Rationale: COVID-19 presentation is multifaceted and up to 44% of patients affected by COVID-19 experience musculoskeletal complaints, mostly in the form of diffuse aspecific arthromyalgias. Nevertheless, only a few cases of arthritis following SARS-CoV2 infection are reported. Patient concerns: A 27-year-old man affected by nail psoriasis presented with monoarthritis 2 weeks after being diagnosed with COVID-19. Diagnoses: Diagnostic work-up and differential diagnosis were made difficult by patient isolation, absence of lab tests, and his visit via telemedicine, even though signs of first metacarpophalangeal joint involvement were clear. Interventions: Due to the inefficacy of acetaminophen and nonsteroidal anti-inflammatory drugs, the patient was prescribed oral steroids with a rapid benefit. Outcomes: The patient's response to oral steroid was prompt and maintained even after therapy tapering. Even so, a formal diagnosis was not possible due to a difficult diagnostic work-up and lack of a long-term follow-up. Lessons: Like many other viral diseases, SARS-CoV2 can play as a causative agent or as a trigger for inflammatory arthritis development in predisposed individuals.

Background Patients with chronic rheumatic diseases (RDs) are more vulnerable and the containment measures related to the COVID-19 pandemic might have severe psychological consequences. We investigated the presence of and risk factors associated with poor mental health, sleep disorders among RDs during the pandemic. Methods This cross-sectional Italian citizen science project evaluated the psychological impact of the COVID-19 pandemic in patients with RDs. Between May and September 2020, eleven RD patients’ associations sent the survey by using their mailing list and the related webpage and social network. 507 RD patients completed an ad-hoc anonymous online survey including the Perceived Stress Scale (PSS) and Impact Event Scale-Revised (IES-R). Results The mean scores on the PSS-10 and the IES-R were 18.1 and 29.7, respectively. Higher PSS scores were associated with younger age (p <  0.01), female gender (p <  0.01), overweight/obesity (p = 0.01), psychiatric pharmacotherapy (p <  0.01), and anxiety for loss of income (p <  0.01). Higher IES-R scores were associated with female gender (p <  0.01), intestinal diseases (p = 0.03), anxiety (p <  0.01), and health concern (p <  0.01). Among 375 patients with inflammatory arthritis, 246 (65.6%) had trouble staying asleep, 238 (63.5%) falling asleep, and 112 (29.9%) had dreams about the pandemic. Older age (OR = 1.038, CI 1.002–1.076), psychiatric pharmacotherapy (OR = 25.819, CI 11.465–58.143), and COVID infection (OR = 2.783, CI 1.215–6.372) were predictive of insomnia during the pandemic. Conclusions A considerable COVID-19 related psychosocial burden has been detected in RDs. Different factors were predictive of poor mental health and sleep disorders in these patients. Focused supportive strategies should be implemented to improve the psychological well-being of fragile patients during pandemics.

BACKGROUND Patients with chronic rheumatic diseases (RDs) are more vulnerable and the containment measures related to COVID-19 pandemic might have severe psychological consequences. We investigated the presence of and risk factors associated with poor mental health, sleep disorders among RDs during the pandemic.METHODS This cross-sectional Italian citizen science project evaluated the psychological impact of the COVID-19 pandemic in patients with RDs. Between May and September 2020, eleven RD patients’ associations sent the survey by using their mailing list and the related webpage and social network. 507 RD patients completed an ad-hoc anonymous online survey including the Perceived Stress Scale (PSS) and Impact Event Scale-Revised (IES-R). RESULTS The mean scores on the PSS-10 and the IES-R were 18.1 and 29.7, respectively. Higher PSS scores were associated with younger age (p<0.01), female gender (p<0.01), overweight/obesity (p=0.01), psychiatric pharmacotherapy (p<0.01), and anxiety for loss of income (p<0.01). Higher IES-R scores were associated with female gender (p<0.01), intestinal diseases (p=0.03), anxiety (p<0.01), and health concern (p<0.01). Among 375 of patients with inflammatory arthritis, 246 (65.6%) had trouble staying asleep, 238 (63.5%) in falling asleep, and 112 (29.9%) had dreams about the pandemic. Older age (OR= 1.038, CI 1.002-1.076), psychiatric pharmacotherapy (OR = 25.819, CI 11.465-58.143), and COVID infection (OR = 2.783, CI 1.215-6.372) were predictive of insomnia during the pandemic.CONCLUSIONS A considerable COVID-19 related psychosocial burden has been detected in RDs. Different factors were predictive of poor mental health and sleep disorders in these patients. Focused supportive strategies should be implemented to improve the psychological well-being of fragile patients during pandemics.

Background:A considerable psychosocial burden is one of the relevant consequences of the COVID-19 pandemic. In particular, quarantine measures have been related to negative psychological effects, including symptoms of post-traumatic stress disorder, stress, anxiety, and depression (1). This rise in mental health disorders might be even worse among people more vulnerable to psychological stress such as patients suffering from chronic rheumatic diseases (RDs).Objectives:The present Italian nationwide survey engages patients with rheumatic conditions through eleven associations of RD patients. It is conducted to establish the COVID-19 related self-reported poor mental health symptoms and to identify potential factors associated with these concerns among RDs who experienced the COVID-19 quarantine in Italy.Methods:We collected data from May to September 2020 from RD patients living in Italy during the COVID-19 quarantine by an ad-hoc online survey. By using their mailing list and the related webpage and social network, eleven patients’ associations sent a call to RD patients asking them to complete an anonymous online survey which included the Perceived Stress Scale (PSS), and the Impact Event Scale-Revised (IES-R). χ2 tests were performed to detect statistically significant differences in both rating scale scores between groups defined by qualitative variables. Correlation analyses were realized with quantitative variables and rating scale scores. Variables significant in univariate analyses were then inserted in multivariate regression models.Results:In total, 507 RD patients completed to the survey. 375 (73.9%) patients had inflammatory arthritis (243 rheumatoid arthritis, 76 psoriatic arthritis, 49 ankylosing spondylitis, and 7 Still’s disease), and 96 (18.9%) with connective tissue diseases or systemic vasculitis. 31 (6.1%) patients had primary fibromyalgia and 5 osteoarthritis or crystal arthropathies. Self-reported major sources of anxiety are reported in the Figure 1 below.The mean (SD) scores of the PSS-10 and the IES-R were 18.1 ± 8.1 and 29.7 ± 17.5, respectively. With regard to the IES-R subscale scores, the total sample did not show a prominence of one of the three main domains (intrusion, avoidance and hyperarousal). Higher PSS scores were significantly associated with younger age (p<0.01), female gender (p<0.01), living outside Lombardy (p=0.03), presence of overweight/obesity (p=0.01), ongoing psychopharmacotherapy (p<0.01), and anxiety for loss of incomes (p<0.01). Female gender (p<0.01) and living outside Lombardy (p=0.02) were associated also with higher IES-R scores, together with the presence of intestinal diseases (p=0.03), anxiety disorders (p<0.01), and worries about health (p<0.01).Conclusion:This nationwide study revealed a high impact of self-reported distress, anxiety, and perceived stress among rheumatic patients after confinement during COVID-19 pandemic in Italy. Different factors were found to be predictive of poor mental health such as having female gender, younger age, living outside Lombardy, having overweight/obesity, or intestinal diseases, having a history of psychiatric symptoms (e.g. anxiety). Moreover, the lockdown experience worsened psychiatric symptoms and increased the assumption of psychopharmacotherapy in this vulnerable population. Prevention strategies focused on specific variables should be implemented to ameliorate psychological well-being of fragile patients during pandemics.References:[1]Brooks SK, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395:912-20Acknowledgements:We wish to thank the Lombard Association of Rheumatic Diseases (ALOMAR) for its invaluable contribution to the planning and dissemination the survey, all the Italian associations among which the National Association of People with Rheumatic and Rare Diseases (APMARR) and National Association of People with Rheumatic Diseases (ANMAR) that disseminated the survey through social media. The authors are grateful to all patients for contributing to this project.Disclosure of Interests:Francesca Ingegnoli: None declared, Massimiliano Buoli: None declared, Cristina Posio: None declared, Raffaele Di Taranto: None declared, Alessandro Lo Muscio: None declared, Enrico Cumbo: None declared, Silvia Ostuzzi: None declared, Roberto Caporali Speakers bureau: Abbvie, Amgen, BMS, Celltrion, Galapagos, Gilead, Lilly, Pfizer, Roche, UCB, Sanofi, Fresenius Kabi, Samsung bioepis, MSD, Consultant of: Galapagos, Gilead, Lilly,Janssen, MSD.