean scores on the Das-28-ESR scale and also scored higher on measures of depression and anxiety. Interestingly, the COVID-19 group exhibited a higher percentage of unmarried individuals, had educational attainment below the university level, and were unemployed. Patients with recent COVID-19 had significantly lower numbers of children, higher disease duration, higher Das-28-ESR scores, and elevated depression and anxiety scores. The statistical analysis revealed that the COVID-19 infection and disease duration were significant predictors of depression and anxiety. The results also exhibited that the depression score was positively correlated with age and DAS scores.

Conclusions

It was observed that patients diagnosed with RA revealed a higher prevalence of COVID-19 infection. The occurrence of depression and anxiety was observed to be widespread among patients diagnosed with RA and, more significantly, prevalent in RA patients who had a recent COVID-19 and had a higher level of disease activity. The occurrence of COVID-19 and disease duration were identified as factors that can anticipate the development of depression and anxiety.

Cardiovascular health worsening in patients with autoimmune rheumatological diseases during the COVID-19 pandemic

Rheumatic autoimmune diseases are associated with a myriad of comorbidities. Of particular importance due to their morbimortality are cardiovascular diseases. COVID-19 greatly impacted the world population in many different areas. Patients with rheumatic diseases had to face changes in their healthcare, in addition to unemployment, a decrease in physical activity, social isolation, and lack of access to certain medications. This review summarizes the impact of COVID-19 pandemic on cardiovascular risk factors, comorbidities, and unhealthy behaviors in patients with rheumatic inflammatory autoimmune diseases, particularly focused on rheumatoid arthritis and systemic lupus erythematosus. Searches were carried out in MEDLINE/PubMed and Scopus from August to December 2022. Four reviewers screened the title and abstract of retrieved records. Potentially eligible reports were then reviewed in full text. Differences were reconciled by either consensus or discussion with an external reviewer. During the COVID-19 pandemic, patients with rheumatic diseases showed an increase in the prevalence of mental health disorders (43.2-57.7%), reduced physical activity (56.8%), and a worsening in eating behaviors. Alcohol intake increased (18.2%), especially in early phases of the pandemic. Smoking prevalence decreased (28.2%). Dyslipidemia and hypertension showed no changes. The pandemic and lockdown affected rheumatic patients not only in disease-related characteristics but in the prevalence of their cardiovascular comorbidities and risk factors. Lifestyle changes, such as healthy eating, physical activity, and optimal management of their rheumatic diseases and comorbidities, are essential to manage the long-lasting consequences of the COVID-19 outbreak. Key Points • During the COVID-19 pandemic, anxiety, depression, sedentarism, obesity, and a worsening in eating behaviors increased. •Patients with rheumatic diseases and comorbidities have worse clinical outcomes and a higher cardiovascular disease burden than those without them. •Comparative studies are necessary to precisely elucidate the pandemic's impact on the prevalence of cardiovascular disease, risk factors, and comorbidities in patients with rheumatoid arthritis and systemic lupus erythematosus.

Tele-yoga in the management of ankylosing spondylitis amidst COVID pandemic: A prospective randomized controlled trial

PURPOSE

Ankylosing spondylitis (AS) signficantly affect day to day activities contributing to signficant disability. Patients with AS often report to have psychological problems and poor quality of life (QoL). This study investigates the effect of a three-month tele-yogic intervention on disease activity, functional index, inflammatory markers, quality of life and mental health measures in patients with AS.

METHODS

One hundred and twenty AS patients were assigned to either the yoga intervention group (YG) or the control group (CG). The YG (n = 57) received a 60-min structured yoga module online for 3 months in addition to standard medical care. The CG participants (n = 52) received only standard care during the same period. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis-Quality of Life (ASQOL) and psychological and inflammatory biomarkers were assessed at baseline and after three months.

RESULTS

YG showed significant improvement in BASDAI (p = 0.001), anxiety (p = 0.0004), and depression (p = 0.001) at three months compared to baseline. The CG showed no significant change in similar outcome measures. At three months, the intervention resulted in a significant improvement in BASDI (-0.79; 95% CI (-1.3, to -0.29); p = 0.0021), BASFI (-0.86, 95% CI (-1.59, to -0.14); p = 0.0193), anxiety (-0.42, 95% CI (-0.84 to -0.01), p = 0.0468), and AS-QoL (-3.37; 95% CI (-5.21 to 1.53); p = 0.0004) compared to the CG.

CONCLUSIONS

The present study suggests that yoga helps improve pain, functional index, and mental health in patients with AS. Tele-yoga intervention is feasible and effective in treating AS.

The impact of the COVID-19 pandemic and stringent social distancing measures on health-related quality of life and COVID-19 infection rates in patients with rheumatic disease: a longitudinal analysis through the pandemic

Objective

The aim was to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic and stringent social isolation measures on patients with rheumatic disease (RD) from the beginning of the pandemic (April 2020).

Methods

In this UK-based single-centre, prospective, observational cohort study, all RD follow-up patients at our centre were invited by SMS text message in April 2020 to participate in the study. Participants completed questionnaires at four time points between April 2020 and December 2021. We collected demographics, clinically extremely vulnerable (CEV) status, short form 12 mental (MCS) and physical health component scores (PCS) for health-related quality of life, vaccination status, COVID-19 infection rates and incidence of long COVID.

Results

We enrolled 1605 patients (female, 69.0%; CEV, 46.5%); 906 of 1605 (56.4%) completed linked responses to our final questionnaire. MCS improved (+0.6, P < 0.05), whereas PCS scores deteriorated (-1.4, P < 0.001) between April 2020 and December 2021. CEV patients had worse mental and physical health scores than non-CEV patients at entry (PCS, 36.7 and 39.3, respectively, P < 0.001; MCS, 40.9 and 43.0, respectively, P < 0.001) and at each time point throughout the study; both mental and physical health outcomes were worse in CEV compared with non-CEV patients (P < 0.001 and P = 0.004, respectively). At study close, 148 of 906 (16.3%) reported COVID infection, with no difference in infection, vaccination or long COVID rates between CEV and non-CEV patients.

Conclusions

Mental and physical health in RD patients has changed throughout the pandemic; outcomes for both metrics of health were worse in CEV patients, although there were no differences in infection rates between the groups. These data might assist the understanding and planning of future health-care policy and social restrictions in RD patients.

Trial registration

ClinicalTrials.gov, www.clinicaltrials.gov, NCT04542031.

Investigation of changes in ankylosing spondylitis disease activity through 2021 COVID-19 wave in Taiwan by using electronic medical record management system

We aim to investigate the alteration in disease activity of ankylosing spondylitis (AS) individuals before, during, and after the COVID-19 wave in Taiwan by using electronic medical-record management system (EMRMS). We identified 126 AS individuals from the single center, and gathered data of the three disease activities (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Ankylosing Spondylitis Disease Activity Score with erythrocyte sedimentation rate [ASDAS-ESR], and Ankylosing Spondylitis Disease Activity Score with C-Reactive Protein [ASDAS-CRP]) by using EMRMS before (7 February to 1 May, 2021), during (2 May to 24 July, 2021), and after the COVID-19 wave (25 July to 16 October, 2021). We compared the disease activity measures of the three phases through a paired t test. Among the 126 individuals, CRP was significantly higher during the COVID-19 wave (0.2 (0.1, 0.5) mg/dl, p = 0.001) than before the wave (0.2 (0.1, 0.4) mg/dl), ESR (8.0 (4.0, 15.0) mm/h, p = 0.003) and ASDAS-ESR (1.4 (1.0, 1.9), p = 0.032) were significantly higher after the wave than during the wave (6.0 (3.0, 12.0) mm/h and 1.2 (0.9, 1.8) mm/h) e. ESR, CRP, ASDAS-ESR and ASDAS-CRP were all significant higher after COVID-19 wave than before. The disease activities of AS individuals in Taiwan worsened after 2021 COVID-19 wave in Taiwan.

Long-term Behavioral Changes During the COVID-19 Pandemic and Impact of Vaccination in Patients With Inflammatory Rheumatic Diseases

OBJECTIVE

To explore anxiety and self-isolation in patients with inflammatory rheumatic disease (IRD)15 months into the coronavirus disease 2019 (COVID-19) pandemic, including attitudes toward and effects of SARS-CoV-2 vaccination.

METHODS

A nationwide online survey was conducted at 3 timepoints: May 2020, November 2020, and May 2021. Patients with IRD followed in the Danish Rheumatology Quality Registry (DANBIO) were asked about the effects of the pandemic, including SARS-CoV-2 infection and their behavior, anxiety, and concerns. The May 2021 survey included attitudes toward SARS-CoV-2 and influenza vaccination. Characteristics associated with self-isolation in May 2021 were explored with adjusted logistic regression analyses that included patient characteristics and SARS-CoV-2 vaccination status.

RESULTS

Respondents to surveys 1, 2, and 3 included 12,789; 14,755; and 13,921 patients, respectively; 64% had rheumatoid arthritis and 63% were female. Anxiety and concerns were highest in May 2020 and decreased to stable levels in November 2020 and May 2021; 86%, 50%, and 52% of respondents reported self-isolation, respectively. In May 2021, 4% of respondents self-reported previous SARS-CoV-2 infection. The SARS-CoV-2 vaccine acceptance rate was 86%, and the proportion of patients vaccinated against influenza had increased from 50% in winter 2019-2020 to 64% in winter 2020-2021. The proportion of patients with anxiety appeared similar among those vaccinated and unvaccinated against SARS-CoV-2. In multivariable analyses, being unvaccinated, female gender, receiving biologic drugs, and poor quality of life were independently associated with self-isolation.

CONCLUSION

Levels of anxiety and self-isolation decreased after the initial lockdown period in patients with IRD. Half of the patients reported self-isolation in May 2021, a phase that included widespread reopening of society and large-scale vaccination. The lack of prepandemic data prevented a full understanding of the long-term effects of the pandemic on anxiety and self-isolation in patients with IRD.

Prevalence and Risk Factors of Depression in Patients with Rheumatic Disease in South Korea during the COVID-19 Pandemic

This study aimed to examine the prevalence and risk factors of depression among patients with rheumatic diseases (RDs) during the coronavirus disease 2019 (COVID-19) pandemic. This study adopted a cross-sectional design, and 160 outpatients with RDs in one university hospital in South Korea were sampled using the convenience sampling method. Data were collected from May to July 2021 using a structured questionnaire. The risk factors of depression were analyzed using descriptive statistics and multiple logistic regression analyses. The prevalence rates of post-traumatic stress disorder (PTSD), insomnia, and depression were 37.5%, 20.0%, and 24.4%, respectively. Multiple logistic regression analyses confirmed that employment status, monthly income, perceived health, PTSD, and insomnia were significant risk factors of depression. The findings highlight the urgent need to assist patients with RDs who are at risk of depression during the COVID-19 pandemic, especially individuals who are unemployed or have low incomes and poor perceived health, individuals with high PTSD, and individuals with severe insomnia. There is a need to provide disease-specific interventions to effectively alleviate depression among these individuals during the COVID-19 pandemic.

Minimal Impact of the COVID ‐19 Pandemic on Disease Activity and Health‐Related Quality of Life in Patients With Ankylosing Spondylitis Receiving Bimekizumab: Exploratory Analyses From a Phase 2b Open‐Label Extension Study

Objective

The impact of the COVID‐19 pandemic on patients with inflammatory rheumatic diseases, such as ankylosing spondylitis (AS), has been variable. Here, we assess disease activity and health‐related quality of life (HRQoL) through the pandemic in patients with AS.

Methods

In the open‐label extension (OLE) of the phase 2b BE AGILE study, patients with AS received 160 mg of subcutaneous bimekizumab every 4 weeks. We assessed Ankylosing Spondylitis Disease Activity Score with C‐reactive protein (ASDAS‐CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Quality of Life (ASQoL) scores in the OLE immediately before and during the COVID‐19 pandemic (September 2019 to April 2021).

Results

A total of 232 patients remained in the BE AGILE OLE and were included in this post hoc study at the start of the analysis period (September 1, 2019); 12 patients had a COVID‐19 treatment‐emergent adverse event, and no cases resulted in death. The number of missed bimekizumab doses due to COVID‐19 (11 doses) was minimal, and missed assessments remained low (≤5%) compared with the prepandemic period. Mean ASDAS‐CRP (1.8), BASDAI (2.4), and ASQoL scores (2.8) in the OLE were low at pre‐pandemic baseline and remained stable at 1.7 to 1.8, 2.2 to 2.4, and 2.0 to 2.8, respectively, across successive 3‐month periods immediately before and during the pandemic. ASDAS‐CRP, BASDAI, and ASQoL stability was consistent across major study countries.

Conclusion

Disease activity and HRQoL remained stable during the COVID‐19 pandemic in patients with AS receiving bimekizumab in the BE AGILE OLE, with no indication of negative effects on these outcomes.

Psychological Stress Reported at the Start of the COVID-19 Pandemic and Subsequent Stress and Successful Coping in Patients With Rheumatic Diseases: A Longitudinal Analysis

OBJECTIVE

In a cohort assembled during the height of mortality-associated coronavirus disease 2019 (COVID-19) in New York City, the objectives of this qualitative-quantitative mixed-methods study were to assess COVID-related stress at enrollment with subsequent stress and clinical and behavioral characteristics associated with successful coping during longitudinal follow-up.

METHODS

Patients with rheumatologist-diagnosed rheumatic disease taking immunosuppressive medications were interviewed in April 2020 and were asked open-ended questions about the impact of COVID-19 on psychological well-being. Stress-related responses were grouped into categories. Patients were interviewed again in January-March 2021 and asked about interval and current disease status and how well they believed they coped. Patients also completed the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29) measuring physical and emotional health during both interviews.

RESULTS

Ninety-six patients had follow-ups; 83% were women, and mean age was 50 years. Patients who reported stress at enrollment had improved PROMIS-29 scores, particularly for the anxiety subscale. At the follow-up, patients reported persistent and new stresses as well as numerous self-identified coping strategies. Overall coping was rated as very well (30%), well (48%), and neutral-fair-poor (22%). Based on ordinal logistic regression, variables associated with worse overall coping were worse enrollment-to-follow-up PROMIS-29 anxiety (odds ratio [OR], 4.4; confidence interval [CI], 1.1-17.3; p = 0.03), not reporting excellent/very good disease status at follow-up (OR, 2.7; CI, 1.1-6.5; p = 0.03), pandemic-related persistent stress (OR, 5.7; CI, 1.6-20.1; p = 0.007), and pandemic-related adverse long-lasting effects on employment (OR, 6.1; CI, 1.9-20.0; p = 0.003) and health (OR, 3.0; CI, 1.0-9.0; p = 0.05).

CONCLUSIONS

Our study reflects the evolving nature of COVID-related psychological stress and coping, with most patients reporting they coped well. For those not coping well, multidisciplinary health care providers are needed to address long-lasting pandemic-associated adverse consequences.

Fears about COVID-19 and perceived risk among people with rheumatoid arthritis or ankylosing spondylitis following the initial lockdown in Aotearoa New Zealand

Background

The COVID‐19 pandemic has disrupted all aspects of life and may raise particular fears for people with rheumatic disease. There is a need for research on fears and perceived risk of SARS‐CoV‐2 so as to understand the impact on wellbeing and inform service provision.

Objectives

The aim of this study was to examine the correlates of COVID‐19 fears and perceived risk of SARS‐CoV‐2 among people with rheumatoid arthritis or ankylosing spondylitis.

Design

A cross‐sectional survey design was applied in Aotearoa New Zealand in the period after initial nationwide lockdowns.

Method

An online survey was completed from July to September 2020 by 126 individuals with rheumatoid arthritis (n = 96) or ankylosing spondylitis (n = 30) who had previously been recruited to the Patient Opinion Real‐Time Anonymous Liaison (PORTAL) study in 2015 or 2018. The survey included demographics and health information as well as measures of COVID‐19 fears and experiences, functional disability and fatigue‐related disability.

Results

Fears about COVID‐19 were higher among younger participants, those who had been tested for SARS‐CoV‐2, and those who experienced more flares over the initial lockdown. Perceived risk of SARS‐CoV‐2 infection was also higher among individual who had been tested for SARS‐CoV‐2 and those taking biologic medications.

Conclusion

Fears about COVID‐19 and perceived risk of infection are related to age, health and medications among individuals with rheumatoid arthritis or ankylosing spondylitis. These findings inform how health professionals can help address the concerns of particular groups of people with rheumatic disease by providing relevant information about the ongoing effects of the pandemic.