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Ryan RE, Silke C, Parkhill A, Virgona A, Merner B, Hurley S, Walsh L, de Moel-Mandel C, Schonfeld L, Edwards AG, Kaufman J, Cooper A, Chung RKY, Solo K, Hellard M, Di Tanna GL, Pedrana A, Saich F, Hill S. Communication to promote and support physical distancing for COVID-19 prevention and control. Cochrane Database Syst Rev 2023; 10:CD015144. [PMID: 37811673 PMCID: PMC10561351 DOI: 10.1002/14651858.cd015144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND This review is an update of a rapid review undertaken in 2020 to identify relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control. The rapid review was published when little was known about transmission, treatment or future vaccination, and when physical distancing measures (isolation, quarantine, contact tracing, crowd avoidance, work and school measures) were the cornerstone of public health responses globally. This updated review includes more recent evidence to extend what we know about effective pandemic public health communication. This includes considerations of changes needed over time to maintain responsiveness to pandemic transmission waves, the (in)equities and variable needs of groups within communities due to the pandemic, and highlights again the critical role of effective communication as integral to the public health response. OBJECTIVES To update the evidence on the question 'What are relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control?', our primary focus was communication approaches to promote and support acceptance, uptake and adherence to physical distancing. SECONDARY OBJECTIVE to explore and identify key elements of effective communication for physical distancing measures for different (diverse) populations and groups. SEARCH METHODS We searched MEDLINE, Embase and Cochrane Library databases from inception, with searches for this update including the period 1 January 2020 to 18 August 2021. Systematic review and study repositories and grey literature sources were searched in August 2021 and guidelines identified for the eCOVID19 Recommendations Map were screened (November 2021). SELECTION CRITERIA Guidelines or reviews focusing on communication (information, education, reminders, facilitating decision-making, skills acquisition, supporting behaviour change, support, involvement in decision-making) related to physical distancing measures for prevention and/or control of COVID-19 or selected other diseases (sudden acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, Ebola virus disease (EVD) or tuberculosis (TB)) were included. New evidence was added to guidelines, reviews and primary studies included in the 2020 review. DATA COLLECTION AND ANALYSIS Methods were based on the original rapid review, using methods developed by McMaster University and informed by Cochrane rapid review guidance. Screening, data extraction, quality assessment and synthesis were conducted by one author and checked by a second author. Synthesis of results was conducted using modified framework analysis, with themes from the original review used as an initial framework. MAIN RESULTS This review update includes 68 studies, with 17 guidelines and 20 reviews added to the original 31 studies. Synthesis identified six major themes, which can be used to inform policy and decision-making related to planning and implementing communication about a public health emergency and measures to protect the community. Theme 1: Strengthening public trust and countering misinformation: essential foundations for effective public health communication Recognising the key role of public trust is essential. Working to build and maintain trust over time underpins the success of public health communications and, therefore, the effectiveness of public health prevention measures. Theme 2: Two-way communication: involving communities to improve the dissemination, accessibility and acceptability of information Two-way communication (engagement) with the public is needed over the course of a public health emergency: at first, recognition of a health threat (despite uncertainties), and regularly as public health measures are introduced or adjusted. Engagement needs to be embedded at all stages of the response and inform tailoring of communications and implementation of public health measures over time. Theme 3: Development of and preparation for public communication: target audience, equity and tailoring Communication and information must be tailored to reach all groups within populations, and explicitly consider existing inequities and the needs of disadvantaged groups, including those who are underserved, vulnerable, from diverse cultural or language groups, or who have lower educational attainment. Awareness that implementing public health measures may magnify existing or emerging inequities is also needed in response planning, enactment and adjustment over time. Theme 4: Public communication features: content, timing and duration, delivery Public communication needs to be based on clear, consistent, actionable and timely (up-to-date) information about preventive measures, including the benefits (whether for individual, social groupings or wider society), harms (likewise) and rationale for use, and include information about supports available to help follow recommended measures. Communication needs to occur through multiple channels and/or formats to build public trust and reach more of the community. Theme 5: Supporting behaviour change at individual and population levels Supporting implementation of public health measures with practical supports and services (e.g. essential supplies, financial support) is critical. Information about available supports must be widely disseminated and well understood. Supports and communication related to them require flexibility and tailoring to explicitly consider community needs, including those of vulnerable groups. Proactively monitoring and countering stigma related to preventive measures (e.g. quarantine) is also necessary to support adherence. Theme 6: Fostering and sustaining receptiveness and responsiveness to public health communication Efforts to foster and sustain public receptiveness and responsiveness to public health communication are needed throughout a public health emergency. Trust, acceptance and behaviours change over time, and communication needs to be adaptive and responsive to these changing needs. Ongoing community engagement efforts should inform communication and public health response measures. AUTHORS' CONCLUSIONS Implications for practice Evidence highlights the critical role of communication throughout a public health emergency. Like any intervention, communication can be done well or poorly, but the consequences of poor communication during a pandemic may mean the difference between life and death. The approaches to effective communication identified in this review can be used by policymakers and decision-makers, working closely with communication teams, to plan, implement and adjust public communications over the course of a public health emergency like the COVID-19 pandemic. Implications for research Despite massive growth in research during the COVID-19 period, gaps in the evidence persist and require high-quality, meaningful research. This includes investigating the experiences of people at heightened COVID-19 risk, and identifying barriers to implementing public communication and protective health measures particular to lower- and middle-income countries, and how to overcome these.
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Affiliation(s)
- Rebecca E Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Charlotte Silke
- UNESCO Child & Family Research Centre, School of Political Science & Sociology, University of Galway, Galway, Ireland
| | - Anne Parkhill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Ariane Virgona
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Shauna Hurley
- Cochrane Australia, School of Public Health & Preventive Medicine, Melbourne, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
- Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, Australia
- Burnet Institute, Melbourne, Australia
| | | | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Adrian Gk Edwards
- Wales COVID-19 Evidence Centre, Cardiff University, 8th floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN , UK
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, 8th floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN, UK
| | - Jessica Kaufman
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
- Vaccine Uptake Group, Murdoch Children's Research Institute , The Royal Children's Hospital, Parkville, Australia
| | - Alison Cooper
- Wales COVID-19 Evidence Centre, Cardiff University, 8th floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN , UK
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, 8th floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN, UK
| | | | - Karla Solo
- GRADE McMaster & Cochrane Canada, Health Research Methods, Evidence & Impact, McMaster University , Hamilton, Ontario , Canada
| | | | - Gian Luca Di Tanna
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | | | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Kim W, Yeon HR, Kim JH, Kim JH, Kim JH, Kim HA, Jung JY, Kim J, Choi IA, Lee KE. Association between SYVN1 and SEL1 genetic polymorphisms and remission in rheumatoid arthritis patients treated with TNF-α inhibitors: a machine learning approach. Immunol Res 2023; 71:709-716. [PMID: 37119459 DOI: 10.1007/s12026-023-09382-4] [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: 12/03/2022] [Accepted: 04/01/2023] [Indexed: 05/01/2023]
Abstract
Rheumatoid arthritis (RA) is a severe chronic inflammatory condition that affects joint synovium. Suppressor/enhancer of lin-12-like (SEL1L)-Synoviolin 1 (SYVN1)-mediated endoplasmic reticulum-associated degradation (ERAD) is highly associated with RA development. Although targeting SEL1L-SYVN1-mediated ERAD can be beneficial, studies that evaluate the association between polymorphisms in their genes and remission from the disease in RA patients taking tumor necrosis factor (TNF)-α inhibitors have yet to be carried out. Hence, the purpose of this study was to investigate the association between SYVN1 and SEL1L polymorphisms and TNF-α inhibitor response using various machine learning models. A total of 12 single-nucleotide polymorphisms (SNPs), including 5 SNPs in SYVN1 and 7 SNPs of SEL1L were investigated. Logistic regression analysis was used to examine the relationship between genetic polymorphisms and response to treatment. Various machine learning methods were employed to evaluate factors associated with remission in patients receiving TNF-α inhibitors. After adjusting for covariates, we found that sulfasalazine and rs2025214 in SEL1L increase the remission rates by approximately 3.3 and 2.8 times, respectively (95% confidence intervals 1.126-9.695 and 1.074-7.358, respectively). Machine learning approaches showed acceptable prediction estimates for remission in RA patients receiving TNF-α inhibitors, with the area under the receiver-operating curve (AUROC) values ranging from 0.60 to 0.65. A polymorphism of the SEL1L gene (rs2025214) and sulfasalazine were found to be associated with treatment response in RA patients receiving TNF-α inhibitors. These preliminary data could be used to tailor treatment for RA patients using TNF-α inhibitors.
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Affiliation(s)
- Woorim Kim
- College of Pharmacy, Chungbuk National University, 660-1, Yeonje-ri, Osong-eup, Heungdeok-gu, Cheongju-si, 28160, Republic of Korea
- College of Pharmacy, Kangwon National University, Chuncheon, Republic of Korea
| | - Ha Rim Yeon
- College of Pharmacy, Chungbuk National University, 660-1, Yeonje-ri, Osong-eup, Heungdeok-gu, Cheongju-si, 28160, Republic of Korea
| | - Jun Hyeob Kim
- College of Pharmacy, Chungbuk National University, 660-1, Yeonje-ri, Osong-eup, Heungdeok-gu, Cheongju-si, 28160, Republic of Korea
| | - Joo Hee Kim
- College of Pharmacy, Ajou University, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Ji Hyoun Kim
- Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, 776, 1sunhwan-ro, Seowon-gu, Cheongju, 28644, Republic of Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, 14, Suwon, 16499, Republic of Korea
| | - Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, 14, Suwon, 16499, Republic of Korea
| | - Jinhyun Kim
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - In Ah Choi
- Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, 776, 1sunhwan-ro, Seowon-gu, Cheongju, 28644, Republic of Korea.
| | - Kyung Eun Lee
- College of Pharmacy, Chungbuk National University, 660-1, Yeonje-ri, Osong-eup, Heungdeok-gu, Cheongju-si, 28160, Republic of Korea.
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Ryan S, Campbell P, Paskins Z, Manning F, Rule K, Brooks M, Hider S, Hassell A. Perceptions of risk in people with inflammatory arthritis during the COVID-19 pandemic. Rheumatol Adv Pract 2022; 6:rkac050. [PMID: 35800066 PMCID: PMC9255274 DOI: 10.1093/rap/rkac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/30/2022] [Indexed: 12/02/2022] Open
Abstract
Objective People with inflammatory arthritis have an increased incidence of serious illness and mortality, placing them at risk of poor outcomes from coronavirus disease 2019 (COVID-19). This study explored patients’ perceptions of risk from COVID-19 over a longitudinal period of the pandemic. Methods Fifteen adults with inflammatory arthritis attending a National Health Service rheumatology service each took part in three semi-structured telephone interviews conducted between 16 September 2020 and 29 July 2021. Interpretive phenomenological analysis was undertaken by two researchers and two public contributors. Results Four main themes relating to perceptions of risk from COVID-19 were identified: inflammatory arthritis; medications and co-morbidities; immediate social environment; health policy communication; and media influence. Participants recognized that having inflammatory arthritis increased their individual risk. Perceptions of risk and associated fear increased during the pandemic, influenced by family/friends who had had COVID-19 and health policy communications. The perceived constant use of negative messages led to many participants disengaging with the media. At the final interviews, when the vaccination programme was well established, participants continued to assess the risk and benefits of engaging in activities. Conclusion This study demonstrates the breadth of factors that influenced perceptions of risk in people with an inflammatory arthritis. As health professionals, we have only a small sphere of influence over some of these factors, namely health-care communications. People with inflammatory arthritis appropriately knew that their condition increased their infection risk, but more could be done to consider how and to what extent we involve patients in explaining risk at times of crisis.
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Affiliation(s)
- Sarah Ryan
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital , Stoke on Trent
- School of Nursing and Midwifery, Keele University , Keele
| | - Paul Campbell
- Department of Research and Innovation, Midlands Partnership NHS Foundation Trust, St George’s Hospital , Stafford
- School of Medicine, Keele University , Keele
| | - Zoe Paskins
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital , Stoke on Trent
- School of Medicine, Keele University , Keele
| | - Fay Manning
- School of Medicine, Keele University , Keele
- Medical School, University of Exeter , Exeter, UK
| | - Katrina Rule
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital , Stoke on Trent
| | - Michael Brooks
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital , Stoke on Trent
| | - Samantha Hider
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital , Stoke on Trent
- School of Medicine, Keele University , Keele
| | - Andrew Hassell
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital , Stoke on Trent
- School of Medicine, Keele University , Keele
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Vasireddy S, Wig S, Hannides M. Technical factors can impact on remote consultations in rheumatology: results from a service evaluation during the COVID-19 pandemic. Rheumatol Int 2022; 42:999-1007. [PMID: 35403853 PMCID: PMC8995407 DOI: 10.1007/s00296-022-05112-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
Since the COVID-19 pandemic started, there have been changes in clinical practice to limit transmission, such as switching from face-to-face to remote consultations. We aimed to study the influence of technical factors on remote consultations in our experience during the pandemic. 12 clinicians completed data collection forms after consultations, recording the technology used (video vs phone); technical problems encountered; discharge or subsequent appointment status; and technical aspects of the consultation process using 0–10 numerical rating scales (NRS) (Time Adequate; Relevant History; Physical Exam; Management Plan; and Communication Quality). Data were collated on an MS Access 2016 database and transferred to SPSS version 25 for statistics. Of 285 forms valid for analysis, 48 (16.8%) had video consultations. Of 259 forms with technical problems data recorded, 48 (18.5%) had a technical problem. Video patients were significantly younger (mean 49.3 vs 61.3 years, p < 0.001), had higher scores on Physical Exam scale (mean 4.0 vs 2.6, p < 0.001), but had no significant difference on Management Plan scale (7.3 vs 7.2). Those with technical problems were more common among video consultations (33.3% vs 15.4%, p = 0.005), had lower scores on Time Adequate scale (7.7 vs 8.7, p < 0.001) and Communication Quality scale (7.1 vs 8.4, p < 0.001), but had no significant difference on Management Plan scale (7.3 vs 7.2). The strongest correlation of Management Plan scale was with Communication Quality scale (Rho = 0.64). Of the NRS, a 1-point reduction in scores on Management Plan scale was the strongest predictor of subsequent face-to-face appointment (Odds Ratio 1.88, 95% CI 1.58–2.24), and this remained an independent predictor in multivariate analysis (adjusted OR 1.90, 1.57–2.31). Having a technical problem was inversely associated with the outcome of a subsequent face-to-face appointment (OR 0.17, 0.04–0.74), and this remained significant after adjustment for Management Plan in multivariate analysis (adjusted OR 0.09, 0.12–0.54). Video patients were younger suggesting a preference for video amongst younger patients. Although technical problems were more common with video, having a video consultation or a technical problem had no significant impact on management plan. Scoring lower on the Management Plan scale was the strongest predictor of, and independently associated with, requesting a subsequent face-to-face appointment. The inverse relationship of technical problems with subsequent face-to-face appointment request will need validation in further studies.
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Affiliation(s)
- Sreekanth Vasireddy
- Department of Rheumatology, Bolton One Health Centre, Bolton NHS FT, Moor Lane, Bolton, BL3 5BN, UK.
- School of Biological Sciences, University of Manchester, Manchester, UK.
| | - Surabhi Wig
- Department of Rheumatology, Bolton One Health Centre, Bolton NHS FT, Moor Lane, Bolton, BL3 5BN, UK
- School of Biological Sciences, University of Manchester, Manchester, UK
| | - Michael Hannides
- Department of Rheumatology, Bolton One Health Centre, Bolton NHS FT, Moor Lane, Bolton, BL3 5BN, UK
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Patients’ perspectives of telemedicine appointments for psoriatic arthritis during the COVID-19 pandemic: results of a patient-driven pilot survey. BMC Rheumatol 2022; 6:13. [PMID: 35189975 PMCID: PMC8860501 DOI: 10.1186/s41927-021-00242-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/26/2021] [Indexed: 02/05/2023] Open
Abstract
Background Over recent years the lack of patient involvement in the design, set-up and implementation of clinical research studies has been well recognised; as such there has been a drive within research communities to increase patient participation. Patient perspectives on telemedicine differ widely, with variation in whether patients feel remote consultations are beneficial. By means of a patient-driven survey, we aimed to formally evaluate patient perspectives on its benefits and pitfalls, focusing on patients with psoriatic arthritis (PsA). Methods An e-survey was developed by two patient representatives on the BritPACT steering committee, with a view to determining unmet needs and the perceived impact on clinical care of virtual consultations amongst patients with PsA. Results 128 patients responded to the e-survey. 109 patients rated the effectiveness of their telemedicine appointment and, of these, 18% felt their virtual consultation was very/extremely effective compared to an in-clinic consultation and 49% felt it was somewhat/equally as effective; furthermore, 48% (51/107) felt that such virtual consultations would be of benefit to them after the pandemic. 36% of respondents felt their virtual consultation was not as effective as an in-clinic review. Themes identified from open-ended questions included the lack of visual cues, lack of physical examination and effect on rapport and ease of open communication as the main pitfalls of virtual consultations. Patients with well-controlled symptoms appeared more satisfied with remote reviews compared to those with active disease, though on the whole respondents recognised the benefits, such as saving travel time and costs. Those who had an established relationship with their health professional appeared less concerned regarding virtual consultations though a recurring view was that newly diagnosed patients should have in-clinic appointments to build rapport and improve symptom control at an early stage. Conclusions Overall patients’ perspectives on virtual consultations varied widely though patients with well-controlled symptoms and those who had a previously established relationship with their healthcare professionals and well-controlled disease appeared more satisfied with remote reviews. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-021-00242-y.
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Rutter M, Lanyon PC, Grainge MJ, Hubbard R, Peach E, Bythell M, Stilwell P, Aston J, Stevens S, Pearce FA. COVID-19 Infection, Admission and Death Amongst People with Rare Autoimmune Rheumatic Disease in England. Results from the RECORDER Project. Rheumatology (Oxford) 2021; 61:3161-3171. [PMID: 34698821 PMCID: PMC8586729 DOI: 10.1093/rheumatology/keab794] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives To calculate the rates of COVID-19 infection and COVID-19-related death among people with rare autoimmune rheumatic diseases (RAIRD) during the first wave of the COVID-19 pandemic in England compared with the general population. Methods We used Hospital Episode Statistics to identify all people alive 01 March 2020 with ICD-10 codes for RAIRD from the whole population of England. We used linked national health records (demographic, death certificate, admissions and PCR testing data) to calculate rates of COVID-19 infection and death up to 31 July 2020. Our primary definition of COVID-19-related death was mention of COVID-19 on the death certificate. General population data from Public Health England and the Office for National Statistics were used for comparison. We also describe COVID-19-related hospital admissions and all-cause deaths. Results We identified a cohort of 168 680 people with RAIRD, of whom 1874 (1.11%) had a positive COVID-19 PCR test. The age-standardised infection rate was 1.54 (95% CI 1.50–1.59) times higher than in the general population. 713 (0.42%) people with RAIRD died with COVID-19 on their death certificate and the age-sex-standardised mortality rate for COVID-19-related death was 2.41 (2.30–2.53) times higher than in the general population. There was no evidence of an increase in deaths from other causes in the RAIRD population. Conclusions During the first wave of COVID-19 in England, people with RAIRD had a 54% increased risk of COVID-19 infection and more than twice the risk of COVID-19-related death compared with the general population. These increases were seen despite shielding policies.
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Affiliation(s)
- Megan Rutter
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter C Lanyon
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK.,National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Matthew J Grainge
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Richard Hubbard
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Emily Peach
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mary Bythell
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK
| | - Peter Stilwell
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK
| | - Jeanette Aston
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK
| | - Sarah Stevens
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK
| | - Fiona A Pearce
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK.,National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
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McKay SC, Lembach H, Hann A, Okoth K, Anderton J, Nirantharakumar K, Magill L, Torlinska B, Armstrong M, Mascaro J, Inston N, Pinkney T, Ranasinghe A, Borrows R, Ferguson J, Isaac J, Calvert M, Perera T, Hartog H. Health-related quality of life, uncertainty and coping strategies in solid organ transplant recipients during shielding for the COVID-19 pandemic. Transpl Int 2021; 34:2122-2137. [PMID: 34378227 PMCID: PMC8420473 DOI: 10.1111/tri.14010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/22/2021] [Accepted: 08/05/2021] [Indexed: 11/27/2022]
Abstract
Strict isolation of vulnerable individuals has been a strategy implemented by authorities to protect people from COVID‐19. Our objective was to investigate health‐related quality of life (HRQoL), uncertainty and coping behaviours in solid organ transplant (SOT) recipients during the COVID‐19 pandemic. A cross‐sectional survey of adult SOT recipients undergoing follow‐up at our institution was performed. Perceived health status, uncertainty and coping strategies were assessed using the EQ‐5D‐5L, Short‐form Mishel Uncertainty in Illness Scale (SF‐MUIS) and Brief Cope, respectively. Interactions with COVID‐19 risk perception, access to health care, demographic and clinical variables were assessed. The survey was completed by 826 of 3839 (21.5%) invited participants. Overall, low levels of uncertainty in illness were reported, and acceptance was the major coping strategy (92%). Coping by acceptance, feeling protected, self‐perceived susceptibility to COVID‐19 were associated with lower levels of uncertainty. Health status index scores were significantly lower for those with mental health illness, compromised access to health care, a perceived high risk of severe COVID‐19 infection and higher levels of uncertainty. A history of mental health illness, risk perceptions, restricted healthcare access, uncertainty and coping strategies was associated with poorer HRQoL in SOT recipients during strict isolation. These findings may allow identification of strategies to improve HRQoL in SOT recipients during the pandemic.
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Affiliation(s)
- Siobhan C McKay
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom.,Department of Academic Surgery, University of Birmingham, Edgbaston, Birmingham, B15 2TH, United Kingdom
| | - Hanns Lembach
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - Angus Hann
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - Kelvin Okoth
- Birmingham Centre for Observational and Prospective Studies (BiCOPS), University of Birmingham, Edgbaston, Birmingham, B15 2TH, United Kingdom
| | - Joy Anderton
- Patient Research Partner, Liver & Gastro-Intestinal Patient and Public Involvement Group, Birmingham Biomedical Research Centre, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Birmingham Centre for Observational and Prospective Studies (BiCOPS), University of Birmingham, Edgbaston, Birmingham, B15 2TH, United Kingdom
| | - Laura Magill
- Birmingham Centre for Observational and Prospective Studies (BiCOPS), University of Birmingham, Edgbaston, Birmingham, B15 2TH, United Kingdom
| | - Barbara Torlinska
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TH, United Kingdom
| | - Matthew Armstrong
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - Jorge Mascaro
- Cardiothoracic Surgery Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - Nicholas Inston
- Renal Surgery Unit, Queen Elizabeth Hospital Birmingham Mindelsohn way, Birmingham, United Kingdom
| | - Thomas Pinkney
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TH, United Kingdom
| | - Aaron Ranasinghe
- Cardiothoracic Surgery Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - Richard Borrows
- Renal Surgery Unit, Queen Elizabeth Hospital Birmingham Mindelsohn way, Birmingham, United Kingdom
| | - James Ferguson
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - John Isaac
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TH, United Kingdom
| | - Thamara Perera
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
| | - Hermien Hartog
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, B152GW, United Kingdom
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Koppert TY, Jacobs JWG, Geenen R. The psychological impact of the COVID-19 pandemic on Dutch people with and without an inflammatory rheumatic disease. Rheumatology (Oxford) 2021; 60:3709-3715. [PMID: 33313870 PMCID: PMC7798513 DOI: 10.1093/rheumatology/keaa842] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/28/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To determine the psychological impact of the COVID-19 pandemic on people with and without an inflammatory rheumatic disease and establish whether psychological flexibility buffers this impact. METHODS From online surveys in the general Dutch population in 2018 and during the peak of the COVID-19 pandemic in 2020, we analysed data of people with (index group, n = 239) and without (control group, n = 1821) an inflammatory rheumatic disease. Worry, stress, mental well-being (SF-36) and psychological flexibility levels were subjected to covariate-adjusted analyses of variance or linear regression analyses. RESULTS During the peak of the COVID-19 pandemic in 2020, as compared with the control group, the index group was more worried about getting infected with the virus (partial η2=0.098; medium effect) and more stressed (partial η2=0.040; small effect). However, as compared with data acquired in 2018, the level of mental well-being during the COVID-19 pandemic peak was not lower in both groups. Levels of psychological flexibility did not moderate associations of group or year with mental well-being. CONCLUSIONS Although patients with an inflammatory rheumatic disease were more worried and stressed during the peak of the COVID-19 pandemic, their level of mental well-being was not reduced, which may have prevented us from finding a buffering effect of psychological flexibility. Overall, our results suggest that the psychological impact of the COVID-19 pandemic in patients with inflammatory rheumatic disease is modest, which could imply that common education and health care will do for most patients.
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Affiliation(s)
- Tim Y Koppert
- Department of Psychology, Leiden University, Leiden, The Netherlands
| | - Johannes W G Jacobs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, The Netherlands
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
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9
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Mahil S, Yates M, Langan S, Yiu Z, Tsakok T, Dand N, Mason K, McAteer H, Meynell F, Coker B, Vincent A, Urmston D, Vesty A, Kelly J, Lancelot C, Moorhead L, Bachelez H, Bruce I, Capon F, Contreras C, Cope A, De La Cruz C, Di Meglio P, Gisondi P, Hyrich K, Jullien D, Lambert J, Marzo‐Ortega H, McInnes I, Naldi L, Norton S, Puig L, Sengupta R, Spuls P, Torres T, Warren R, Waweru H, Weinman J, Griffiths C, Barker J, Brown M, Galloway J, Smith C. Risk-mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey. Br J Dermatol 2021; 185:80-90. [PMID: 33368145 PMCID: PMC9214088 DOI: 10.1111/bjd.19755] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse coronavirus disease 2019 (COVID-19) outcomes compared with patients receiving no systemic treatments. OBJECTIVES We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation. METHODS Online surveys were completed by individuals with psoriasis (globally) or rheumatic and musculoskeletal diseases (RMDs) (UK only) between 4 May and 7 September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterized international variation in a mixed-effects model. RESULTS Of 3720 participants (2869 psoriasis, 851 RMDs) from 74 countries, 2262 (60·8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term 'shielding'). A greater proportion of those receiving targeted therapies (biologics and Janus Kinase inhibitors) reported shielding compared with those receiving no systemic therapy [adjusted odds ratio (OR) 1·63, 95% confidence interval (CI) 1·35-1·97]. The association between targeted therapy and shielding was preserved when standard systemic therapy was used as the reference group (OR 1·39, 95% CI 1·23-1·56). Shielding was associated with established risk factors for severe COVID-19 [male sex (OR 1·14, 95% CI 1·05-1·24), obesity (OR 1·37, 95% CI 1·23-1·54), comorbidity burden (OR 1·43, 95% CI 1·15-1·78)], a primary indication of RMDs (OR 1·37, 95% CI 1·27-1·48) and a positive anxiety or depression screen (OR 1·57, 95% CI 1·36-1·80). Modest differences in the proportion shielding were observed across nations. CONCLUSIONS Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk-mitigation strategies and may help inform updated public health guidelines as the pandemic continues.
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10
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Zateri C, Birtane M, Aktaş İ, Sarıkaya S, Rezvani A, Altan L, Dursun N, Dursun E, Taştekin N, Çeliker R, Özdolap Ş, Akgün K. Attitudes of patients with spondylarthritis or rheumatoid arthritis regarding biological treatment during COVID-19 pandemic: A multi-center, phone-based, cross-sectional study. Arch Rheumatol 2021; 36:473-481. [PMID: 35382368 PMCID: PMC8957759 DOI: 10.46497/archrheumatol.2021.8364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/18/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives
In this study, we aimed to investigate the medical treatment attitudes of patients with spondylarthritis or rheumatoid arthritis (RA) who were using biological drugs during the novel coronavirus-2019 (COVID-19) pandemic. Patients and methods
In this multi-center, cross-sectional study, a total of 277 patients (178 males, 99 females; median age: 45 years; range, 20 to 77 years) who were using biological disease-modifying anti-rheumatic drugs (bDMARDs) for rheumatic diseases and were reached by phone between June 1st, 2020 and June 30th, 2020 were included. Demographic characteristics, working status, type of the rheumatic disease, comorbidities, smoking habits, and type of the bDMARDs were recorded. Disease activity was evaluated using the Visual Analog Scale (VAS). The patients were asked whether they continued the treatment plan, as it was before or changed and, if changed, how they changed the plan and what happened after the change. Results
Of the patients, 229 had spondylarthritis and 48 had RA. A total of 36.1% of the patients were smokers, and the most common comorbidity was hypertension (17.3%). Totally, 5.8% of the patients had a history of contact with a COVID-19 positive person. Only three (1.1%) patients were diagnosed with COVID-19 infection and none of them died. Of the patients, 64.3% continued their treatment, while 35.7% adopted various changes. Most patients made the decision about the treatment plan on their own (n=160, 57.8%), while 38.3% of them consulted their physicians and 13.9% of them consulted any health staff. The only significant parameter for changing the drug course was receiving intravenous bDMARDs (by infusion at hospital) (p=0.001). These patients had also a higher disease activity as measured by VAS, compared to the patients receiving non-infusion therapy (p=0.021). As a result of these changes, severity of the symptoms increased in 91 (32.9%) patients. Disruption of regular biological treatment and prior infusion therapy more likely worsened the complaints (p<0.001 and p=0.024, respectively). Conclusion
Intravenous bDMARD therapy seems to be the main factor affecting the continuity of the treatment in the pandemic period. During the pandemic period, alternative treatment options should be considered other than infusion therapy not to interrupt the treatment of these patients.
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Affiliation(s)
- Coskun Zateri
- Department of Physical Medicine and Rehabilitation, Çanakkale Onsekiz Mart University, Faculty of Medicine, Çanakkale, Turkey
| | - Murat Birtane
- Department of Physical Medicine and Rehabilitation, Trakya University, Faculty of Medicine, Edirne, Turkey
| | - İlknur Aktaş
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Selda Sarıkaya
- Department of Physical Medicine and Rehabilitation, Bülent Ecevit University, Faculty of Medicine, Zonguldak, Turkey
| | - Aylin Rezvani
- Department of Physical Medicine and Rehabilitation, Medipol University, International Faculty of Medicine, Istanbul, Turkey
| | - Lale Altan
- Department of Physical Medicine and Rehabilitation, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Nigar Dursun
- Department of Physical Medicine and Rehabilitation, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Erbil Dursun
- Department of Physical Medicine and Rehabilitation, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Nurettin Taştekin
- Department of Physical Medicine and Rehabilitation, Trakya University, Faculty of Medicine, Edirne, Turkey
| | - Reyhan Çeliker
- Department of Physical Medicine and Rehabilitation, Acıbadem University, Faculty of Medicine, Istanbul, Turkey
| | - Şenay Özdolap
- Department of Physical Medicine and Rehabilitation, Bülent Ecevit University, Faculty of Medicine, Zonguldak, Turkey
| | - Kenan Akgün
- Department of Physical Medicine and Rehabilitation, Istanbul University, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
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11
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Sheikh A, Anderson M, Albala S, Casadei B, Franklin BD, Richards M, Taylor D, Tibble H, Mossialos E. Health information technology and digital innovation for national learning health and care systems. Lancet Digit Health 2021; 3:e383-e396. [PMID: 33967002 DOI: 10.1016/s2589-7500(21)00005-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/24/2020] [Accepted: 01/04/2021] [Indexed: 01/01/2023]
Abstract
Health information technology can support the development of national learning health and care systems, which can be defined as health and care systems that continuously use data-enabled infrastructure to support policy and planning, public health, and personalisation of care. The COVID-19 pandemic has offered an opportunity to assess how well equipped the UK is to leverage health information technology and apply the principles of a national learning health and care system in response to a major public health shock. With the experience acquired during the pandemic, each country within the UK should now re-evaluate their digital health and care strategies. After leaving the EU, UK countries now need to decide to what extent they wish to engage with European efforts to promote interoperability between electronic health records. Major priorities for strengthening health information technology in the UK include achieving the optimal balance between top-down and bottom-up implementation, improving usability and interoperability, developing capacity for handling, processing, and analysing data, addressing privacy and security concerns, and encouraging digital inclusivity. Current and future opportunities include integrating electronic health records across health and care providers, investing in health data science research, generating real-world data, developing artificial intelligence and robotics, and facilitating public-private partnerships. Many ethical challenges and unintended consequences of implementation of health information technology exist. To address these, there is a need to develop regulatory frameworks for the development, management, and procurement of artificial intelligence and health information technology systems, create public-private partnerships, and ethically and safely apply artificial intelligence in the National Health Service.
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Affiliation(s)
- Aziz Sheikh
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
| | - Michael Anderson
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Sarah Albala
- UCL Institute for Innovation and Public Purpose, University College London, London, UK
| | - Barbara Casadei
- Radcliffe Department of Medicine, BHF Centre for Research Excellence, NIHR Biomedical Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Bryony Dean Franklin
- UCL School of Pharmacy, University College London, London, UK; NIHR Imperial Patient Safety Translational Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Mike Richards
- Department of Health Policy, London School of Economics and Political Science, London, UK; The Health Foundation, London, UK
| | - David Taylor
- UCL School of Pharmacy, University College London, London, UK
| | - Holly Tibble
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, UK; Institute of Global Health Innovation, Imperial College London, London, UK
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12
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Tam LS, Tanaka Y, Handa R, Li Z, Lorenzo JP, Louthrenoo W, Hill C, Pile K, Robinson PC, Dans LF, Hsu LY, Lee SM, Cho J, Hasan ATMT, Salim B, Samreen S, Shaharir SS, Wong P, Chau J, Danda D, Haq SA. Updated APLAR consensus statements on care for patients with rheumatic diseases during the COVID-19 pandemic. Int J Rheum Dis 2021; 24:733-745. [PMID: 33945214 PMCID: PMC8206920 DOI: 10.1111/1756-185x.14124] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022]
Abstract
AIM To update previous guidance of the Asia Pacific League of Associations for Rheumatology (APLAR) on the management of patients with rheumatic and musculoskeletal diseases (RMD) during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Research questions were formulated focusing on diagnosis and treatment of adult patients with RMD within the context of the pandemic, including the management of RMD in patients who developed COVID-19. MEDLINE was searched for eligible studies to address the questions, and the APLAR COVID-19 task force convened 2 meetings through video conferencing to discuss its findings and integrate best available evidence with expert opinion. Consensus statements were finalized using the modified Delphi process. RESULTS Agreement was obtained around key aspects of screening for or diagnosis of COVID-19; management of patients with RMD without confirmed COVID-19; and management of patients with RMD with confirmed COVID-19. The task force achieved consensus on 25 statements covering the potential risk of acquiring COVID-19 in RMD patients, advice on RMD medication adjustment and continuation, the roles of telemedicine and vaccination, and the impact of the pandemic on quality of life and on treatment adherence. CONCLUSIONS Available evidence primarily from descriptive research supported new recommendations for aspects of RMD care not covered in the previous document, particularly with regard to risk factors for complicated COVID-19 in RMD patients, modifications to RMD treatment regimens in the context of the pandemic, and COVID-19 vaccination in patients with RMD.
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Affiliation(s)
- Lai-Shan Tam
- Division of Rheumatology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | - Zhanguo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Jose Paulo Lorenzo
- Section of Rheumatology, Department of Medicine, Makati Medical Center, Makati City, Philippines
| | - Worawit Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Catherine Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Kevin Pile
- Rheumatology Unit, Campbelltown Hospital, Western Sydney University, Sydney, NSW, Australia
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland School of Medicine, Brisbane, QLD, Australia
| | - Leonila F Dans
- Department of Pediatrics and Department of Clinical Epidemiology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jiacai Cho
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
| | - A T M Tanveer Hasan
- Department of Rheumatology, Enam Medical College & Hospital, Dhaka, Bangladesh
| | - Babur Salim
- Department of Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Saba Samreen
- Department of Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Syahrul Sazliyana Shaharir
- Division of Rheumatology, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Priscilla Wong
- Division of Rheumatology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jeffrey Chau
- Hong Kong Psoriatic Arthritis Association, Hong Kong, Hong Kong
| | - Debashish Danda
- Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital, Vellore, India
| | - Syed Atiqul Haq
- Department of Rheumatology, BSM Medical University, Dhaka, Bangladesh
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13
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Conway R, Konig MF, Graef ER, Webb K, Yazdany J, Kim AHJ. Inflammatory arthritis in patients with COVID-19. Transl Res 2021; 232:49-59. [PMID: 33626415 PMCID: PMC7897406 DOI: 10.1016/j.trsl.2021.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 12/12/2022]
Abstract
Patients with inflammatory arthritis represent a possible high-risk group to COVID-19 due to their immunosuppressive regimen designed to maintain low disease activity. Thus, substantial effort has been put forth to understand the impact of COVID-19 on these patients. Patients with rheumatic diseases as a whole do not appear to be more susceptible to acquiring COVID-19. Furthermore, immunosuppression generally did not increase the likelihood of developing severe COVID-19, with the important exception of medium and high-dose glucocorticoid use. In addition, a small number of COVID-19 patients have developed new inflammatory arthritis; whether this represents an unmasking of previous subclinical disease or a bone fide virus-induced arthritis is unclear. Nevertheless, it appears that inflammatory arthritis patients currently on immunosuppression should continue their medication to prevent future flares and limit glucocorticoid usage. While this continues to be a rapidly evolving field, these data are reassuring to both patients with and providers treating inflammatory arthritides.
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Key Words
- ace-2, angiotensin converting enzyme-2
- acr, american college of rheumatology
- c1, complement component 1
- ci, confidence interval
- covid-19, coronavirus disease-2019
- dmard, disease-modifying antirheumatic drugs
- eular, european league against rheumatism
- gra, global rheumatology alliance
- hcq, hydroxychloroquine
- hiv, human immunodeficiency virus
- hla, human leukocyte antigen
- hr, hazard ratio
- mis-c, multisystem inflammatory syndrome in children
- mri, magnetic resonance imaging
- nhs, national health service
- or, odds ratio
- pcr, polymerase chain reaction
- ra, rheumatoid arthritis
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- sle, systemic lupus erythematosus
- slicc, systemic lupus erythematosus international collaborating clinics
- tnfi, tumor necrosis factor inhibitor
- tracr, trinity rheumatology and covid-19 registry
- uk, united kingdom
- us, united states
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Affiliation(s)
- Richard Conway
- Department of Rheumatology, St. James's Hospital, Dublin, Ireland
| | - Maximilian F Konig
- Division of Rheumatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Kate Webb
- Division of Paediatric Rheumatology, School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Crick African Network, Francis Crick Institute, London, UK
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, California.
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
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14
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Peach E, Rutter M, Lanyon P, Grainge MJ, Hubbard R, Aston J, Bythell M, Stevens S, Pearce F. Risk of death among people with rare autoimmune diseases compared with the general population in England during the 2020 COVID-19 pandemic. Rheumatology (Oxford) 2021; 60:1902-1909. [PMID: 33271595 PMCID: PMC7798585 DOI: 10.1093/rheumatology/keaa855] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/21/2020] [Indexed: 01/28/2023] Open
Abstract
Objectives To quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 pandemic compared with the general population, and compared with their pre-COVID risk. Methods We conducted a cohort study in Hospital Episode Statistics for England 2003 onwards, and linked data from the NHS Personal Demographics Service. We used ONS published data for general population mortality rates. Results We included 168 691 people with a recorded diagnosis of RAIRD alive on 01/03/2020. Their median age was 61.7 (IQR 41.5–75.4) years, and 118 379 (70.2%) were female. Our case ascertainment methods had a positive predictive value of 85%. 1,815 (1.1%) participants died during March and April 2020. The age-standardised mortality rate (ASMR) among people with RAIRD (3669.3, 95% CI 3500.4–3838.1 per 100 000 person-years) was 1.44 (95% CI 1.42–1.45) times higher than the average ASMR during the same months of the previous 5 years, whereas in the general population of England it was 1.38 times higher. Age-specific mortality rates in people with RAIRD compared with the pre-COVID rates were higher from the age of 35 upwards, whereas in the general population the increased risk began from age 55 upwards. Women had a greater increase in mortality rates during COVID-19 compared with men. Conclusion The risk of all-cause death is more prominently raised during COVID-19 among people with RAIRD than among the general population. We urgently need to quantify how much risk is due to COVID-19 infection and how much is due to disruption to healthcare services.
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Affiliation(s)
- Emily Peach
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Megan Rutter
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Peter Lanyon
- Division of Epidemiology and Public Health, University of Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK.,National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, UK
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Richard Hubbard
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Jeanette Aston
- National Disease Registration Service, Public Health England, UK
| | - Mary Bythell
- National Disease Registration Service, Public Health England, UK
| | - Sarah Stevens
- National Disease Registration Service, Public Health England, UK
| | - Fiona Pearce
- Division of Epidemiology and Public Health, University of Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK.,National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, UK
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15
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Rutter M, Lanyon PC, Sandhu R, Batten RL, Garner R, Little J, Narayan N, Sharp CA, Bruce IN, Erb N, Griffiths B, Guest H, Macphie E, Packham J, Hiley C, Obrenovic K, Rivett A, Gordon C, Pearce FA. Estimation of the burden of shielding among a cross-section of patients attending rheumatology clinics with SLE-data from the BSR audit of systemic lupus erythematosus. Rheumatology (Oxford) 2021; 60:1474-1479. [PMID: 33677595 PMCID: PMC7665698 DOI: 10.1093/rheumatology/keaa620] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/31/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives We aimed to estimate what proportion of people with SLE attending UK rheumatology clinics would be categorized as being at high risk from coronavirus disease 2019 (COVID-19) and therefore asked to shield, and explore what implications this has for rheumatology clinical practice. Methods We used data from the British Society for Rheumatology multicentre audit of SLE, which included a large, representative cross-sectional sample of patients attending UK Rheumatology clinics with SLE. We calculated who would receive shielding advice using the British Society for Rheumatology’s risk stratification guidance and accompanying scoring grid, and assessed whether ethnicity and history of nephritis were over-represented in the shielding group. Results The audit included 1003 patients from 51 centres across all 4 nations of the UK. Overall 344 (34.3%) patients had a shielding score ≥3 and would have been advised to shield. People with previous or current LN were 2.6 (1.9–3.4) times more likely to be in the shielding group than people with no previous LN (P < 0.001). Ethnicity was not evenly distributed between the groups (chi-squared P < 0.001). Compared with White people, people of Black ethnicity were 1.9 (1.3–2.8) and Asian 1.9 (1.3–2.7) times more likely to be in the shielding group. Increased risk persisted after controlling for LN. Conclusion Our study demonstrates the large number of people with SLE who are likely to be shielding. Implications for clinical practice include considering communication across language and cultural differences, and ways to conduct renal assessment including urinalysis, during telephone and video consultations for patients who are shielding.
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Affiliation(s)
- Megan Rutter
- Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter C Lanyon
- Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Epidemiology and Public Health, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Ravinder Sandhu
- Rheumatology, Dudley Group of Hospitals NHS Foundation Trust, Dudley, UK
| | - Rebecca L Batten
- Rheumatoloy, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rozeena Garner
- Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jayne Little
- Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nehal Narayan
- Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Charlotte A Sharp
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust UK, Manchester, UK
| | - Ian N Bruce
- Manchester University NHS Foundation Trust UK, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Epidemiology Versus Arthritis, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Nicola Erb
- Rheumatology, Dudley Group of Hospitals NHS Foundation Trust, Dudley, UK
| | | | - Hannah Guest
- Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elizabeth Macphie
- Rheumatology, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Jon Packham
- Epidemiology and Public Health, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,Rheumatology, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Chris Hiley
- Clinical Projects Advisor, British Society for Rheumatology, London, UK
| | - Karen Obrenovic
- Clinical Audit Department, Dudley Group of Hospitals NHS Foundation Trust, Dudley, UK
| | - Ali Rivett
- CEO, British Society for Rheumatology, London, UK
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Fiona A Pearce
- Epidemiology and Public Health, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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16
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Barlow-Pay F, Htut TW, Khezrian M, Myint PK. Systematic review of immunosuppressant guidelines in the COVID-19 pandemic. Ther Adv Drug Saf 2021; 12:2042098620985687. [PMID: 33628418 PMCID: PMC7882764 DOI: 10.1177/2042098620985687] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/09/2020] [Indexed: 01/01/2023] Open
Abstract
Aims: Individuals taking immunosuppressants are at increased susceptibility to viral infections in general. However, due to the novel nature of the COVID-19, there is a lack of evidence about the specific risks of the disease in this patient group. This systematic review aims to summarize the current international clinical guidelines to highlight areas where research is needed through critical appraisal of the evidence base of these guidelines. Methods: We conducted a systematic review of clinical practice guidelines about the usage of immunosuppressants during the COVID-19 pandemic. Electronic databases including MEDLINE and the websites of relevant professional bodies were searched for English language guidelines that were published or updated between March 2020 and May 2020 in this area. We assessed the quality and consistency of guidelines. The evidence base underpinning these guidelines was critically appraised using GRADE criteria. Results: Twenty-three guidelines were included. Most guidelines (n = 15, 65.2%) informed and updated evidence based on expert opinion. The methodological quality of the guidelines varied, ranging from ‘very low’ to ‘moderate’. Guidelines consistently recommended that high-risk patients, including those who are taking high doses of steroids for more than a month, or a combination of two or more immunosuppressants, should be shielding during the outbreak. Most guidelines stated that steroids usage should not be stopped abruptly and advised on individualized risk–benefit analysis considering the risk of the effect of COVID-19 infection and the relapse of the autoimmune condition in patients. Discussion: Clinical practice guidelines on taking immunosuppressants during the COVID-19 outbreak vary in quality. The level of evidence informing the available guidelines was generally low. Given the novel nature of COVID-19, the guidelines draw on existing knowledge and data, refer to the use of immunosuppressants and risks of serious infections of other aetiologies and have extrapolated these to form their evidence base.
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Affiliation(s)
- Fenella Barlow-Pay
- Specialist Training Registrar in Anaesthesia, Royal Alexandra Hospital, Paisley, Scotland
| | - Thura Win Htut
- Specialist Training Registrar in Haematology, Aberdeen Royal Infirmary, Aberdeen, Scotland
| | - Mina Khezrian
- Research Associate, School of Medicine, Medical Sciences and Nutrition, Aberdeen, Scotland
| | - Phyo Kyaw Myint
- Professor of Medicine of Old Age, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Room 4.013, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland
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Sloan M, Gordon C, Lever E, Harwood R, Bosley MA, Pilling M, Brimicombe J, Naughton F, Blane M, Walia C, D’Cruz D. COVID-19 and shielding: experiences of UK patients with lupus and related diseases. Rheumatol Adv Pract 2021; 5:rkab003. [PMID: 33728396 PMCID: PMC7928599 DOI: 10.1093/rap/rkab003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The shielding guidance in the UK for the clinically extremely vulnerable (CEV) commenced on 23 March 2020 in response to the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this study was to explore the impact of the pandemic and shielding on patients with lupus and related systemic autoimmune rheumatic diseases (SARDs). METHODS This was a mixed-methods cohort study (n = 111) including pre-lockdown baseline surveys (March 2020), follow-up surveys (June 2020) and in-depth interviews during July 2020 (n = 25). RESULTS Most participants had a high level of anxiety regarding their mortality risk from COVID-19 and supported the concept of shielding. Shielding allocations and communications were perceived as inconsistently applied and delivered. More than half of those not classified as CEV reported feeling abandoned, at increased risk and with no support. Shielding communications increased feelings of being 'cared about', but also increased fear, and the 'vulnerable' labelling was perceived by some to damage social and self-identity. More than 80% of those classified as CEV stated that the classification and subsequent communications had changed their social-mixing behaviour. Despite many negative impacts of COVID-19 and shielding/lockdown being identified, including isolation, fear and reduced medical care, the quantitative data during the pandemic showed increases in most measures of wellbeing (which was low at both time points) from pre-lockdown, including reductions in the impact of fatigue and pain (P-values < 0.001). CONCLUSION Shielding classifications and communications were, in general, viewed positively, although they were perceived as inconsistently delivered and anxiety-provoking by some participants. More frequent positively framed communication and wellbeing support could benefit all SARD patients. Slower-paced lockdown lifestyles might confer health/wellbeing benefits for some people with chronic diseases.
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Affiliation(s)
- Melanie Sloan
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Science, University of Birmingham, Birmingham
| | - Elliott Lever
- Rheumatology Department, Northwick Park Hospital, London
| | - Rupert Harwood
- Patient and Public Involvement in Lupus Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | - Michael A Bosley
- Patient and Public Involvement in Lupus Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | - Mark Pilling
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge
| | - James Brimicombe
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich
| | - Moira Blane
- Patient and Public Involvement in Lupus Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | | | - David D’Cruz
- The Louise Coote Lupus unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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18
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Dubey S, Kumar K, Bunting H, Sheeran T, Douglas B, Sabu J, Attwal M, Moorthy A. Testing the waters: COVID-19 first wave and shielding among BAME patients with rheumatological conditions in the United Kingdom. Musculoskeletal Care 2020; 19:244-246. [PMID: 33306871 DOI: 10.1002/msc.1531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Shirish Dubey
- Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Kanta Kumar
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Royal Wolverhampton NHS Foundation Trust, Wolverhampton, West Midlands, UK
| | - Helen Bunting
- Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Tom Sheeran
- Royal Wolverhampton NHS Foundation Trust, Wolverhampton, West Midlands, UK
| | - Barbara Douglas
- Royal Wolverhampton NHS Foundation Trust, Wolverhampton, West Midlands, UK
| | - Jessy Sabu
- University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - Manjeet Attwal
- University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - Arumugam Moorthy
- University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK.,College of Biological Sciences, University of Leicester, Leicester, UK
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19
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Felsenstein S, Hedrich CM. SARS-CoV-2 infections in children and young people. Clin Immunol 2020; 220:108588. [PMID: 32905851 PMCID: PMC7474910 DOI: 10.1016/j.clim.2020.108588] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 01/08/2023]
Abstract
Though recent reports link SARS-CoV-2 infections with hyper-inflammatory states in children, most children experience no/mild symptoms, and hospitalization and mortality rates are low in the age group. As symptoms are usually mild and seroconversion occurs at low frequencies, it remains unclear whether children significantly contribute to community transmission. Several hypotheses try to explain age-related differences in disease presentation and severity. Possible reasons for milder presentations in children as compared to adults include frequent contact to seasonal coronaviruses, presence of cross-reactive antibodies, and/or co-clearance with other viruses. Increased expression of ACE2 in young people may facilitate virus infection, while limiting inflammation and reducing the risk of severe disease. Further potential factors include recent vaccinations and a more diverse memory T cell repertoire. This manuscript reviews age-related host factors that may protect children from COVID-19 and complications associated, and addresses the confusion around seropositivity and immunity.
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Affiliation(s)
- Susanna Felsenstein
- Department of Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Christian M Hedrich
- Department of Women's & Children's Health, Institute of Live Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK.
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20
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Roongta R, Ghosh A. Managing rheumatoid arthritis during COVID-19. Clin Rheumatol 2020; 39:3237-3244. [PMID: 32892311 PMCID: PMC7474575 DOI: 10.1007/s10067-020-05358-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022]
Abstract
The outbreak of coronavirus in the world has led to an uncertainty about treatment of patients with autoimmune disorders because of their weakened immune system coupled with immunosuppressive agents they take which predisposes them to a host of infections. Data on COVID-19 patients with underlying rheumatological diseases has been emerging mostly in the form of small case series and one global registry. From these data, it seems like our patients, although immunosuppressed, are not particularly susceptible to the coronavirus infection and if infected, do not have significantly worse outcomes than other patients. In fact, drugs like hydroxychloroquine, dexamethasone, and tocilizumab have been studied for treatment of COVID-19. However, this is only preliminary data, and since a few parts of the world are still grappling with the pandemic at its peak, we need to be equipped on how to protect and manage our immunosuppressed patients. Published evidence to guide treatment decisions are lacking and doubts regarding continuation and initiation of immunosuppressants remain. Rheumatoid arthritis (RA) is the most common immune-mediated disorder in COVID-19 patients, and in this review, we discuss how the commonly used drugs in RA alter the patients' susceptibility to this infection. The review also summarizes the recommendations from the major bodies on how to manage this disease in these times. Key Points • Patients on immunosuppressive medications are not found to be at a greatly increased risk of acquiring COVID-19 infection. • Patients doing well on a stable dose of steroid and/or Disease-Modifying Antirheumatic Drugs (DMARDs) should be allowed to continue the same unless they get infected in which case, temporary stoppage of methotrexate and leflunomide may be considered. • Initiation of high-dose steroids, DMARDs, and biologics, if the clinical situation demands so, can be done. • Maintenance biologic therapy for stable patients should be individualized by the treating physician.
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Affiliation(s)
- Rashmi Roongta
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Alakendu Ghosh
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India.
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21
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Reilly E, Skeoch S, Hardcastle S, Pauling JD, Rowe M, Ahmed T, Allard A, Boyce B, Korendowych E, Lapraik C, Tillett W, Sengupta R. Evaluation of a patient self-stratification methodology to identify those in need of shielding during COVID-19. Clin Med (Lond) 2020; 20:e212-e214. [PMID: 32917745 DOI: 10.7861/clinmed.2020-0469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The logistical challenges of rapidly and accurately identifying those patients who needed to shield during the COVID-19 pandemic were unprecedented. We report our experiences of meeting this challenge for >9,000 patients with rheumatic and musculoskeletal disease at our centre, incorporating an element of guided patient self-stratification. Our results indicate that patients are able to stratify their own risk accurately using the BSR COVID-19 risk stratification guidance.
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Affiliation(s)
- Elizabeth Reilly
- Royal United Hospitals Bath NHS Trust, Bath, UK and University of Bath, Bath, UK
| | | | | | - John D Pauling
- Royal United Hospitals Bath NHS Trust, Bath, UK and senior lecturer, University of Bath, Bath, UK
| | - Megan Rowe
- Royal United Hospitals Bath NHS Trust, Bath, UK
| | | | | | | | | | | | - William Tillett
- Royal United Hospitals Bath NHS Trust, Bath, UK and senior lecturer, University of Bath, Bath, UK
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22
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Cleaton N, Raizada S, Barkham N, Venkatachalam S, Sheeran T, Adizie T, Sapkota H, Singh B, Bateman J. COVID-19 prevalence and the impact on quality of life from stringent social distancing in a single large UK rheumatology centre. Ann Rheum Dis 2020; 80:e93. [PMID: 32719041 DOI: 10.1136/annrheumdis-2020-218236] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Natasha Cleaton
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Sabrina Raizada
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Nick Barkham
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | | | - Tom Sheeran
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Tochukwu Adizie
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Hem Sapkota
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Baldev Singh
- Department of Diabetes and Endocrinology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - James Bateman
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
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Systemic autoimmune diseases, anti-rheumatic therapies, COVID-19 infection risk and patient outcomes. Rheumatol Int 2020; 40:1353-1360. [PMID: 32654078 PMCID: PMC7353833 DOI: 10.1007/s00296-020-04629-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/13/2020] [Indexed: 12/24/2022]
Abstract
As of June 10th 2020 about 7.2 million individuals have tested positive for, and more than 410,000 have died due to COVID-19. In this review we outline the pathophysiology that underpins the potential use of anti-rheumatic therapies for severe COVID-19 infection and summarize the current evidence regarding the risk and outcome of COVID-19 in patients with systemic autoimmune diseases. Thus far there is no convincing evidence that any disease-modifying anti-rheumatic drug (conventional synthetic, biologic or targeted synthetic) including hydroxychloroquine, may protect against severe COVID-19 infection; answers about their possible usefulness in the management of the cytokine storm associated with severe COVID-9 infection will only arise from ongoing randomized controlled trials. Evidence on COVID-19 risk and outcome in patients with systemic autoimmune diseases is extremely limited; thus, any conclusions would be unsafe and should be seen with great caution. At present, the risk and severity (hospitalization, intensive care unit admission and death) of COVID-19 infection in people with autoimmune diseases do not appear particularly dissimilar to the general population, with the possible exception of hospitalization in patients exposed to high glucocorticoid doses. At this stage it is impossible to draw any conclusions for differences in COVID-19 risk and outcome between different autoimmune diseases and between the various immunomodulatory therapies used for them. More research in the field is obviously required, including as a minimum careful and systematic epidemiology and appropriately controlled clinical trials.
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