Clinical outcomes of Covid‐19 in patients with rheumatic diseases and the effects of the pandemic on rheumatology outpatient care: A single‐centre experience from Turkey

Abstract

Objective The aim of the study was to detect the frequency and course of coronavirus disease 2019 (Covid‐19) infection among our rheumatology outpatients and to investigate how patient follow‐up differed during Covid‐19 pandemic in a tertiary University Hospital in the capital of Turkey. Patients and method Patients with inflammatory rheumatic diseases (IRDs) registered in our rheumatology clinic were assessed during their routine outpatient follow‐up control or contacted via phone between July and December 2020. Patients' demographics, diagnosis, medication, comorbidities, frequency of going outside during the pandemic, work status, whether patients could attend their routine follow‐up, treatment changes, access to drugs during the pandemic, and the incidence of Covid‐19 infection were collected. Results A total of 320 patients with IRD were analysed; 114 (35.6%) patients were treated with conventional synthetic disease‐modifying antirheumatic drugs (csDMARDs) (methotrexate/leflunomide/sulfasalazine), 93 (29.1%) patients with biologic DMARDs (bDMARDs), 113 (35.3%) patients with glucocorticoids, and 103 (32.2%) patients with hydroxychloroquine (HCQ). A total of 15.9% of patients on HCQ experienced problems in medication supply. Only 87 (27.2%) patients presented for their routine follow‐up appointment, and 38 (11.9%) of the patients changed their treatment without professional health advice. While 53 (57%) patients on biological agents continued their treatment, 31 patients (33.3%) interrupted the treatment with doctor's recommendation and 9 patients (9.6%) on their initiative, and 23 of these 31 patients had to restart treatment because of disease activation. The nasopharyngeal swab collected from 30 patients with a suspected Covid‐19 contact but without any symptoms was negative. In total, there were 33 patients diagnosed with Covid‐19; none of whom had severe respiratory complications or death. Conclusions Many patients with rheumatic diseases are left without disease monitoring during the pandemic. There was no increased risk of severe Covid‐19 infection among patients with IRD.

Influence of the COVID-19 Pandemic on Medical Management and on Healthcare Delivery of Immune-Mediated Rheumatic and Musculoskeletal Diseases during the First Pandemic Period February to July 2020: A Systematic Review

“…Seventeen studies were from Europe [15,16,18,19,21,22,24,[28][29][30][31]37,39,41,42,46,47], three from Africa [14,17,34], ten from North America [23,[25][26][27]33,35,36,38,45,48,49] and five from Asia [20,32,40,43,44]. Details of the included studies are shown in Table 1.…”

“…The non-availability of rheumatic medication was a prevalent issue, important examples being hydroxychloroquine (HCQ) and tocilizumab. Shortages or difficulties in the availability of HCQ was an issue in 16-69% of patients [14,15,17,20,23,30,47], with the highest level reported from India [20]. Shortages of tocilizumab was reported in 14% of patients [45,47].…”

“…Longer disease durations of the underlying rheumatic disease and higher disease activity were significantly associated with medication discontinuation [19]. Disease flares were described in high proportions of the patients (63-74%) who had stopped their DMARDs [15,18].…”

“…Further detailed information regarding non-adherence to or the non-availability of medication is shown in Table 2. [15] 23% [17] 25% [18] 42% (hydroxychloroquine) [33] 10% (hydroxychloroquine) [34] 4-7% [34] Vasculitis Vasculitis in general 5% [36] 11% [35] 20% [29] No information Spondyloarthritis Spondyloarthritis in general 19% [18] 20% (DMARDs) [15] 21% (bDMARDs) [27] 38% [17] 54% [29] No information Psoriasis arthritis 19% (DMARDs) [15] 31% [17] No information (d) Influence on the treating rheumatologist Lastly, there was also an influence of the pandemic on the treating physician regarding medication. Rheumatologists reduced the dose of steroids in 23-36% of patients [14,47], and in 17% of patients, steroids were stopped completely [14].…”

“…Rheumatologists reduced the dose of steroids in 23-36% of patients [14,47], and in 17% of patients, steroids were stopped completely [14]. In contrast, csDMARDs were stopped only rarely (in 2% of patients) [14], whereas bDMARDs were stopped more frequently (in 33% of patients) [15]. In a few cases, drug application intervals of bDMARDs were extended [28].…”