1
|
Dey D, Katso B, Issaka S, Adjei P. COVID-19 and autoimmune rheumatic disease: behavioural changes adopted by patients amid the pandemic. Intern Med J 2024. [PMID: 38816941 DOI: 10.1111/imj.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/21/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Amid concerns about severe COVID-19 in patients with autoimmune rheumatic disease (AIRD) during the outbreak, it is crucial to explore behavioural changes, whether healthy or unhealthy, arising from this patient population in response to the changing healthcare environment. AIM To investigate COVID-19-driven behavioural changes in patients with AIRD. METHODS This observational study invited patients who attended the rheumatology clinic of the Korle Bu Teaching Hospital from 1 August 2020 to 1 July 2021, to respond to a survey questionnaire distributed on the patient's WhatsApp platform. Variables observed were changes in patient behaviour and decision-making related to medication, healthcare service utilisation and clinical advice. RESULTS Results for 233 patients were analysed in the study, the majority (89.7%) of whom were women. The most significant behavioural changes were a reduction in hydroxychloroquine (HCQ) dosage, adoption of telemedicine for clinical consultation and keen adherence to protective/preventive health measures. Patients also expressed anxiety regarding the risk of contracting COVID-19 (52.5%), infecting their families (66.5%) and losing income (50.2%) due to the pandemic. Women and students were more likely to engage in self-isolation/shielding behaviour. Employed participants practised social distancing more, reduced HCQ dosage and had more fear of losing income. Having mixed connective tissue disease is associated with being anxious about the risk of COVID-19 infection. CONCLUSION The COVID-19 pandemic has resulted in behaviour changes among patients with AIRD. Despite the perceived risk, most of these patients continue to adhere to their prescribed medication regimens, especially maintaining the dosage of traditional immunosuppressive agents.
Collapse
Affiliation(s)
- Dzifa Dey
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Bright Katso
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Saudatu Issaka
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Patrick Adjei
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| |
Collapse
|
2
|
Schlegel M, Bachmann S. Influence of the COVID-19 Pandemic on Medical Management and on Healthcare Delivery of Immune-Mediated Rheumatic and Musculoskeletal Diseases during the First Pandemic Period February to July 2020: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:596. [PMID: 38674242 PMCID: PMC11052197 DOI: 10.3390/medicina60040596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
(1) Background and Objectives: The COVID-19 pandemic influenced the management of patients with immune-mediated rheumatic and musculoskeletal diseases (imRMDs) in various ways. The goal of our systematic review was to determine the influence of the first period of the COVID-19 pandemic (February 2020 to July 2020) on the management of imRMDs regarding the availability of drugs, adherence to therapy and therapy changes and on healthcare delivery. (2) Materials and Methods: We conducted a systematic literature search of PubMed, Cochrane and Embase databases (carried out 20-26 October 2021), including studies with adult patients, on the influence of the COVID-19 pandemic on the management of imRMDs. There were no restrictions regarding to study design except for systematic reviews and case reports that were excluded as well as articles on the disease outcomes in case of SARS-CoV-2 infection. Two reviewers screened the studies for inclusion, and in case of disagreement, a consensus was reached after discussion. (3) Results: A total of 5969 potentially relevant studies were found, and after title, abstract and full-text screening, 34 studies were included with data from 182,746 patients and 2018 rheumatologists. The non-availability of drugs (the impossibility or increased difficulty to obtain a drug), e.g., hydroxychloroquine and tocilizumab, was frequent (in 16-69% of patients). Further, medication non-adherence was reported among patients with different imRMDs and between different drugs in 4-46% of patients. Changes to preexisting medication were reported in up to 33% of patients (e.g., reducing the dose of steroids or the cessation of biological disease-modifying anti-rheumatic drugs). Physical in-office consultations and laboratory testing decreased, and therefore, newly implemented remote consultations (particularly telemedicine) increased greatly, with an increase of up to 80%. (4) Conclusions: The COVID-19 pandemic influenced the management of imRMDs, especially at the beginning. The influences were wide-ranging, affecting the availability of pharmacies, adherence to medication or medication changes, avoidance of doctor visits and laboratory testing. Remote and telehealth consultations were newly implemented. These new forms of healthcare delivery should be spread and implemented worldwide to routine clinical practice to be ready for future pandemics. Every healthcare service provider treating patients with imRMDs should check with his IT provider how these new forms of visits can be used and how they are offered in daily clinical practice. Therefore, this is not only a digitalization topic but also an organization theme for hospitals or outpatient clinics.
Collapse
Affiliation(s)
- Marco Schlegel
- Department of Rheumatology, Rehabilitations Zentrum Valens, Kliniken Valens, 7317 Valens, Switzerland
| | - Stefan Bachmann
- Department of Rheumatology, Rehabilitations Zentrum Valens, Kliniken Valens, 7317 Valens, Switzerland
- Department of Geriatrics, Inselspital, Bern University Hospital, Faculty of Medicine, University of Bern, 3010 Bern, Switzerland
| |
Collapse
|
3
|
Bui HB, Lai HT, Nguyen TL, Vu TD, Bui NL, Nguyen VH, Tran TTC, Nguyen TPT, Nguyen TNL, Al-Tawfiq JA, Chu DT. The impact of COVID-19 and other factors on the usage status of the biologic drug therapies for rheumatoid arthritis: A study from Vietnam. REUMATOLOGIA CLINICA 2024; 20:128-135. [PMID: 38494304 DOI: 10.1016/j.reumae.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/21/2023] [Indexed: 03/19/2024]
Abstract
OBJECTIVES To describe the status of using biological Disease Modifying Anti Rheumatic Drugs (bDMARDs) to treat rheumatoid arthritis (RA) and related factors. In addition, the study determined the impact of COVID-19 on the usage of bDMARDs. METHODS This is a cross-sectional study and included 219 RA patients over 18 years old. The Kaplan-Meier method and the log-rank test (p<0.05) were used to estimate the retention time and compare between different times. Cox regression analysis was used to determine the factors affecting the retention time of biological drugs (p<0.05). RESULTS Out of 1967 courses of treatment, there were 149 (7.6%) drug discontinuations, 760 (38.6%) doses extensions and 64 (3.3%) drug switch. Moderate disease level and choosing tumor necrosis factor (TNF) inhibitors initially were associated with retention time of COVID-19. Drug discontinuations and dose extensions increased after COVID-19 emergence. The retention time during COVID-19 was significantly different from that of pre-COVID-19. Gender, type of first-used bDMARD, conventional synthetic DMARDs (csDMARDs) and corticoid usage status, disease activity levels were associated with retention time. CONCLUSION The presence of COVID-19 has a significant effect on usage status of the biologic drug. Further longitudinal studies are needed to clarify the relationship between COVID-19 and drug usage as well as related factors.
Collapse
Affiliation(s)
- Hai-Binh Bui
- Department of Rheumatology, Bach Mai Hospital, Hanoi 100000, Viet Nam
| | - Hong-Thinh Lai
- Department of Neurology and Rheumatology, Ha Nam Provincial General Hospital, Hanam, Viet Nam
| | - Thanh-Lam Nguyen
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi 100000, Viet Nam
| | - Thuy-Duong Vu
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi 100000, Viet Nam
| | - Nhat-Le Bui
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi 100000, Viet Nam
| | - Van-Hung Nguyen
- Department of Rheumatology, Bach Mai Hospital, Hanoi 100000, Viet Nam; Internal Medicine Department, Hanoi Medical University, Hanoi, Viet Nam
| | - Thi-To-Chau Tran
- Department of Rheumatology, Bach Mai Hospital, Hanoi 100000, Viet Nam
| | - Thi-Phuong-Thuy Nguyen
- Department of Rheumatology, Bach Mai Hospital, Hanoi 100000, Viet Nam; Internal Medicine Department, Hanoi Medical University, Hanoi, Viet Nam
| | | | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dinh-Toi Chu
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi 100000, Viet Nam; Faculty of Applied Sciences, International School, Vietnam National University, Hanoi 100000, Viet Nam.
| |
Collapse
|
4
|
Pugliesi A, Sachetto Z, de Medeiros Pinheiro M, Salviato Pileggi G, Sarot Pereira da Cunha G, Hajar FN, Marques Negrisolli Cunha ML, Henrique da Mota LM, Lopes Marques CD, Kakehasi AM, Rodrigues Ferreira WH, Araújo NC, Monteiro Gomides Reis AP, Rodrigues de Abreu Vieira RM, Ferreira GA, Danowski A, de Souza VA, Soares Egypto de Brito DC, Dos Santos Paiva E, Provenza JR, Feijó Azevedo V. How Did Patients Living With Immune-Mediated Rheumatic Diseases Face the Beginning of the COVID-19 Pandemic in Brazil? Results of the COnVIDa Study. J Clin Rheumatol 2024; 30:e29-e33. [PMID: 35699528 DOI: 10.1097/rhu.0000000000001882] [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: 11/25/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has brought additional burden to patients living with immune-mediated rheumatic diseases (IMRDs), especially at the beginning of 2020, for which information for this population is lacking. METHODS COnVIDa is a cross-sectional study on patients with IMRD from all regions of Brazil who were invited to answer a specific and customized Web questionnaire about how they were facing the COVID-19 pandemic, especially focusing on health care access, use of medications, and patient-reported outcomes related to IMRD activity. The questionnaire was applied from June 1 to 30, 2020. RESULTS In total, 1722 of 2576 patients who answered the Web questionnaire were included in the final analysis. Participants were most frequently women, 56% were between 31 and 50 years old, and most (55%) has private health insurance. The most commonly reported IMRD was rheumatoid arthritis (39%), followed by systemic lupus erythematosus (28%). During the study period, 30.7% did not have access to rheumatology consultations, and 17.6% stopped chronic medications. Telemedicine was reported in 44.8% of patients. CONCLUSION COnVIDa demonstrated a negative impact on health care access and treatment maintenance of patients living with IMRD during the COVID-19 pandemic. However, it also presented an uptake of telemedicine strategies. Data presented in this study may assist future coping policies.
Collapse
Affiliation(s)
- Alisson Pugliesi
- From the Reumatologia, Universidade Estadual de Campinas, Campinas
| | - Zoraida Sachetto
- From the Reumatologia, Universidade Estadual de Campinas, Campinas
| | | | | | | | | | | | | | | | | | | | - Nafice Costa Araújo
- Reumatologia, Hospital do Servidor Público Estadual de São Paulo-IAMSPE, São Paulo
| | | | | | - Gilda Aparecida Ferreira
- Reumatologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais
| | - Adriana Danowski
- Reumatologia, Hospital Federal dos Servidores do Estado-RJ, Rio de Janeiro
| | | | | | | | - José Roberto Provenza
- Reumatologia, Pontifícia Universidade Católica de Campinas, Campinas, São Paulo, Brazil
| | | |
Collapse
|
5
|
Larkin L, Raad T, Moses A, Fraser A, Gallagher S, Appel Esbensen B, Glynn L, Griffin A, Tierney AC, Kennedy N. The impact of COVID-19 on clinical research: the PIPPRA and MEDRA experience. HRB Open Res 2023; 4:55. [PMID: 38187120 PMCID: PMC10767248 DOI: 10.12688/hrbopenres.13283.2] [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] [Accepted: 11/08/2023] [Indexed: 01/09/2024] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has had a significant impact on clinical research. This paper aims to provide an insight into how the COVID-19 pandemic, associated public health restrictions and international guidance on the conduct of clinical research impacted two clinical rheumatology research trials - the Physiotherapist-led Intervention to Promote Physical Activity in Rheumatoid Arthritis (PIPPRA) and the MEDiterranean diet in Rheumatoid Arthritis (MEDRA) projects. Methods The March 2019 public health restrictions imposed to mitigate the risk of COVID-19 occurred at a time when PIPPRA was in the process of delivering assessment and intervention on a face-to-face basis (n=48) and MEDRA had commenced recruitment. Participants in PIPPRA and MEDRA had a diagnosis of rheumatoid arthritis, with some being immunosuppressed and thus at a higher risk for COVID-19. The decision-making processes of both trials is outlined to demonstrate the required amendments to continue in the context of the COVID-19 pandemic. Results Amendments to PIPPRA and MEDRA trial protocols were agreed and received ethical and funder approval. Both trials switched from a face-to-face delivery to a telehealth using online platforms. The PIPPRA study was paused for five months (April-August 2020), resulting in n=33 (60%) negative deviations from assessment protocol. MEDRA switched from face-to-face to online recruitment with 20% (n=35/44) negative deviations in recruitment. Of the n=18 participants who consented to participating in a face-to-face trial, just n=2 (11%) opted to engage with telehealth delivery of the intervention. MEDRA assessment and intervention deviations were 100% as no sessions were completed as planned in 2020. Conclusions The COVID-19 pandemic has severely impacted the PIPPRA and MEDRA clinical trials. Moving face-to-face clinical research to telehealth delivery may not be the panacea it is purported to be. Our experiences may be of benefit to researchers, clinicians, and funders in seeking to continue clinical research during a global pandemic.
Collapse
Affiliation(s)
- Louise Larkin
- School of Allied Health, Faculty of Education & Health Sciences, University of Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Implementation Science and Technology, Health Research Institute, University of Limerick, V94 T9PX, Ireland
| | - Tala Raad
- School of Allied Health, Faculty of Education & Health Sciences, University of Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Anusha Moses
- School of Allied Health, Faculty of Education & Health Sciences, University of Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Alexander Fraser
- School of Medicine, Faculty of Education & Health Sciences, University of Limerick, V94 T9PX, Ireland
- Department of Rheumatology, University Hospitals Limerick, Limerick, Ireland
| | - Stephen Gallagher
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
- Department of Psychology, Faculty of Education & Health Sciences, University of Limerick, Ireland
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Liam Glynn
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
- School of Medicine, Faculty of Education & Health Sciences, University of Limerick, V94 T9PX, Ireland
- HRB Primary Care Clinical Trials Network Ireland, Limerick, Ireland
| | - Anne Griffin
- School of Allied Health, Faculty of Education & Health Sciences, University of Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Audrey C Tierney
- School of Allied Health, Faculty of Education & Health Sciences, University of Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Implementation Science and Technology, Health Research Institute, University of Limerick, V94 T9PX, Ireland
| | - Norelee Kennedy
- School of Allied Health, Faculty of Education & Health Sciences, University of Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Implementation Science and Technology, Health Research Institute, University of Limerick, V94 T9PX, Ireland
| |
Collapse
|
6
|
Liaghat B, Folkestad L, Skou ST, Koes B, Stammerjohan AF, Hartvigsen J. Prevalence and consequences of spinal pain among people with type 1 and type 2 diabetes mellitus in Denmark. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3744-3752. [PMID: 37659046 DOI: 10.1007/s00586-023-07911-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/30/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE To describe 1-week and 1-year prevalence of spinal pain and its consequences in relation to leisure activity, work-life, and care-seeking in people with type 1 and 2 diabetes mellitus (DM). METHODS A cross-sectional survey including adults diagnosed with DM from two Danish secondary care centres. Using the Standardised Nordic Questionnaire, spinal pain prevalence (cervical, thoracic, lumbar) and its consequences were evaluated (proportions, 95% confidence intervals) and compared to the general population. RESULTS Among 3767 people, 1-week and 1-year spinal pain prevalence were 11.6-32.4 and 18.5-49.6%, respectively, highest for lumbar pain (24.6-49.6%). The prevalence was similar between DM types for cervical and thoracic pain, but higher in type 2 for lumbar spine. Women had higher pain prevalence across spinal regions and DM types, while cervical and thoracic pain estimates were higher for age < 60 vs. ≥ 60. Within the past year, > 50% reported pain > 30 days, high proportions had reduced their activities (leisure time, 43.7-63.9%; work, 20.7-33.3%), 13.3-28.1% reported sick-leave > 30 days, and 44.3-48.5% had sought care due to spinal pain. CONCLUSION Spinal pain is common in people with type 1 and 2 DM, resulting in considerable consequences for work/leisure activities, sick-leave, and healthcare utilisation as compared to the general population.
Collapse
Affiliation(s)
- Behnam Liaghat
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
- Centre for Evidence-Based Orthopaedics, Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Exploratory Network, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Bart Koes
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- Department of General Practice, Erasmus MC, Rotterdam, The Netherlands
| | - Amalie Frost Stammerjohan
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| |
Collapse
|
7
|
Svensson ALL, Emborg HD, Bartels LE, Ellingsen T, Adelsten T, Cordtz R, Dreyer L, Obel N. Outcomes following SARS-CoV-2 infection in individuals with and without inflammatory rheumatic diseases: a Danish nationwide cohort study. Ann Rheum Dis 2023; 82:1359-1367. [PMID: 37414519 DOI: 10.1136/ard-2023-223974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE In a setting with an extensive SARS-CoV-2 test strategy and availability of effective vaccines, we aimed to investigate if patients with inflammatory rheumatic diseases (IRD) face greater risk of contracting SARS-CoV-2 and have a worse prognosis of increased risk of hospitalisation, assisted ventilation and death compared with the general population. METHODS This was a nationwide, population-based register study that compared outcomes of SARS-CoV-2 infection in Danish patients with IRD (n=66 840) with matched population controls (n=668 400). The study period was from March 2020 to January 2023. Cox regression analyses were used to calculate incidence rate ratios (IRRs) for SARS-CoV-2-related outcomes. RESULTS We observed a difference in time to first and second positive SARS-CoV-2 test in patients with IRD compared with the general population (IRR 1.06, 95% CI 1.05 to 1.07) and (IRR 1.21, 95% CI 1.15 to 1.27). The risks of hospital contact with COVID-19 and severe COVID-19 were increased in patients with IRD compared with population controls (IRR 2.11, 95% CI 1.99 to 2.23) and (IRR 2.18, 95% CI 1.94 to 2.45). The risks of assisted ventilation (IRR 2.33, 95% CI 1.89 to 2.87) and COVID-19 leading to death were increased (IRR 1.98, 95% CI 1.69 to 2.33). Patients with IRD had more comorbidities compared with the general population. A third SARS-CoV-2 vaccination was associated with a reduced need for hospitalisation with COVID-19 and reduced the risk of death. CONCLUSION Patients with IRD have a risk of SARS-CoV-2, which nearly corresponds to the general population but had a substantial increased risk of hospitalisation with COVID-19, severe COVID-19, requiring assisted ventilation and COVID-19 leading to death, especially in patients with comorbidities.
Collapse
Affiliation(s)
- Annemarie Lyng Lyng Svensson
- Department of Rheumatology, Center for Rheumatology and Spine Diseases, Rigshospitalet HovedOrtoCentret, Kobenhavn, Denmark
| | - Hanne-Dorthe Emborg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Kobenhavn, Denmark
| | | | | | - Thomas Adelsten
- Department of Rheumatology, Sjællands Universitetshospital Køge, Koge, Denmark
| | - René Cordtz
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Rheumatology, Gentofte Hospital, Hellerup, Denmark
| | - Lene Dreyer
- Department of Rheumatology and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Niels Obel
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Kobenhavn, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Kobenhavn, Denmark
| |
Collapse
|
8
|
FitzGerald C, Vaughan-Witts A, Barry L, Corey G, Leahy F, Egan S, Conway E, O'Connor M, Galvin R. Clinical research stakeholders' experiences of clinical research during COVID-19: a qualitative study. BMC Res Notes 2023; 16:240. [PMID: 37777795 PMCID: PMC10544112 DOI: 10.1186/s13104-023-06534-5] [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] [Received: 04/13/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic created a complex high-risk clinical research environment with clinical research activities significantly impacted. Clinical research stakeholders adapted rapidly to new clinical practices; PPE, infection control policies, all while engaging with a more unwell patient demographic. The aim of this study is to explore the experiences of conducting clinical research during COVID-19 with clinical research stakeholders. METHODS This qualitative study of semi-structured interviews conducted with clinical research stakeholders in an acute Hospital setting across a variety of disciplines; Consultant Geriatrician, Clinical Research Nurse, Occupational Therapy, Physiotherapy. Interviews were fully transcribed prior to reflexive thematic analysis. NVivo software was used to support data management and analysis. RESULTS Three main themes were produced; (1) The challenging COVID-19 clinical research landscape, (2) COVID-19 clinical research communication barriers, and (3) Adaptations and learnings from clinical research during COVID-19. CONCLUSIONS This study explored the experiences of conducting clinical research during COVID-19 with clinical research stakeholders examining challenges faced and adaptations required. The findings inform, equip and support clinical research stakeholders in the event of future adverse public health events.
Collapse
Affiliation(s)
- Christine FitzGerald
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Aoife Vaughan-Witts
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Louise Barry
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Gillian Corey
- Clinical Research Support Unit, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Fiona Leahy
- Clinical Research Support Unit, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Siobhán Egan
- Clinical Research Support Unit, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Elaine Conway
- Clinical Research Support Unit, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Margaret O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| |
Collapse
|
9
|
Liaghat B, Folkestad L, Skou ST, Koes B, Hartvigsen J. Prevalence and consequences of musculoskeletal pain in the upper and lower extremities: A cross-sectional analysis of patients with type 1 and type 2 diabetes in Denmark. Prim Care Diabetes 2023; 17:267-272. [PMID: 36890059 DOI: 10.1016/j.pcd.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/18/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023]
Abstract
AIMS To describe the one-week and 12-month prevalence of musculoskeletal pain in the upper and lower extremities and consequences in relation to care seeking, leisure time activity, and work life in patients with type 1 and 2 diabetes. METHODS A cross-sectional survey including adults diagnosed with type 1 and 2 diabetes from two Danish secondary care databases. Questions covered pain prevalence (shoulder, elbow, hand, hip, knee, ankle) and its consequences based on the Standardised Nordic Questionnaire. Data was presented using proportions (95 % confidence intervals). RESULTS The analysis included 3767 patients. The one-week prevalence was 9.3-30.8 % and 12-month prevalence 13.9-41.8 %, highest for shoulder pain (30.8-41.8 %). The prevalence was similar between type 1 and 2 diabetes for the upper extremity, but higher in type 2 for the lower extremity. Women had a higher pain prevalence for any joint for both diabetes types, while estimates did not vary between age groups (<60 or ≥60 years). More than half of the patients had reduced their activities at work or leisure time, and more than one-third had sought care during the past year because of pain. CONCLUSIONS Musculoskeletal pain in the upper and lower extremities is common in patients with type 1 and 2 diabetes from Denmark, with considerable consequences for work and leisure activities.
Collapse
Affiliation(s)
- Behnam Liaghat
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Centre for Evidence-Based Orthopaedics, Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient Exploratory Network, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Bart Koes
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of General Practice, Erasmus MC, Rotterdam, the Netherlands
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Chiropractic Knowledge Hub, Odense, Denmark
| |
Collapse
|
10
|
Aboud FM, Hussein RS, Hassan RM. Safety and reported adverse effects of coronavirus disease-2019 (COVID-19) vaccines in patients with rheumatic diseases. THE EGYPTIAN RHEUMATOLOGIST 2023; 45:133-137. [PMID: 36597426 PMCID: PMC9800813 DOI: 10.1016/j.ejr.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Symptoms and severity of COVID19 are variable. Aim of the work To evaluate the effectiveness and to identify side effects of the COVID-19 vaccines among Egyptian patients with autoimmune rheumatic diseases (RDs). Patients and methods The study included 126 patients with various RDs and 200 control. Detailed medical history was recorded with special concern regarding COVID-19 vaccination, types, doses, side effects, post-vaccination infection and treatment. Results In patients, BBIBP-CorV (Sinopharm) was the most frequent vaccine 42.3 % (n = 52); CoronaVac (Sinovac) 22 % (n = 27); ChAdOx1 (AstraZeneca) 17.9 % (n = 22); BNT162 (Pfizer BioNTech) 14.6 % (n = 18); Sputnik V 1.6 % (n = 2) and Ad26.COV2-S (Johnson & Johnson) 1.6 % (n = 2). Regarding the control, 34.4 % (n = 62) received AstraZeneca; 26.1 % (n = 47) Sinopharm; 16.7 % (n = 30) Pfizer; 11.7 % (n = 21) Sinovac; 6.7 % (n = 12) Sputnik; 3.3 % (n = 6) Johnson & Johnson and 1.2 % (n = 2) mRNA1273 (Moderna). COVID-19 infection decreased after vaccination from 32 (25.4 %) to 7 (5.6 %), and from 162 (81.0 %) to 85 (42.7 %) in RD patients and the control respectively. ICU admission decreased from (6.3 %) among RD patients and from (1.3 %) in control to 0 % after vaccination in both groups. In RD patients, body ache was the commonest reported vaccine adverse effect (44.4 %). Pain at the injection site was the commonest among control (77 %). ChAdOx1 (AstraZeneca) had the highest incidence of side effects, mRNA1273 (Moderna) showed the lowest. Conclusion COVID-19 vaccine was effective in decreasing infection and disease severity in RDs patients and control, with similar, mild adverse effects.
Collapse
Affiliation(s)
- Fatma M. Aboud
- Internal Medicine Department, Rheumatology Division, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rasha S. Hussein
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt,Corresponding author
| | - Rasha M. Hassan
- Internal Medicine Department, Rheumatology Division, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
11
|
Hider S, Muller S, Gray L, Manning F, Brooks M, Heining D, Menon A, Packham J, Roddy E, Ryan S, Scott IC, Paskins Z. Exploring the longer-term impact of the COVID-19 pandemic on physical and mental health of people with inflammatory rheumatic diseases: a cross-sectional survey. Clin Rheumatol 2023:10.1007/s10067-023-06565-0. [PMID: 36882533 PMCID: PMC9990972 DOI: 10.1007/s10067-023-06565-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To assess the longer term impact of the COVID-19 pandemic on the self-reported physical and mental health of people with inflammatory rheumatic diseases (IRDs). METHODS Two thousand twenty-four patients with IRDs were randomly selected from electronic health records. Survey invitations were sent (August 2021 coinciding with relaxation of UK COVID-19 restrictions) using SMS and postal approaches. Self-reported data included demographics, shielding status and physical (MSK-HQ) and mental health (PHQ8 and GAD7). RESULTS Six hundred thirty-nine people completed the survey (mean (SD) age 64.5 (13.1) years, 384 (60%) female). Moderate/severe impact of the pandemic on physical and mental health was reported by 250 (41%) and 241 (39%) respectively. One hundred seventy-two (29%) reported moderate/severe depression (PHQ8 ≥ 10) and 135 (22%) moderate/severe anxiety (GAD7 ≥ 10). Females reported greater impacts of the pandemic on physical health (44% vs 34%), mental health (44% vs 34%), arthritis symptoms (49% vs 36%) and lifestyle factors (weight gain and reduced exercise and physical activity) than males. The physical and mental impacts were less in people with RA compared with other IRDs. Physical health impacts did not differ between age groups, but younger patients reported greater impacts on mental health. CONCLUSION The COVID-19 pandemic has had a significant impact on the physical and mental health of people with IRDs. These effects were greatest in females. Recovery needs to address the negative impact of the pandemic on lifestyle factors to minimise the long-term impacts for people with IRDs. Key Points • The pandemic had a significant impact on long term physical and mental health in almost 40% of people with IRDs. • The impact of the pandemic was greater in women for physical health, mental health and arthritis symptoms. • Many people reported negative pandemic impacts on lifestyle factors including weight and physical activity.
Collapse
Affiliation(s)
- Samantha Hider
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-On-Trent, UK. .,School of Medicine, Keele University, Keele, UK.
| | - Sara Muller
- School of Medicine, Keele University, Keele, UK
| | - Lauren Gray
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-On-Trent, UK
| | - Fay Manning
- School of Medicine, Keele University, Keele, UK.,School of Medicine, University of Exeter, Exeter, UK
| | - Mike Brooks
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-On-Trent, UK
| | - Dominic Heining
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-On-Trent, UK
| | - Ajit Menon
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-On-Trent, UK
| | - Jonathan Packham
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-On-Trent, UK.,Academic Unit of Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - Edward Roddy
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-On-Trent, UK.,School of Medicine, Keele University, Keele, UK
| | - Sarah Ryan
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-On-Trent, UK
| | - Ian C Scott
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-On-Trent, UK.,School of Medicine, Keele University, Keele, UK
| | - Zoe Paskins
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-On-Trent, UK.,School of Medicine, Keele University, Keele, UK
| |
Collapse
|
12
|
Kernder A, Filla T, de Groot K, Hellmich B, Holle J, Lamprecht P, Moosig F, Ruffer N, Specker C, Vordenbäumen S, Schneider M, Chehab G. COVID-19 pandemic impairs medical care of vasculitis patients in Germany: Results of a national patient survey. Front Med (Lausanne) 2023; 9:1103694. [PMID: 36698843 PMCID: PMC9868561 DOI: 10.3389/fmed.2022.1103694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To analyze the impact of the COVID-19 pandemic on medical care and vaccination acceptance of vasculitis patients in Germany. Methods A web-based national survey was developed by rheumatology centers and vasculitis patient advocacy groups. The survey was distributed nationwide by mail and flyers and could be accessed via a QR-code or weblink from December 2021 to April 2022. Descriptive statistics [mean, median, standard derivation (SD), 25%, 75% quantile] were calculated. 95% confidence intervals were presented for responses that were directly related to the impact of COVID-19 on parameters associated with vasculitis patient care. Results The online survey was completed by 117 patients with small and large vessel vasculitis [granulomatosis with polyangiitis (n = 69), eosinophilic granulomatosis with polyangiitis (n = 16), microscopic polyangiitis (n = 12), giant cell arteritis (n = 17) and Takayasu's arteritis (n = 3)]. Prescheduled rheumatological appointments had been canceled due to the COVID-19 pandemic in 12.6% of the respondents [95% confidence interval (CI), 7.3-20.0%); in 9% (95% CI, 4.5-15.6%)] appointments had been replaced by digital services. Therapeutic regimens were changed (shifted, reduced, or discontinued) due to the pandemic in 15.5% (95% CI 9.5-22.2%). Vaccination coverages were generally high compared to patients with other rheumatic diseases and the general population. Highest vaccination coverage was observed against COVID-19 (98.1% 95% CI 93.9-99.6%). Conclusion Vasculitis patients experienced changes in medical care during COVID-19 pandemic such as cancelation of prescheduled rheumatology appointments and modifications in therapeutic regimens. The overall acceptance rate for vaccination was comparatively high, particularly for vaccination against COVID-19.
Collapse
Affiliation(s)
- Anna Kernder
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany,Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany,*Correspondence: Anna Kernder ✉
| | - Tim Filla
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany,Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Kirsten de Groot
- Medical Clinic III, Sana Klinikum Offenbach GmbH, Offenbach, Germany
| | - Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatolgie und Immunologie, Medius Klinik Kirchheim, University Tübingen, Kirchheim unter Teck, Germany
| | - Julia Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Frank Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | - Nikolas Ruffer
- Department of Rheumatology and Immunology, Klinikum Bad Bramstedt GmbH, Bad Bramstedt, Germany,III Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
| | - Stefan Vordenbäumen
- Department of Rheumatology, St. Elisabeth-Hospital Meerbusch-Lank, Meerbusch, Germany
| | - Matthias Schneider
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany,Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Gamal Chehab
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany,Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| |
Collapse
|
13
|
Kelly D, Koay A, Mineva G, Volz M, McCool A, McLoughlin E, Ó Conluain R, Sharma M, Kerr A, Franklin BD, Grimes T. A scoping review of non-professional medication practices and medication safety outcomes during public health emergencies. Public Health 2023; 214:50-60. [PMID: 36521272 DOI: 10.1016/j.puhe.2022.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/06/2022] [Accepted: 10/18/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Public health emergencies (PHE) can disrupt personal medication practices and increase the risk of medication-related harm and other negative medication-related outcomes. Our aim was to examine the extent and nature of published research on this topic to guide future research and practice. STUDY DESIGN Scoping review. METHODS Standard electronic databases were searched. PRISMA-ScR guidelines were followed. Extracted data were organised in response to review questions and narrative accounts developed. RESULTS A total of 129 studies were included, conducted across 32 countries, mostly in the USA (n = 42). Sixty-eight (53%) reported on infectious events, 49 (39%) climatological or ecological events and the remainder a mixture of terrorism, war or other disasters. The studies described several medication safety outcomes (medication-related harm, adherence, supply) and adaptive medication practices (self-altering prescribed medications, sharing medications and changing healthcare providers). Challenges to maintaining routine medication practices during a PHE included transport, finance, quarantine and knowledge-related issues. Twenty-eight studies (22%) examined health inequalities pertaining to adverse medication-related outcomes, with findings suggesting that gender, age, ethnicity, educational and socio-economic status may be related to inequalities. Research gaps identified included carers', children's and minority communities' experiences and intervention studies. CONCLUSIONS There is considerable evidence of disruptions to routine personal medication practices during PHEs and of medication-related harm and other negative outcomes. Maintaining medication supply for the management of chronic conditions is a universal problem across all emergency types. Research is needed to address these disruptions, particularly amongst people who experience health inequalities who may need additional support.
Collapse
Affiliation(s)
- Dervla Kelly
- School of Medicine, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aaron Koay
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Gabriela Mineva
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Monika Volz
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Aoibhin McCool
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Eavan McLoughlin
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | | | - Manuj Sharma
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Aisling Kerr
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - Bryony Dean Franklin
- Imperial College Healthcare NHS Trust, London, UK; NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, UK; UCL School of Pharmacy, London, UK
| | - Tamasine Grimes
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.
| |
Collapse
|
14
|
Rebić N, Park JY, Garg R, Ellis U, Kelly A, Davidson E, De Vera MA. Rapid Review of Medication Taking (Adherence) Among Patients With Rheumatic Diseases During the COVID-19 Pandemic. Arthritis Care Res (Hoboken) 2022; 74:1961-1969. [PMID: 34219400 PMCID: PMC8426729 DOI: 10.1002/acr.24744] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/15/2021] [Accepted: 07/01/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We aimed to identify, appraise, synthesize, and contextualize rapidly emerging reports on medication taking (adherence) among patients with rheumatic diseases during the COVID-19 pandemic. METHODS We searched MEDLINE, EMBASE, and CINAHL for peer-reviewed communications, letters, and articles published during the COVID-19 pandemic evaluating medication taking among individuals with rheumatic diseases. We appraised assessment and reporting of medication adherence according to established definitions of 3 distinct problems of medication taking (i.e., noninitiation, poor implementation, and discontinuation) and pooled findings using random-effects models. RESULTS We included 31 peer-reviewed studies in our synthesis from various jurisdictions, of which 25 described medication taking among rheumatology patients and 6 described medication prescribing among rheumatology providers. The pooled prevalence of overall medication nonadherence was 14.8% (95% confidence interval [95% CI] 12.3-17.2) and that of medication discontinuation (i.e., stopping of prescriptions) and poor implementation (i.e., not taking medication at the dose/frequency prescribed) as 9.5% (95% CI 5.1-14.0) and 9.6% (95% CI 6.2-13.0), respectively. Noninitiation (i.e., not starting/not filling new prescriptions) was not addressed. CONCLUSION Medication taking among individuals with rheumatic diseases during the COVID-19 pandemic varies globally. Unclear reporting and extensive variation in research methods between studies create barriers to research replication, comparison, and generalization to specific patient populations. Future research in this area should use consistent and transparent approaches to defining and measuring medication taking problems to ensure that findings appropriately describe the epidemiology of medication adherence and have the potential to identify modifiable targets for improving patient care.
Collapse
Affiliation(s)
- Nevena Rebić
- University of British Columbia and Collaboration for Outcomes Research and Evaluation, Vancouver, and Arthritis Research CanadaRichmondBritish ColumbiaCanada
| | - Jamie Y. Park
- University of British Columbia and Collaboration for Outcomes Research and EvaluationVancouverBritish ColumbiaCanada
| | - Ria Garg
- University of British Columbia and Collaboration for Outcomes Research and EvaluationVancouverBritish ColumbiaCanada
| | - Ursula Ellis
- University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Ayano Kelly
- Australian National University and Canberra Rheumatology, Canberra, ACT, and The Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | | | - Mary A. De Vera
- University of British Columbia and Collaboration for Outcomes Research and Evaluation, Vancouver, and Arthritis Research CanadaRichmondBritish ColumbiaCanada
| |
Collapse
|
15
|
Glintborg B, Jensen DV, Terslev L, Hendricks O, Østergaard M, Horskjær Rasmussen S, Jensen MP, Adelsten T, Colic A, Danebod K, Kildemand M, Loft AG, Munk HL, Pedersen JK, Østgård RD, Møller Sørensen C, Krogh NS, Agerbo J, Ziegler C, Hetland ML. Nationwide, large-scale implementation of an online system for remote entry of patient-reported outcomes in rheumatology: characteristics of users and non-users and time to first entry. RMD Open 2022; 8:rmdopen-2022-002549. [PMID: 36418086 PMCID: PMC9685239 DOI: 10.1136/rmdopen-2022-002549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022] Open
Abstract
Aims In May 2020, a nationwide, web-based system for remote entry of patient-reported outcomes (PROs) in inflammatory rheumatic diseases was launched and implemented in routine care (DANBIO-from-home). After 1.5 years of use, we explored clinical characteristics of patients who did versus did not use the system, and the time to first entry of PROs. Methods All patients followed in DANBIO were informed about DANBIO-from-home by electronic invitations or when attending their clinic. Characteristics of patients who did/did not use DANBIO-from-home in the period after implementation were explored by multivariable logistic regression analyses including demographic and clinical variables (gender, age group, diagnosis, disease duration, use of biological disease-modifying agent (bDMARD), Health Assessment Questionnaire (HAQ), Patient Acceptable Symptom Scale (PASS)). Time from launch to first entry was presented as cumulative incidence curves by age group (<40/40–60/61–80/>80 years). Results Of 33 776 patients, 68% entered PROs using DANBIO-from-home at least once. Median (IQR) time to first entry was 27 (11–152) days. Factors associated with data entry in multivariate analyses (OR (95% CI)) were: female gender (1.19 (1.12 to 1.27)), bDMARD treatment (1.41 (1.33 to 1.50)), age 40–60 years (1.79 (1.63 to 1.97)), 61–80 years (1.87 (1.70 to 2.07), or age >80 years (0.57 (0.50 to 0.65)) (reference: age <40 years), lower HAQ (0.68 (0.65 to 0.71)) and PASS ‘no’ (1.09 (1.02 to 1.17). Diagnosis was not associated. Time to first entry of PROs was longest in patients <40 years of age (119 (24–184) days) and shortest in the 61–80 years age group (25 (8–139) days). Conclusion A nationwide online platform for PRO in rheumatology achieved widespread use. Higher age, male gender, conventional treatment and disability were associated with no use.
Collapse
Affiliation(s)
- Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte Vendelbo Jensen
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Rheumatology, Center for Rheumatology and Spine Diseases, Gentofte University Hospital, Gentofte, Denmark
| | - Lene Terslev
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Oliver Hendricks
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mikkel Østergaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Simon Horskjær Rasmussen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Mogens Pfeiffer Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Thomas Adelsten
- Department of Rheumatology, Zealand University Hospital Koge, Koge, Denmark
| | - Ada Colic
- Department of Rheumatology, Zealand University Hospital Koge, Koge, Denmark
| | - Kamilla Danebod
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Malene Kildemand
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Heidi Lausten Munk
- Rheumatology Research Unit, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Jens Kristian Pedersen
- Department of Rheumatology, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | | | - Jette Agerbo
- Danish Rheumatism Association/Gigtforeningen, Copenhagen, Denmark
| | - Connie Ziegler
- Danish Rheumatism Association/Gigtforeningen, Copenhagen, Denmark
| | - Merete Lund Hetland
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| |
Collapse
|
16
|
Glintborg B, Jensen DV, Terslev L, Hendricks O, Østergaard M, Rasmussen SH, Jensen MP, Adelsten T, Colic A, Danebod K, Kildemand M, Loft AG, Munk HL, Pedersen JK, Østgård RD, Sørensen CM, Krogh NS, Agerbo JN, Ziegler C, Hetland ML. Long-term Behavioral Changes During the COVID-19 Pandemic and Impact of Vaccination in Patients With Inflammatory Rheumatic Diseases. J Rheumatol 2022; 49:1163-1172. [PMID: 35705237 DOI: 10.3899/jrheum.211280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
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.
Collapse
Affiliation(s)
- Bente Glintborg
- B. Glintborg, MD, PhD, DMSc, M. Østergaard, MD, PhD, DMSc, Professor, M.L. Hetland, MD, PhD, DMSc, Professor, DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen Rigshospitalet, Glostrup, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen;
| | - Dorte Vendelbo Jensen
- D.V. Jensen, MD, DANBIO, Rigshospitalet, Glostrup, Copenhagen, and Department of Rheumatology, Center for Rheumatology and Spine Diseases Gentofte and Herlev Hospital, Gentofte
| | - Lene Terslev
- L. Terslev, MD, PhD, Professor, M. Pfeiffer Jensen, MD, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Glostrup, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | - Oliver Hendricks
- O. Hendricks, MD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, and Department of Regional Health Research, University of Southern Denmark, Odense
| | - Mikkel Østergaard
- B. Glintborg, MD, PhD, DMSc, M. Østergaard, MD, PhD, DMSc, Professor, M.L. Hetland, MD, PhD, DMSc, Professor, DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen Rigshospitalet, Glostrup, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | - Simon Horskjær Rasmussen
- S.H. Rasmussen, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen
| | - Mogens Pfeiffer Jensen
- L. Terslev, MD, PhD, Professor, M. Pfeiffer Jensen, MD, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Glostrup, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | - Thomas Adelsten
- T. Adelsten, MD, A. Colic, MD, Department of Rheumatology, Zealand University Hospital, Køge
| | - Ada Colic
- T. Adelsten, MD, A. Colic, MD, Department of Rheumatology, Zealand University Hospital, Køge
| | - Kamilla Danebod
- K. Danebod, MD, Department of Rheumatology, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup
| | - Malene Kildemand
- M. Kildemand, RN, Department of Rheumatology, Odense University Hospital, Odense
| | - Anne Gitte Loft
- A. Gitte Loft, MD, DMSc, Department of Rheumatology, Aarhus University Hospital, and Department of Clinical Medicine, Health, Aarhus University, Aarhus
| | - Heidi Lausten Munk
- H.L. Munk, MD, PhD, Rheumatology Research Unit, Odense University Hospital and University of Southern Denmark, Odense
| | - Jens Kristian Pedersen
- J.K. Pedersen, MD, PhD, Rheumatology Section, Department of Medicine, Odense University Hospital and Svendborg Hospital, Svendborg, and Department of Clinical Research, University of Southern Denmark, Odense
| | - René Drage Østgård
- R.D. Østgård, MD, PhD, Diagnostic Center, Silkeborg Regional Hospital, Silkeborg
| | | | | | - Jette Nørgaard Agerbo
- J.N. Agerbo, Patient Representative, C. Ziegler, Patient Representative, Gigtforeningen/Danish Rheumatism Association, Denmark
| | - Connie Ziegler
- J.N. Agerbo, Patient Representative, C. Ziegler, Patient Representative, Gigtforeningen/Danish Rheumatism Association, Denmark
| | - Merete Lund Hetland
- B. Glintborg, MD, PhD, DMSc, M. Østergaard, MD, PhD, DMSc, Professor, M.L. Hetland, MD, PhD, DMSc, Professor, DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen Rigshospitalet, Glostrup, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| |
Collapse
|
17
|
Ammitzbøll C, Thomsen MK, Andersen JB, Bartels LE, Hermansen MLF, Johannsen AD, Mistegaard CE, Mikkelsen S, Vils SR, Erikstrup C, Hauge EM, Troldborg A. COVID-19 Vaccination in Patients with Rheumatic Diseases Leads to a High Seroconversion Rate and Reduced Self-Imposed Isolation and Shielding Behavior. Mod Rheumatol 2022:6647614. [PMID: 35860843 PMCID: PMC9384499 DOI: 10.1093/mr/roac069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/03/2022] [Accepted: 07/20/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION We investigated the effect of a two-dose mRNA vaccine on antibody levels against SARS-CoV-2 and patient behavior and shielding concerning fear of COVID-19 in patients with systemic lupus erythematosus or rheumatoid arthritis. METHODS Three-hundred-and-three patients and 44 blood donors were included. All patients received two doses of an mRNA vaccine and had total antibodies against SARS-CoV-2 measured before vaccination and 2 and 9 weeks after the second vaccination. Further, patients answered an electronic questionnaire before and after vaccination concerning behavior, anxiety, and symptoms of depression (PHQ-9). RESULTS Significantly fewer patients (90%) had measurable antibodies against SARS-CoV-2 compared to blood donors (100%) after the second vaccination (p<0.001). Treatment with rituximab was the strongest predictor of an unfavorable vaccine response, as only 27% had measurable antibodies. Nearly all patients (97%) not treated with rituximab experienced seroconversion. Prednisone and methotrexate had a negative effect on seroconversion, but no effect of age or comorbidity was observed. Patients experienced significant improvement after vaccination in 10 out of 12 questions regarding behavior and fear of COVID-19, while no change in PHQ-9 or anxiety was observed. CONCLUSION We find a very high seroconversion rate among rheumatic patients, and reduced self-imposed isolation and shielding after COVID-19 vaccination.
Collapse
Affiliation(s)
- Christian Ammitzbøll
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marianne Kragh Thomsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lars Erik Bartels
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Clara Elbæk Mistegaard
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Susan Mikkelsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Signe Risbøl Vils
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Christian Erikstrup
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne Troldborg
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
18
|
Bieber A, Sagy I, Novack L, Brikman S, Abuhasira R, Ayalon S, Novofastovski I, Abu-Shakra M, Mader R. BNT162b2 mRNA COVID-19 vaccine and booster in patients with autoimmune rheumatic diseases: a national cohort study. Ann Rheum Dis 2022; 81:1028-1035. [PMID: 35418481 PMCID: PMC9023845 DOI: 10.1136/annrheumdis-2021-221824] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/26/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Emerging evidence supports the immunogenic response to mRNA COVID-19 vaccine in patients with autoimmune rheumatic diseases (ARD). However, large-scale data about the association between vaccination, and COVID-19 outcomes in patients with ARD is limited. METHODS We used data from Clalit Health Services, which covers more than half of the population in Israel. Patients with ARD older than 18 were included between 20 December 2020 and 30 September 2021, when the BNT162b2 mRNA COVID-19 vaccine, and later a third booster dose, were available. The primary outcome was a documented positive SARS-CoV-2 PCR test. We used a Cox regression models with vaccination status as time-dependent covariate and calculated the HR for the study outcome. RESULTS We included 127 928 patients with ARD, of whom, by the end of the study follow-up, there were 27 350 (21.3%) unvaccinated patients, 31 407 (24.5%) vaccinated patients and 69 171 (54.1%) patients who also received a third booster-dose. We identified 8470 (6.6%) patients with a positive SARS-CoV-2 PCR test during the study period. The HR for SARS-CoV-2 infection among the vaccination group was 0.143 (0.095 to 0.214, p<0.001), and among the booster group was 0.017 (0.009 to 0.035, p<0.001). Similar results were found regardless of the type of ARD group or antirheumatic therapy. CONCLUSION Our results indicate that both the BNT162b2 mRNA COVID-19 vaccine and the booster are associated with better COVID-19 outcomes in patients with ARD.
Collapse
Affiliation(s)
- Amir Bieber
- Rheumatology, Emek Medical Center, Afula, Northern, Israel
| | - Iftach Sagy
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
- Rheumatology, Soroka Medical Center, Beer Sheva, Israel
- Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lena Novack
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Shay Brikman
- Rheumatology, Emek Medical Center, Afula, Northern, Israel
- Technion Israel Institute of Technology The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Ran Abuhasira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department Medicine B, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
| | - Snait Ayalon
- Reseach Authority, Emek Medical Center, Afula, Northern, Israel
| | | | - Mahmoud Abu-Shakra
- Rheumatology, Soroka Medical Center, Beer Sheva, Israel
- Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Reuven Mader
- Rheumatology, Emek Medical Center, Afula, Northern, Israel
- Technion Israel Institute of Technology The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| |
Collapse
|
19
|
Safety of Biologic-DMARDs in Rheumatic Musculoskeletal Disorders: A Population-Based Study over the First Two Waves of COVID-19 Outbreak. Viruses 2022; 14:v14071462. [PMID: 35891442 PMCID: PMC9316145 DOI: 10.3390/v14071462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 12/24/2022] Open
Abstract
This study aims to explore disease patterns of coronavirus disease (COVID-19) in patients with rheumatic musculoskeletal disorders (RMD) treated with immunosuppressive drugs in comparison with the general population. The observational study considered a cohort of RMD patients treated with biologic drugs or small molecules from September 2019 to November 2020 in the province of Udine, Italy. Data include the assessment of both pandemic waves until the start of the vaccination, between February 2020 and April 2020 (first), and between September 2020 and November 2020 (second). COVID-19 prevalence in 1051 patients was 3.5% without significant differences compared to the general population, and the course of infection was generally benign with 2.6% mortality. A small percentage of COVID-19 positive subjects were treated with low doses of steroids (8%). The most used treatments were represented by anti-TNF agents (65%) and anti-IL17/23 agents (16%). More than two-thirds of patients reported fever, while gastro-intestinal symptoms were recorded in 27% of patients and this clinical involvement was associated with longer swab positivity. The prevalence of COVID-19 in RMD patients has been confirmed as low in both waves. The benign course of COVID-19 in our patients may be linked to the very low number of chronic corticosteroids used and the possible protective effect of anti-TNF agents, which were the main class of biologics herein employed. Gastro-intestinal symptoms might be a predictor of viral persistence in immunosuppressed patients. This finding could be useful to identify earlier COVID-19 carriers with uncommon symptoms, eventually eligible for antiviral drugs.
Collapse
|
20
|
Medication Adherence and Belief about Medication among Vietnamese Patients with Chronic Cardiovascular Diseases Within the Context of Implementing Measures to Prevent COVID-19. J Cardiovasc Dev Dis 2022; 9:jcdd9070202. [PMID: 35877564 PMCID: PMC9324658 DOI: 10.3390/jcdd9070202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Long-term adherence is crucial for optimal treatment outcomes in chronic cardiovascular diseases (CVDs), especially throughout the COVID-19 wide-spreading periods, making patients with chronic CVDs vulnerable subjects. Aim: To investigate the relationship between the characteristics, beliefs about prescribed medication, COVID-19 prevention measures, and medication adherence among patients with chronic CVDs. Methods: This is a cross-sectional study of outpatients with chronic CVDs in Southern Vietnam. The specific parts regarding the Beliefs about Medicines Questionnaires (BMQ—Specific) and the General Medication Adherence Scale (GMAS) were applied to assess the beliefs about and adherence to medication. The implementation measures to prevent COVID-19 in patients were evaluated according to the 5K message (facemask, disinfection, distance, no gathering, and health declaration) of the Vietnam Ministry of Health. A multivariable logistic regression with the Backward elimination (Wald) method was used to identify the associated factors of medication adherence. Results: A slightly higher score in BMQ-Necessity compared to BMQ-Concerns was observed. A total of 40.7% of patients were recorded as having not adhered to their medications. Patients’ behavior was most frequently self-reported by explaining their non-adherence (34.7%). Statistical associations were found between rural living place, unemployment status, no or only one measure(s) of COVID-19 prevention application, and medication adherence. Conclusion: During the COVID-19 spreading stage, patients generally showed a positive belief about medication when they rated the importance of taking it higher than its side effects. The data analysis suggested that rather than patients’ beliefs, the clinicians should consider the patient factors, including living place, employment, and the number of epidemic preventive measures applied for guiding the target patients for improving medication adherence.
Collapse
|
21
|
Experiences during the COVID-19 Pandemic among People with Inflammatory Arthritis: “Reopening of Society Is Harder than Lock-Down”—A Qualitative Interview Study. Vaccines (Basel) 2022; 10:vaccines10070982. [PMID: 35891146 PMCID: PMC9318035 DOI: 10.3390/vaccines10070982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 02/04/2023] Open
Abstract
People with inflammatory arthritis (IA) treated with immunosuppressive disease-modifying anti-rheumatic drugs (DMARDs) were initially considered to have an increased risk of severe illness from the SARS-CoV-2 virus compared to the general population. The aim of this study was to explore how people with IA experienced restrictions during the pandemic and the possible impact of vaccination on their protection against COVID-19 and their everyday lives. Nineteen people with IA were interviewed in May–August 2021; shortly thereafter they were enrolled in the Danish national COVID-19 vaccination programme. Concurrently, society gradually reopened after a national complete lockdown. The analysis was inspired by inductive qualitative content analysis. Participants expressed a lack of targeted information on the specific risk associated with IA if they contracted COVID-19. They had to define their own level of daily-life restrictions to protect themselves and their families. They were impacted by inconsistent announcements by the authorities, and some expressed concerns regarding the potential influence of DMARDs on vaccine effectiveness. A societal spirit of being “in this together” emerged through the lockdown, and some were concerned that the reduced level of restrictions in the reopened society would put them at higher risk of a COVID-19 infection and force them to continue self-isolating.
Collapse
|
22
|
Medication Adherence of Vietnamese Outpatients with Chronic Diseases during the COVID-19 Pandemic. Trop Med Infect Dis 2022; 7:tropicalmed7060101. [PMID: 35736980 PMCID: PMC9228239 DOI: 10.3390/tropicalmed7060101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to determine the medication adherence of outpatients with chronic diseases and the association between both patient attitudes and preventive practices regarding COVID-19 and their medication adherence. We performed a cross-sectional study in Vietnam. Medication adherence was determined using the translated and validated Vietnamese version of the General Medication Adherence Scale (GMAS). Patient attitudes and preventive practices regarding COVID-19 were measured using the 5K message of the Vietnam Ministry of Health (facemasks, disinfection, distance, no gatherings, health declarations). The associations between patient characteristics and medication adherence were determined by multivariable regression. The study included 1852 outpatients, and 57.6% of the patients adhered to their medications. Patients who recognized the pandemic’s obstruction of medical follow-ups (OR = 1.771; 95%CI = 1.461−2.147; p < 0.001), who applied ≥2 preventive methods (OR = 1.422; 95%CI = 1.173−1.725; p = 0.001), who were employed (OR = 1.677; 95%CI = 1.251−2.248; p = 0.001), who were living in urban areas (OR = 1.336; 95%CI = 1.090−1.637; p = 0.005,) who possessed higher education levels (OR = 1.313; 95%CI = 1.059−1.629; p = 0.013), or who had ≤2 comorbidities (OR = 1.293; 95%CI = 1.044−1.600; p = 0.019) were more likely to adhere to their medications. The adherence percentage for outpatients with chronic diseases was quite low during the pandemic. Patients who did not recognize the COVID-19 pandemic’s obstruction of medical follow-ups or who had poor preventive practices were less likely to adhere to medications. Healthcare providers should pay more attention to these groups to achieve desired treatment outcomes.
Collapse
|
23
|
Boekel L, Hooijberg F, Besten YR, Vogelzang EH, Steenhuis M, Leeuw M, Atiqi S, van Vollenhoven R, Lems WF, Bos WH, Wijbrandts CA, Gerritsen M, Krieckaert C, Voskuyl AE, van der Horst-Bruinsma IE, Tas SW, Boers M, Rispens T, Nurmohamed MT, Wolbink G. COVID-19 vaccine acceptance over time in patients with immune-mediated inflammatory rheumatic diseases. THE LANCET RHEUMATOLOGY 2022; 4:e310-e313. [PMID: 35156061 PMCID: PMC8824534 DOI: 10.1016/s2665-9913(22)00009-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Laura Boekel
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Femke Hooijberg
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Yaëlle R Besten
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Erik H Vogelzang
- Department of Medical Microbiology and Infection Control, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory Academic Medical Center, Amsterdam, Netherlands
| | - Maureen Leeuw
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Sadaf Atiqi
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Ronald van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam UMC, Netherlands
| | - Willem F Lems
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Vrije Universiteit, Amsterdam UMC, Netherlands
| | - Wouter H Bos
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Carla A Wijbrandts
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Martijn Gerritsen
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Charlotte Krieckaert
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam UMC, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Vrije Universiteit, Amsterdam UMC, Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Vrije Universiteit, Amsterdam UMC, Netherlands
| | - Irene E van der Horst-Bruinsma
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Vrije Universiteit, Amsterdam UMC, Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam UMC, Netherlands
| | - Maarten Boers
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
- Department of Epidemiology and Data Science, Vrije Universiteit, Amsterdam UMC, Amsterdam, Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory Academic Medical Center, Amsterdam, Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam UMC, Netherlands
| | - Gertjan Wolbink
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
- Department of Immunopathology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory Academic Medical Center, Amsterdam, Netherlands
| |
Collapse
|
24
|
Tanaka E, Inoue E, Abe M, Saka K, Sugano E, Ochiai M, Yamaguchi R, Ikari K, Yamanaka H, Harigai M. Changes in treatment adherence and behaviour during the COVID-19 pandemic in Japanese patients with rheumatoid arthritis: Results from cross-sectional study in the IORRA cohort. Mod Rheumatol 2022; 32:1193-1195. [PMID: 35445721 PMCID: PMC9047218 DOI: 10.1093/mr/roab120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/23/2021] [Accepted: 11/30/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Eiichi Tanaka
- Correspondence: Eiichi Tanaka; ; Department of Internal Medicine, Division of Rheumatology, Tokyo Women’s Medial University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Eisuke Inoue
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women’s Medial University School of Medicine, Tokyo, Japan,Research Administration Center, Showa University, Tokyo, Japan
| | - Mai Abe
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women’s Medial University School of Medicine, Tokyo, Japan,Institute of Rheumatology, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Kumiko Saka
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women’s Medial University School of Medicine, Tokyo, Japan,Institute of Rheumatology, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Eri Sugano
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women’s Medial University School of Medicine, Tokyo, Japan,Institute of Rheumatology, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Moeko Ochiai
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women’s Medial University School of Medicine, Tokyo, Japan,Institute of Rheumatology, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Rei Yamaguchi
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women’s Medial University School of Medicine, Tokyo, Japan,Institute of Rheumatology, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Katsunori Ikari
- Institute of Rheumatology, Tokyo Women’s Medical University Hospital, Tokyo, Japan,Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan,Department of Orthopedic Surgery, Tokyo Women’s Medial University School of Medicine, Tokyo, Japan
| | - Hisashi Yamanaka
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women’s Medial University School of Medicine, Tokyo, Japan,Rheumatology, Sanno Medical Center, Tokyo, Japan,Department of Rheumatology, International University of Health and Welfare, Tokyo, Japan
| | - Masayoshi Harigai
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women’s Medial University School of Medicine, Tokyo, Japan,Institute of Rheumatology, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| |
Collapse
|
25
|
Sakur FJ, Ward K, Khatri NN, Lau AYS. Self-care Behaviours and Technology utilised during COVID-19: Systematic Review. JMIR Hum Factors 2022; 9:e35173. [PMID: 35442904 PMCID: PMC9217152 DOI: 10.2196/35173] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 02/18/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background Self-care behaviors are essential for people living with chronic conditions; however, the outbreak of the COVID-19 pandemic has imposed additional complications on their daily routines. Few studies have analyzed how self-care behaviors have changed during COVID-19 and the role of digital technology, especially among people with chronic conditions. Objective This study aims to review how self-care behaviors have changed for people with chronic conditions during the COVID-19 pandemic, and what technology they have adopted to manage their conditions during that period. Methods A systematic review was conducted using narrative synthesis. Data were extracted from PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, and Google Scholar, including articles from December 2019 onward. Eligible studies focused on adults diagnosed with chronic conditions undertaking any self-care tasks in line with the middle-range theory of self-care of chronic illness (ie, self-care maintenance, monitoring, and management). The methodological quality of the included articles was assessed with the McMaster Critical Review Forms for Quantitative or Qualitative Studies. Results In total, 36 primary research articles were included. Changes to self-care behaviors during COVID-19 among people with chronic conditions were organized according to the middle-range theory of self-care of chronic illness focusing on self-care maintenance (ie, medication adherence, physical activity, and diet control), self-care monitoring (ie, monitoring signs and symptoms), and self-care management (ie, consultations with health care providers). Positive self-care behaviors observed include the following: individuals trying to maintain good glycemic control during COVID-19 increased their medication adherence in 27% (10/36) of studies; and diet control improved in 50% (18/36) of studies. Negative self-care behaviors observed include the following: decline in physical activities and increased sedentariness were observed in 65% (23/36) of studies; poor diet control was observed in 57% (21/36) of studies; and self-monitoring of health status dropped in 43% (15/36) of studies. The use of technology to support self-care of chronic conditions during COVID-19 was reported in 72% (26/36) of studies. The actual use of telehealth in place of physical consultations during COVID-19 was observed in 50% (18/36) of studies, and other digital technologies (eg, social media apps, smartphone apps, web-based platforms, and web browsing) were used in 50% (18/36) of studies. Telehealth was discussed and recommended as the default technology in delivering future health care services during COVID-19 and beyond in 77% (28/36) of studies. Conclusions This review highlighted the necessity to rethink how models of self-care should continue to address the demands of chronic conditions while being responsive to the imminent threats of infectious diseases. Perhaps the silver lining of COVID-19 is that adoption of digital technology (especially telehealth) among a vast cross-section of people with chronic conditions is possible. Future research should investigate effective ways to incorporate evidence-based digital health tools into these new models of self-care that address the challenges of chronic and infectious conditions.
Collapse
Affiliation(s)
- Fareeya Jan Sakur
- Australian Institute of Health Innovation, Macquarie University,, 75 Talavera Rd,, North Ryde, AU
| | - Kanesha Ward
- Australian Institute of Health Innovation, Macquarie University, North Ryde, AU
| | - Neha Nafees Khatri
- Australian Institute of Health Innovation, Macquarie University, North Ryde, AU
| | - Annie Y S Lau
- Australian Institute of Health Innovation, Macquarie University, North Ryde, AU
| |
Collapse
|
26
|
Cordtz R, Kristensen S, Westermann R, Duch K, Pearce F, Lindhardsen J, Torp-Pedersen C, Andersen MP, Dreyer L. COVID-19 infection and hospitalization risk according to vaccination status and DMARD treatment in patients with rheumatoid arthritis. Rheumatology (Oxford) 2022; 62:77-88. [PMID: 35416949 PMCID: PMC9047209 DOI: 10.1093/rheumatology/keac241] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The objectives of this study were to investigate the incidence of COVID-19 hospitalization in unvaccinated and vaccinated patients with RA compared with matched controls, and in patients with RA according to DMARD treatment. METHODS This was a Danish nationwide matched-cohort study from January to October 2021. Patients with RA were identified in the DANBIO register and matched 1:20 with individuals from the general population on age, sex, and vaccination status. Primary and secondary outcomes were COVID-19 hospitalization (Danish National Patient Register) and first-time positive SARS-CoV-2 PCR test (Danish COVID-19 Surveillance Register), respectively. Stratified by vaccination status, incidence rates (IRs) per 1000 person years (PYs) and comorbidity-adjusted hazard ratios (aHRs) in cause-specific Cox models were calculated with 95% confidence intervals. RESULTS In total, 28 447 unvaccinated patients and 568 940 comparators had IRs for COVID-19 hospitalization of 10.4 (8.0-13.4) and 4.7 (4.3-5.1) per 1000 PYs, respectively (aHR 1.88, 1.44-2.46). When fully vaccinated, corresponding IRs were 0.9 (0.5-1.6) and 0.5 (0.4-0.6) per 1000 PYs (aHR 1.94, 1.03-3.66). Unvaccinated RA patients had an aHR of 1.22 (1.09-1.57) for testing positive for SARS-CoV-2 and 1.09 (0.92-1.14) among vaccinated RA patients. Vaccinated rituximab-treated patients had increased crude IR of COVID-19 hospitalization compared with conventional DMARD-treated patients. CONCLUSION The incidence of COVID-19 hospitalization was increased for both unvaccinated and vaccinated patients with RA compared with controls. Importantly, the parallel decreasing risk for patients with RA suggests a comparable relative benefit of vaccination in most patients.
Collapse
Affiliation(s)
- René Cordtz
- Correspondence: Rene Cordtz, , Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 9000-Aalborg, Denmark
| | - Salome Kristensen
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rasmus Westermann
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - Kirsten Duch
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark,Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Fiona Pearce
- Division of Epidemiology and Public Health, Department of Rheumatology, University of Nottingham, Nottingham, United Kingdom
| | - Jesper Lindhardsen
- Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Lene Dreyer
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark,DANBIO, Denmark
| |
Collapse
|
27
|
Eriksen TE, Dinesen WKH, Uhrenholt L, Dreyer L, Duch K, Kristensen S. Isolation in patients with inflammatory rheumatic diseases during COVID-19 pandemic compared to healthy individuals: a questionnaire survey. Rheumatol Int 2022; 42:783-790. [PMID: 35359192 PMCID: PMC8970065 DOI: 10.1007/s00296-022-05111-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/07/2022] [Indexed: 10/31/2022]
Abstract
As a result of the pandemic, many patients with an inflammatory rheumatic disease (IRD) have isolated themselves. The lack of disease management together with fear of infection could lead to changes in physical- and mental health. The aim of this study was to evaluate the social- and health behaviour in patients with an IRD compared with the behaviour of healthy individuals during the COVID-19 pandemic. The study was a questionnaire survey answered by patients with an IRD and healthy individuals (HI). The questionnaire contained seven sections with questions regarding COVID-19 and quality of life including SF-36, EQ-5D-5L, and visual analogue scale (VAS) pain, fatigue and global health. Of 1663 invited participants, 661 patients with IRD and 266 HI were included in the analyses. Patients with an IRD felt more isolated during the COVID-19 pandemic compared with HI (IRD: 9.5% (61/644), HI: 3.1% (8/259), p-value = 0.001). More HI (5.4%) had been infected with COVID-19 than patients with an IRD (1.7%). Among patients with an IRD those with worse self-reported disease activity outcomes (VAS pain, fatigue and global health, all p-value < 0.001), worse social functioning and emotional well-being were more isolated than individuals with low disease activity. Patients with an IRD feel more isolated during the COVID-19 pandemic compared to HI. Isolation seems to be most pronounced in patients with worse disease related patient-reported outcomes and lower quality of life.
Collapse
Affiliation(s)
- Tobias Eschricht Eriksen
- Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Wilfred K H Dinesen
- Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Line Uhrenholt
- Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lene Dreyer
- Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirsten Duch
- Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark.,Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Salome Kristensen
- Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| |
Collapse
|
28
|
Mirza M, Siebert S, Pratt A, Insch E, McIntosh F, Paton J, Wright C, Buckley CD, Isaacs J, McInnes IB, Raza K, Falahee M. Impact of the COVID-19 pandemic on recruitment to clinical research studies in rheumatology. Musculoskeletal Care 2022; 20:209-213. [PMID: 33938621 PMCID: PMC8242596 DOI: 10.1002/msc.1561] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 04/15/2023]
Affiliation(s)
- Mazin Mirza
- Sandwell and West Birmingham NHS TrustBirminghamUK
| | - Stefan Siebert
- Institute of Infection, Immunity and InflammationUniversity of GlasgowGlasgowUK
- Research into Inflammatory Arthritis Centre (RACE)Versus ArthritisUK
| | - Arthur Pratt
- Research into Inflammatory Arthritis Centre (RACE)Versus ArthritisUK
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Elspeth Insch
- Research into Inflammatory Arthritis Centre (RACE)Versus ArthritisUK
| | - Frances McIntosh
- Research into Inflammatory Arthritis Centre (RACE)Versus ArthritisUK
| | - John Paton
- Research into Inflammatory Arthritis Centre (RACE)Versus ArthritisUK
| | - Claire Wright
- Institute of Infection, Immunity and InflammationUniversity of GlasgowGlasgowUK
- Research into Inflammatory Arthritis Centre (RACE)Versus ArthritisUK
| | - Christopher D. Buckley
- Research into Inflammatory Arthritis Centre (RACE)Versus ArthritisUK
- Rheumatology Research GroupInstitute of Inflammation and AgeingCollege of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- Kennedy Institute of RheumatologyUniversity of OxfordOxfordUK
- NIHR Birmingham Biomedical Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
| | - John Isaacs
- Research into Inflammatory Arthritis Centre (RACE)Versus ArthritisUK
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
- Translational and Clinical Research Institute and Musculoskeletal UnitNewcastle UniversityNewcastle upon TyneUK
| | - Iain B. McInnes
- Institute of Infection, Immunity and InflammationUniversity of GlasgowGlasgowUK
- Research into Inflammatory Arthritis Centre (RACE)Versus ArthritisUK
| | - Karim Raza
- Sandwell and West Birmingham NHS TrustBirminghamUK
- Research into Inflammatory Arthritis Centre (RACE)Versus ArthritisUK
- Rheumatology Research GroupInstitute of Inflammation and AgeingCollege of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- NIHR Birmingham Biomedical Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing ResearchUniversity of BirminghamBirminghamUK
| | - Marie Falahee
- Research into Inflammatory Arthritis Centre (RACE)Versus ArthritisUK
- Rheumatology Research GroupInstitute of Inflammation and AgeingCollege of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| |
Collapse
|
29
|
Chiriboga K, Pipitone O, Jones C, Greenberg B, Jones J. Risk of COVID-19 Infection and Hospitalization in Patients With Inflammatory Rheumatic Disease Compared With the General Population. J Clin Rheumatol 2022; 28:e629-e632. [PMID: 35107953 DOI: 10.1097/rhu.0000000000001769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kali Chiriboga
- From the College of Osteopathic Medicine of the Pacific-Northwest, Western University of Health Sciences, Lebanon
| | - Olivia Pipitone
- Health Outcomes Research and Evaluation Department, Good Samaritan Regional Medical Center, Corvallis, OR
| | | | - Brian Greenberg
- Rheumatology Department, Kaiser Permanente of the Northwest, Portland
| | - Jonathan Jones
- Rheumatology Department, Good Samaritan Regional Medical Center, Corvallis, OR
| |
Collapse
|
30
|
Guaracha-Basáñez GA, Contreras-Yáñez I, Hernández-Molina G, Estrada-González VA, Pacheco-Santiago LD, Valverde-Hernández SS, Galindo-Donaire JR, Peláez-Ballestas I, Pascual-Ramos V. Quality of life of patients with rheumatic diseases during the COVID-19 pandemic: The biopsychosocial path. PLoS One 2022; 17:e0262756. [PMID: 35041692 PMCID: PMC8765619 DOI: 10.1371/journal.pone.0262756] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous models that assess quality-of-Life (QoL) in patients with rheumatic diseases have a strong biomedical focus. We evaluated the impact of COVID-19 related-health care interruption (HCI) on the physical, psychological, social relationships and environment QoL-dimensions, and explored factors associated with QoL when patients were reincorporated to the outpatient clinic, and after six-month follow-up. PATIENTS AND METHODS Study phase-1 consisted of a COVID-19 survey administered from June 24th-October 31st 2020, to outpatients with rheumatic diseases who had face-to-face consultation at outpatient clinic reopening. Study phase-2 consisted of 3 consecutive assessments of patient´s QoL (WHOQOL-BREF), disease activity/severity (RAPID-3), and psychological comorbidity/trauma (DASS-21 and IES-R) to patients from phase-1 randomly selected. Sociodemographic, disease and treatment-related information, and comorbidities were obtained. Multiple linear regression analysis identified factors associated with the score assigned to each WHOQOL-BREF dimension. RESULTS Patients included (670 for phase-1 and 276 for phase-2), had primarily SLE and RA (44.2% and 34.1%, respectively), and all the dimensions of their WHOQOL-BREF were affected. There were 145 patients (52.5%) who referred HCI, and they had significantly lower dimensions scores (but the environment dimension score). Psycho-emotional factors (primarily feeling confused, depression and anxiety), sociodemographic factors (age, COVID-19 negative economic impact, years of scholarship, HCI and having a job), and biomedical factors (RAPID-3 score and corticosteroid use) were associated with baseline QoL dimensions scores. Psycho-emotional factors showed the strongest magnitude on dimensions scores. Most consistent predictor of six-month follow-up QoL dimensions scores was each corresponding baseline dimension score, while social determinants (years of scholarship and having a job), emotional factors (feeling bored), and biomedical aspects (RAPID 3) had an additional impact. CONCLUSIONS HCI impacted the majority of patient´s QoL dimensions. Psycho-emotional, sociodemographic and biomedical factors were consistently associated with QoL dimensions scores, and these consistently predicted the QoL trajectory.
Collapse
Affiliation(s)
- Guillermo A. Guaracha-Basáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Mexico City, Mexico
| | - Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Mexico City, Mexico
| | - Gabriela Hernández-Molina
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Mexico City, Mexico
| | - Viviana A. Estrada-González
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Mexico City, Mexico
| | - Lexli D. Pacheco-Santiago
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Mexico City, Mexico
| | - Salvador S. Valverde-Hernández
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Mexico City, Mexico
| | - José Roberto Galindo-Donaire
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Mexico City, Mexico
| | | | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Mexico City, Mexico
| |
Collapse
|
31
|
Impact of the COVID-19 lockdown on the adherence of stroke patients to direct oral anticoagulants: a secondary analysis from the MAAESTRO study. J Neurol 2022; 269:19-25. [PMID: 34081196 PMCID: PMC8173508 DOI: 10.1007/s00415-021-10631-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The negative impact of the COVID-19 outbreak on stroke care has been reported, but no data exist on the influence of the lockdown on medication adherence to antithrombotic treatment for stroke prevention. We present a comparison of electronic adherence data of stroke patients treated with direct oral anticoagulants (DOAC) prior to and during the COVID-19 lockdown in spring 2020 in Switzerland. METHODS This is a secondary analysis using data from the ongoing MAAESTRO study, in which stroke patients with atrial fibrillation electronically monitor their adherence to DOAC treatment. Eligible patients for this analysis had at least four weeks of adherence data prior to and during the COVID-19 lockdown. Three adherence metrics (taking adherence, timing adherence, drug holidays) were calculated and compared descriptively. RESULTS The analysis included eight patients (median age 81.5 years, IQR 74.8-84.5). Five patients had a pre-lockdown taking adherence over 90% (mean 96.8% ± 2.9), with no change during lockdown, high timing adherence in both periods and no drug holidays. The remaining three patients had pre-lockdown taking and timing adherence below 90%. Of those, two patients showed a moderate decline either in taking or timing adherence compared to pre-lockdown. One showed a substantial increase in taking and timing adherence during lockdown (both + 25.8%). CONCLUSION Our data suggest that a major disruption of social life (i.e., the imposed COVID-19 lockdown) is unlikely to relevantly affect the medication intake behaviour of patients with high pre-established adherence, but might have an impact in patients with previously suboptimal adherence. TRIAL REGISTRATION NUMBER MAAESTRO: electronic Monitoring and improvement of Adherence to direct oral Anticoagulant treatment-a randomized crossover study of an Educational and reminder-based intervention in ischaemic STROke patients under polypharmacy, NCT03344146.
Collapse
|
32
|
Baraliakos X, Tsiami S, Vijayan S, Jung H, Barkham N. Real-world evidence for subcutaneous infliximab (CT-P13 SC) treatment in patients with psoriatic arthritis during the coronavirus disease (COVID-19) pandemic: A case series. Clin Case Rep 2022; 10:e05205. [PMID: 35079380 PMCID: PMC8777045 DOI: 10.1002/ccr3.5205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic highlighted the benefits of subcutaneous (SC) administration for healthcare systems. The first SC infliximab, CT-P13 SC, was safe and effective for the treatment of psoriatic arthritis. Observed patient preferences for continuing CT-P13 SC suggest that patients receiving IV infliximab should be offered a switch to CT-P13 SC.
Collapse
Affiliation(s)
| | | | - Sooraj Vijayan
- Department of RheumatologyNew Cross HospitalRoyal Wolverhampton NHS TrustWolverhamptonUK
- SUT Academy of Medical SciencesThiruvananthapuramIndia
| | | | - Nick Barkham
- Department of RheumatologyNew Cross HospitalRoyal Wolverhampton NHS TrustWolverhamptonUK
| |
Collapse
|
33
|
Cook C, Cox H, Fu X, Zhang Y, Stone JH, Choi HK, Wallace ZS. Perceived Risk and Associated Shielding Behaviors in Patients With Rheumatoid Arthritis During the Coronavirus 2019 Pandemic. ACR Open Rheumatol 2021; 3:834-841. [PMID: 34498436 PMCID: PMC8653208 DOI: 10.1002/acr2.11340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/12/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To investigate the perceived risk of coronavirus disease 2019 (COVID-19) infection and outcomes as well as shielding practices among patients with rheumatoid arthritis (RA) during the COVID-19 pandemic. METHODS We surveyed participants with RA in a large health care system between July 16 and November 8, 2020. Participants reported RA treatment, COVID-19 risk perception, and shielding practices (eg, masks, social distancing, and quarantining). We examined the association of demographic and disease-specific factors with risk perception and the association of risk perception with shielding practices. RESULTS Of 494 participants, 195 (40%), 169 (34%), and 130 (26%) strongly agreed, agreed, or were uncertain/disagreed that their RA put them at higher risk for COVID-19 or poor outcomes, respectively. Younger age (odds ratio [OR]: 0.98), having a comorbidity (OR: 1.60), and biologic disease-modifying antirheumatic drug (bDMARD) use (OR: 1.75) were independently associated with a higher perceived risk. Among those who strongly agreed, agreed, or were uncertain/disagreed that they had greater risk, 165 (85%), 118 (70%), and 69 (53%), respectively, practiced all three shielding measures (P < 0.0001). Those who strongly agreed or agreed that they were at higher risk were more likely to use all three shielding practices (OR: 4.16 and 1.97, respectively). bDMARD use and glucocorticoid use were associated with using all three shielding measures (OR: 1.99 and 1.81, respectively). CONCLUSION Perception of COVID-19 risk among patients with RA varies substantially. Factors associated with perceived risk are different from those found to be associated with worse outcomes in observational studies. Greater perceived risk is associated with more strict shielding, which has implications for patient education and mental health.
Collapse
Affiliation(s)
- Claire Cook
- Division of Rheumatology, Allergy, and ImmunologyMassachusetts General HospitalBoston
| | - Huel Cox
- Division of Rheumatology, Allergy, and ImmunologyMassachusetts General HospitalBoston
| | - Xiaoqing Fu
- Division of Rheumatology, Allergy, and ImmunologyMassachusetts General HospitalBoston
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and ImmunologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
| | - John H. Stone
- Division of Rheumatology, Allergy, and ImmunologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Hyon K. Choi
- Division of Rheumatology, Allergy, and ImmunologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Zachary S. Wallace
- Division of Rheumatology, Allergy, and ImmunologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
| |
Collapse
|
34
|
Glintborg B, Jensen DV, Terslev L, Pfeiffer Jensen M, Hendricks O, Østergaard M, Engel S, Horskjær Rasmussen S, Adelsten T, Colic A, Danebod K, Kildemand M, Loft AG, Munk HL, Pedersen JK, Østgård RD, Møller Sørensen C, Krogh NS, Nørgaard Agerbo J, Ziegler C, Hetland ML. Impact of the COVID-19 pandemic on treat-to-target strategies and physical consultations in >7000 patients with inflammatory arthritis. Rheumatology (Oxford) 2021; 60:SI3-SI12. [PMID: 34146099 PMCID: PMC8344418 DOI: 10.1093/rheumatology/keab500] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/09/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To explore the impact of the COVID-19 pandemic on treat-to-target strategies (disease activity, remission rates) and access to physical consultations in patients with inflammatory rheumatic disease, as well as to explore characteristics of patients with/without physical consultations in the clinic and the impact of early vs established disease. METHODS Patients with RA, PsA or axial SpA (axSpA) prospectively followed in the nationwide DANBIO registry answered online questionnaires and reported patient-reported outcomes (PROs) in June and November 2020. Patient characteristics, disease activity and physical consultations in the clinic before and during the pandemic were identified in DANBIO [all patients and subgroups with early disease (disease duration ≤2 years)]. In individual patients, changes in PROs before and during the pandemic were calculated. Characteristics of patients with/without physical consultations were described (age, gender, education level, comorbidities, disease duration, treatment). RESULTS We included 7836 patients (22% of eligible patients), 12% of which had early disease. PROs were stable before and during the pandemic, with median changes approximating zero, as well as in patients with early disease. Remission rates were stable. The relative decrease in the number of patients with physical consultations was 21-72%, which was highest in axSpA. Characteristics of patients with/without physical consultations were similar. Self-reported satisfaction with treatment options and access was >70%; the preferred contact form was physical consultation (66%). CONCLUSION In this nationwide study performed during the first 8 months of the pandemic, patient satisfaction was high and the PROs and remission rates remained stable despite the remarkable reduction in physical consultations, as well as in patients with early disease. Characteristics of patients with/without physical consultations appeared similar.
Collapse
Affiliation(s)
- Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | - Dorte Vendelbo Jensen
- DANBIO and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet
- Department of Rheumatology, Center for Rheumatology and Spine Diseases, Gentofte and Herlev Hospital
| | - Lene Terslev
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen
| | - Mogens Pfeiffer Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen
| | - Oliver Hendricks
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg
- Department of Regional Health Research, University of Southern Denmark, Odense
| | - Mikkel Østergaard
- DANBIO and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | - Sara Engel
- DANBIO and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet
| | - Simon Horskjær Rasmussen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen
| | - Thomas Adelsten
- Department of Rheumatology, Zealand University Hospital, Køge
| | - Ada Colic
- Department of Rheumatology, Zealand University Hospital, Køge
| | - Kamilla Danebod
- Department of Rheumatology, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup
| | | | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital
- Department of Clinical Medicine, Health, Aarhus University, Aarhus
| | - Heidi Lausten Munk
- Department of Rheumatology, Odense University Hospital, Odense
- Department of Clinical Research, University of Southern Denmark, Odense
| | - Jens Kristian Pedersen
- Department of Clinical Research, University of Southern Denmark, Odense
- Rheumatology Section, Department of Medicine M, Odense University Hospital and Svendborg Hospital, Svendborg
| | - René Drage Østgård
- Rheumatology Section, Department of Medicine M, Odense University Hospital and Svendborg Hospital, Svendborg
- Diagnostic Center, Silkeborg Regional Hospital, Silkeborg
| | | | | | | | | | - Merete Lund Hetland
- DANBIO and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| |
Collapse
|
35
|
Sattui SE, Liew JW, Kennedy K, Sirotich E, Putman M, Moni TT, Akpabio A, Alpízar-Rodríguez D, Berenbaum F, Bulina I, Conway R, Singh AD, Duff E, Durrant KL, Gheita TA, Hill CL, Howard RA, Hoyer BF, Hsieh E, El Kibbi L, Kilian A, Kim AH, Liew DFL, Lo C, Miller B, Mingolla S, Nudel M, Palmerlee CA, Singh JA, Singh N, Ugarte-Gil MF, Wallace J, Young KJ, Bhana S, Costello W, Grainger R, Machado PM, Robinson PC, Sufka P, Wallace ZS, Yazdany J, Harrison C, Larché M, Levine M, Foster G, Thabane L, Rider LG, Hausmann JS, Simard JF, Sparks JA. Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey. RMD Open 2021; 7:e001814. [PMID: 34493645 PMCID: PMC8424419 DOI: 10.1136/rmdopen-2021-001814] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/18/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We describe the early experiences of adults with systemic rheumatic disease who received the COVID-19 vaccine. METHODS From 2 April to 30 April 2021, we conducted an online, international survey of adults with systemic rheumatic disease who received COVID-19 vaccination. We collected patient-reported data on clinician communication, beliefs and intent about discontinuing disease-modifying antirheumatic drugs (DMARDs) around the time of vaccination, and patient-reported adverse events after vaccination. RESULTS We analysed 2860 adults with systemic rheumatic diseases who received COVID-19 vaccination (mean age 55.3 years, 86.7% female, 86.3% white). Types of COVID-19 vaccines were Pfizer-BioNTech (53.2%), Oxford/AstraZeneca (22.6%), Moderna (21.3%), Janssen/Johnson & Johnson (1.7%) and others (1.2%). The most common rheumatic disease was rheumatoid arthritis (42.3%), and 81.2% of respondents were on a DMARD. The majority (81.9%) reported communicating with clinicians about vaccination. Most (66.9%) were willing to temporarily discontinue DMARDs to improve vaccine efficacy, although many (44.3%) were concerned about rheumatic disease flares. After vaccination, the most reported patient-reported adverse events were fatigue/somnolence (33.4%), headache (27.7%), muscle/joint pains (22.8%) and fever/chills (19.9%). Rheumatic disease flares that required medication changes occurred in 4.6%. CONCLUSION Among adults with systemic rheumatic disease who received COVID-19 vaccination, patient-reported adverse events were typical of those reported in the general population. Most patients were willing to temporarily discontinue DMARDs to improve vaccine efficacy. The relatively low frequency of rheumatic disease flare requiring medications was reassuring.
Collapse
Affiliation(s)
| | - Jean W Liew
- Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kevin Kennedy
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Emily Sirotich
- Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michael Putman
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Tarin T Moni
- Department of Biochemistry & Biomedical Sciences, McMaster University Faculty of Science, Hamilton, Ontario, Canada
| | - Akpabio Akpabio
- Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - Inita Bulina
- Department of Internal Diseases, Rheumatology Centre, Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | | | - Eimear Duff
- Department of Rheumatology, Saint James's Hospital, Dublin, Ireland
| | | | - Tamer A Gheita
- Rheumatology and Clinical Immunology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Catherine L Hill
- Rheumatology Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Bimba F Hoyer
- Medical Department I, Department for Rheumatology and Clinical Immunology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Evelyn Hsieh
- Section of Rheumatology, Allergy & Immunology, Yale School of Medicine, New Haven, Connecticut, USA
- Section of Rheumatology, VA Connecticut Healthcare System-West Haven Campus, West Haven, Connecticut, USA
| | - Lina El Kibbi
- Rheumatology, Specialized Medical Center Hospital, Riyadh, Saudi Arabia
| | - Adam Kilian
- Department of Internal Medicine, Division of Rheumatology, Saint Louis University, Saint Louis, Missouri, USA
| | - Alfred Hyoungju Kim
- Medicine/Rheumatology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - David F L Liew
- Rheumatology, Austin Health, Heidelberg West, Victoria, Australia
- Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, Victoria, Australia
| | - Chieh Lo
- I-Shou University College of Medicine, Yanchau Sheng, Taiwan
| | - Bruce Miller
- Medicine, University of California San Diego, La Jolla, California, USA
| | - Serena Mingolla
- Italian National Patient Association for Rehumatoid and Rare Disease (APMARR), Rome, Italy
| | - Michal Nudel
- The Israeli Association for RMD Patients "Mifrakim Tz'eirim", Haifa, Israel
| | - Candace A Palmerlee
- Relapsing Polychondritis Foundation, International Relapsing Polychondritis Research Network, Walnut Creek, California, USA
| | - Jasvinder A Singh
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Namrata Singh
- Medicine, Division of Rheumatology, University of Washington, Seattle, Washington, USA
| | - Manuel Francisco Ugarte-Gil
- Department of Rheumatology, Universidad Cientifica del Sur, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | | | - Kristen J Young
- Division of Rheumatology, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | | | - Wendy Costello
- Irish Children's Arthritis Network (iCAN), Tipperary, Ireland
| | - Rebecca Grainger
- Department of Medicine, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, University College London, London, UK
- Rheumatology, University College London Centre for Rheumatology, London, UK
| | - Philip C Robinson
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Metro North Hospital & Health Service, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
| | | | - Zachary S Wallace
- Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology,Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jinoos Yazdany
- Medicine/Rheumatology, University of California, San Francisco, California, USA
| | | | - Maggie Larché
- Division of Clinical Immunology and Allergy, McMaster University Department of Medicine, Hamilton, Ontario, Canada
| | - Mitchell Levine
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Gary Foster
- Department of Health Research Methods, Evidence, and Impact (HEI); Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Lisa G Rider
- Environmental Autoimmunity Group, NIEHS/NIH/DHHS, Bethesda, Maryland, USA
| | - Jonathan S Hausmann
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Julia F Simard
- Epidemiology and Population Health and Department of Medicine, Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA
- Department of Medicine, Clinical Epidemiology Unit, Sweden
| | - Jeffrey A Sparks
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
36
|
Incidence of COVID-19 Hospitalisation in Patients with Systemic Lupus Erythematosus: A Nationwide Cohort Study from Denmark. J Clin Med 2021; 10:jcm10173842. [PMID: 34501290 PMCID: PMC8432052 DOI: 10.3390/jcm10173842] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Patients with systemic lupus erythematosus (SLE) have an increased risk of infections due to impaired immune functions, disease activity, and treatment. This study investigated the impact of having SLE on the incidence of hospitalisation with COVID-19 infection. Methods: This was a nationwide cohort study from Denmark between 1 March 2020 to 2 February 2021, based on the linkage of several nationwide registers. The adjusted incidence of COVID-19 hospitalisation was estimated for patients with SLE compared with the general population in Cox-regression models. Among SLE patients, the hazard ratio (HR) for hospitalisation was analysed as nested case-control study. Results: Sixteen of the 2533 SLE patients were hospitalised with COVID-19 infection. The age-sex adjusted rate per 1000 person years was 6.16 (95% CI 3.76–10.08) in SLE patients, and the corresponding hazard ratio was 2.54 (95% CI 1.55–4.16) compared with the matched general population group after adjustment for comorbidities. Among SLE patients, hydroxychloroquine treatment was associated with a HR for hospitalisation of 0.61 (95% CI 0.19–1.88), and 1.06 (95% CI 0.3–3.72) for glucocorticoid treatment. Conclusion: Patients with SLE were at increased risk of hospitalisation with COVID-19.
Collapse
|
37
|
Boekel L, Hooijberg F, Vogelzang EH, Klarenbeek PL, Bos WH, Tas SW, Wolbink GJ. Spinning straw into gold: description of a disruptive rheumatology research platform inspired by the COVID-19 pandemic. Arthritis Res Ther 2021; 23:207. [PMID: 34348783 PMCID: PMC8338203 DOI: 10.1186/s13075-021-02574-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/06/2021] [Indexed: 02/03/2023] Open
Abstract
Clinical research projects often use traditional methods in which data collection and signing informed consent forms rely on patients' visits to the research institutes. However, during challenging times when the medical community is in dire need of information, such as the current COVID-19 pandemic, it becomes more urgent to use digital platforms that can rapidly collect data on large numbers of patients. In the current manuscript, we describe a novel digital rheumatology research platform, consisting of almost 5000 patients with autoimmune diseases and healthy controls, that was set up rapidly during the COVID-19 pandemic, but which is sustainable for the future. Using this platform, uniform patient data can be collected via questionnaires and stored in a single database readily available for analysis. In addition, the platform facilitates two-way communication between patients and researchers, so patients become true research partners. Furthermore, blood collection via a finger prick for routine and specific laboratory measurements has been implemented in this large cohort of patients, which may not only be applicable for research settings but also for clinical care. Finally, we discuss the challenges and potential future applications of our platform, including supplying tailored information to selected patient groups and facilitation of patient recruitment for clinical trials.
Collapse
Affiliation(s)
- L Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Dr. Jan van Breemenstraat 2, 1056 AB, Amsterdam, the Netherlands.
| | - F Hooijberg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Dr. Jan van Breemenstraat 2, 1056 AB, Amsterdam, the Netherlands
| | - E H Vogelzang
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, location AMC, 1105 AZ, Amsterdam, the Netherlands
| | - P L Klarenbeek
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, location AMC, Department of Rheumatology and Clinical Immunology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - W H Bos
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Dr. Jan van Breemenstraat 2, 1056 AB, Amsterdam, the Netherlands
| | - S W Tas
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, location AMC, Department of Rheumatology and Clinical Immunology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - G J Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Dr. Jan van Breemenstraat 2, 1056 AB, Amsterdam, the Netherlands.,Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Plesmanlaan 125, 1066 CX, Amsterdam, the Netherlands
| |
Collapse
|
38
|
Schreiber K, Hendricks O. First data on COVID-19 morbidity and mortality in patients with rheumatic disease from South Korea. LANCET RHEUMATOLOGY 2021; 3:e673-e675. [PMID: 34179833 PMCID: PMC8213377 DOI: 10.1016/s2665-9913(21)00213-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Karen Schreiber
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg 6400, Denmark.,Institute of Regional Health Research (IRS), University of Southern Denmark, Odense, Denmark.,Thrombosis and Haemophilia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Oliver Hendricks
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg 6400, Denmark.,Institute of Regional Health Research (IRS), University of Southern Denmark, Odense, Denmark
| |
Collapse
|
39
|
Boyle E, Folkestad L, Frafjord E, Koes BW, Skou ST, Hartvigsen J. The Danish Diabetes Musculoskeletal Cohort: Non-Responder Analysis of an Electronic Survey Using Registry Data. Clin Epidemiol 2021; 13:397-405. [PMID: 34103998 PMCID: PMC8180289 DOI: 10.2147/clep.s293186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/29/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose To conduct a non-responder analysis on a musculoskeletal (MSK) electronic questionnaire. Methods Individuals aged 18 years and older, diagnosed with diabetes mellitus (DM), and attended an ambulatory DM clinic formed the sample frame. They were invited to complete an electronic musculoskeletal (MSK) conditions and symptoms questionnaire booklet using a secured electronic email system. Individuals whose secured email box was not active at the time were discarded. Using the Central Person Registry number, a unique number assigned to all Danish residents, we linked the sample frame to different registries to learn more about non-responders. Non-responders were either individuals who did not respond to a single question and those who responded “No” to the first question about willing to participate. We calculated descriptive statistics for each characteristic. Univariate logistic regression models were conducted to determine the relationship between each characteristic and non-responder status. Results The response rate was 36% (n = 3812). Individuals with type 2 DM (OR 2.0 (95% CI 1.8–2.2)), secondary DM (1.9 (1.3–2.8)) or unspecified DM (2.1 (1.8–2.4)) were more likely to be non-responders than individuals with Type 1 DM. Also, individuals aged 70–79 (1.3 (1.1–1.6)) and 80 years and older (5.9 (4.5–7.7)) were more likely to be non-responders than 18–29 years old individuals. However, individuals aged 40–49 (1.5 (1.2–1.8)), 50–59 (1.5 (1.3–1.8)) or 60–69 (1.4 (1.1–1.6)) were more likely to be responders than 18–29 years old individuals. Individuals with Charlson Comorbidity Index (CCI) of 1 (2.0 (1.3.2.9) or CCI of 2 (1.7 (1.1–2.5) were more likely to be responders than individuals with a CCI of 0. Lastly, individuals who were currently outside of the workforce (1.6 (2.4–2.9) or had unknown/missing socioeconomic status (3.9 (2.8–5.3) were more likely to be non-responders than individuals who were working. Conclusion Although we did find a non-response bias, this cohort will be an important source to determine the prevalence and consequences of MSK conditions in a secondary care DM population.
Collapse
Affiliation(s)
- Eleanor Boyle
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars Folkestad
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.,Department of Internal Medicine, Hospital of South West Denmark, Esbjerg, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient Exploratory Network, University of Southern Denmark, Odense, Denmark
| | | | - Bart W Koes
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of General Practice, Erasmus MC, Rotterdam, the Netherlands
| | - Soren Thorgaard Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| |
Collapse
|
40
|
Glintborg B, Jensen DV, Engel S, Terslev L, Pfeiffer Jensen M, Hendricks O, Østergaard M, Horskjær Rasmussen S, Adelsten T, Colic A, Danebod K, Kildemand M, Loft AG, Munk HL, Pedersen JK, Østgård RD, Møller Sørensen C, Krogh NS, Nørgaard Agerbo J, Ziegler C, Lund Hetland M. Anxiety and concerns related to the work situation during the second wave of the COVID-19 pandemic in >5000 patients with inflammatory rheumatic disease followed in the DANBIO registry. RMD Open 2021; 7:rmdopen-2021-001649. [PMID: 33941664 PMCID: PMC8098969 DOI: 10.1136/rmdopen-2021-001649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 12/18/2022] Open
Affiliation(s)
- Bente Glintborg
- DANBIO, Rigshospitalet Glostrup, Glostrup, Denmark .,Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark.,Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Dorte Vendelbo Jensen
- DANBIO, Rigshospitalet Glostrup, Glostrup, Denmark.,Department of Rheumatology, Center for Rheumatology and Spine Diseases, Gentofte University Hospital, Hellerup, Hovedstaden, Denmark
| | - Sara Engel
- DANBIO, Rigshospitalet Glostrup, Glostrup, Denmark.,Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Lene Terslev
- DANBIO, Rigshospitalet Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark.,Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Mogens Pfeiffer Jensen
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark.,Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Oliver Hendricks
- Danish Hospital for Rheumatology, University of Southern Denmark, Sønderborg, Syddanmark, Denmark.,Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Mikkel Østergaard
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark.,Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Simon Horskjær Rasmussen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Thomas Adelsten
- Department of Rheumatology, Sjællands Universitetshospital Køge, Koge, Sjælland, Denmark
| | - Ada Colic
- Department of Rheumatology, Sjællands Universitetshospital Køge, Koge, Sjælland, Denmark
| | - Kamilla Danebod
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Malene Kildemand
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Health, Aarhus Universitet, Aarhus, Midtjylland, Denmark
| | - Heidi Lausten Munk
- Department of Rheumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Jens Kristian Pedersen
- Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark.,Department of Medicine M, Svendborg, Odense University Hospital, Svendborg, Denmark
| | - René Drage Østgård
- Diagnostic center, Silkeborg Regional Hospital, Silkeborg, Midtjylland, Denmark
| | | | | | | | - Connie Ziegler
- Danish Rheumatism Association/Gigtforeningen, Copenhagen, Denmark
| | - Merete Lund Hetland
- DANBIO, Rigshospitalet Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark.,Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| |
Collapse
|
41
|
Larkin L, Raad T, Moses A, Fraser A, Gallagher S, Appel Esbensen B, Glynn L, Griffin A, Tierney A, Kennedy N. The impact of COVID-19 on clinical research: the PIPPRA and MEDRA experience. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13283.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has had a significant impact on clinical research. This paper aims to provide an insight into how the COVID-19 pandemic, associated public health restrictions and international guidance on the conduct of clinical research impacted two clinical rheumatology research trials - the Physiotherapist-led Intervention to Promote Physical Activity in Rheumatoid Arthritis (PIPPRA) and the MEDiterranean diet in Rheumatoid Arthritis (MEDRA) projects. Methods: The March 2019 public health restrictions imposed to mitigate the risk of COVID-19 occurred at a time when PIPPRA was in the process of delivering assessment and intervention on a face-to-face basis (n=48) and MEDRA had commenced recruitment. Participants in PIPPRA and MEDRA had a diagnosis of rheumatoid arthritis, with some being immunosuppressed and thus at a higher risk for COVID-19. The decision-making processes of both trials is outlined to demonstrate the required amendments to continue in the context of the COVID-19 pandemic. Results: Amendments to PIPPRA and MEDRA trial protocols were agreed and received ethical and funder approval. Both trials switched from a face-to-face delivery to a telehealth using online platforms. The PIPPRA study was paused for five months (April-August 2020), resulting in n=33 (60%) deviations from assessment protocol. MEDRA switched from face-to-face to online recruitment with 20% (n=35/44) deviation in recruitment. Of the n=18 participants who consented to participating in a face-to-face trial, just n=2 (11%) opted to engage with telehealth delivery of the intervention. MEDRA assessment and intervention deviations were 100% as no sessions were completed as planned in 2020. Conclusions: The COVID-19 pandemic has severely impacted the PIPPRA and MEDRA clinical trials. Moving face-to-face clinical research to telehealth delivery may not be the panacea it is purported to be. Our experiences may be of benefit to researchers, clinicians, and funders in seeking to continue clinical research during a global pandemic.
Collapse
|
42
|
Macfarlane GJ, Hollick RJ, Morton L, Heddle M, Bachmair EM, Anderson RS, Whibley D, Keenan KF, Murchie P, Stelfox K, Beasley MJ, Jones GT. The effect of COVID19 public health restrictions on the health of people with musculoskeletal conditions and symptoms: the CONTAIN study. Rheumatology (Oxford) 2021; 60:SI13-SI24. [PMID: 34009314 PMCID: PMC8244573 DOI: 10.1093/rheumatology/keab374] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To quantify the change in quality of life, disease-specific indicators, health, and lifestyle before and during the COVID19 pandemic amongst people with musculoskeletal diagnoses and symptoms. METHODS We undertook an additional follow-up of two existing UK registers involving people with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA) and participants in a trial in the UK who had regional pain and were identified at high risk of developing chronic widespread pain. Participants completed the study questionnaire between July and December 2020, throughout which time there were public health restrictions in place. RESULTS 1054 people took part in the study (596 axSpA, 162 PsA, 296 regional pain). In comparison to their previous (pre-pandemic) assessment, there was an age-adjusted significant, small, decrease in quality of life measured by EQ-5D (-0.020 95% CI (-0.030, -0.009)) overall and across all population groups examined. This was primarily related to poorer mental health and pain. There was a small increase in fibromyalgia symptoms, but a small decrease in sleep problems. There was a small deterioration in axSpA disease activity, and disease-specific quality of life and anxiety in PsA participants. Predictors of poor quality of life were similar pre- and during the pandemic. The effect of lockdown on activity differed according to age, gender, and deprivation. CONCLUSION Important lessons include focussing on addressing anxiety and providing enhanced support for self-management in the absence of normal health care being available, and awareness that all population groups are likely to be affected.
Collapse
Affiliation(s)
- Gary J Macfarlane
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Rosemary J Hollick
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - LaKrista Morton
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Maureen Heddle
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Eva-Maria Bachmair
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - R Stuart Anderson
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Daniel Whibley
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Karen Forrest Keenan
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Peter Murchie
- Centre for Primary Care Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Kevin Stelfox
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Marcus J Beasley
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Gareth T Jones
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| |
Collapse
|
43
|
Nissen CB, Sciascia S, de Andrade D, Atsumi T, Bruce IN, Cron RQ, Hendricks O, Roccatello D, Stach K, Trunfio M, Vinet É, Schreiber K. The role of antirheumatics in patients with COVID-19. LANCET RHEUMATOLOGY 2021; 3:e447-e459. [PMID: 33817665 PMCID: PMC8009617 DOI: 10.1016/s2665-9913(21)00062-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The COVID-19 pandemic has resulted in more than 2 million deaths globally. Two interconnected stages of disease are generally recognised; an initial viral stage and a subsequent immune response phase with the clinical characteristics of hyperinflammation associated with acute respiratory distress syndrome. Therefore, many immune modulators and immunosuppressive drugs, which are widely used in rheumatological practice, have been proposed as treatments for patients with moderate or severe COVID-19. In this Review, we provide an overview of what is currently known about the efficacy and safety of antirheumatic therapies for the treatment of patients with COVID-19. Dexamethasone has been shown to reduce COVID-19 related mortality, interleukin-6 inhibitors to reduce risk of cardiovascular or respiratory organ support, and baricitinib to reduce time to recovery in hospitalised patients requiring oxygen support. Further studies are needed to identify whether there is any role for glucocorticoids in patients with less severe COVID-19. Although evidence on the use of other antirheumatic drugs has suggested some benefits, results from adequately powered clinical trials are urgently needed. The heterogeneity in dosing and the absence of uniform inclusion criteria and defined stage of disease studied in many clinical trials have affected the conclusions and comparability of trial results. However, after the success of dexamethasone in proving the anti-inflammatory hypothesis, the next 12 months will undoubtedly bring further clarity about the clinical utility and optimal dose and timing of other anti-rheumatic drugs in the management of COVID-19.
Collapse
Affiliation(s)
- Christoffer B Nissen
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Danmark
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, Nephrology and Dialysis, Department of Clinical and Biological Sciences, University of Turin, Italy
| | - Danieli de Andrade
- Department of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Medicine and Health, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre Manchester, Manchester, UK
| | - Randy Q Cron
- Division of Rheumatology, Children's of Alabama and Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Oliver Hendricks
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Danmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Dario Roccatello
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, Nephrology and Dialysis, Department of Clinical and Biological Sciences, University of Turin, Italy
| | - Ksenija Stach
- Fifth Department of Medicine and European Center for Angioscience, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mattia Trunfio
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo di Savoia Hospital, Torino, Italy
| | - Évelyne Vinet
- Division of Rheumatology, McGill University Health Centre, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Karen Schreiber
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Danmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Thrombosis and Haemostasis, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
44
|
Elera-Fitzcarrald C, Huarcaya-Victoria J, Alarcón GS, Ugarte-Gil MF. Rheumatology and psychiatry: allies in times of COVID-19. Clin Rheumatol 2021; 40:3363-3367. [PMID: 34050441 PMCID: PMC8162488 DOI: 10.1007/s10067-021-05792-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/15/2021] [Accepted: 05/23/2021] [Indexed: 02/06/2023]
Abstract
The COVID-19 (coronavirus disease 2019) pandemic has had a significant global impact. Physical, emotional, and psychological health, particularly its specific mental health area, has been affected. Patients with rheumatic diseases are more likely to be concerned about COVID-19 than the public in general. Depression and anxiety are the symptoms most commonly reported by these patients. Therefore, now more than ever before, rheumatologists and psychiatrists should work together to improve the care of rheumatic disease patients, identifying the symptoms that uniquely reflect mental health problems, so the patients' quality of life can be substantially improved.
Collapse
Affiliation(s)
- Claudia Elera-Fitzcarrald
- Facultad de Medicina, Universidad Científica del Sur, Av. Panamericana Sur km 19, Villa El Salvador, 15067, Lima, Peru.
| | - Jeff Huarcaya-Victoria
- Departamento Académico de Psiquiatría, Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Unidad de Psiquiatría de Enlace, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Graciela S Alarcón
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, The University of Alabama At Birmingham, Birmingham, AL, USA
| | - Manuel F Ugarte-Gil
- Facultad de Medicina, Universidad Científica del Sur, Av. Panamericana Sur km 19, Villa El Salvador, 15067, Lima, Peru
- Servicio de Reumatología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| |
Collapse
|