Increased risk of mental health disorders in patients with RA during the COVID-19 pandemic: a possible surge and solutions

Abstract

Depression is a common co-morbidity among rheumatoid arthritis (RA) patients, which may translate into difficulty performing activities of daily living. COVID-19 is an unprecedented disaster that has disrupted lives worldwide and led to a rise in the incidence of mental health disorders. Given the widespread economic devastation due to COVID-19, many RA patients, already susceptible to mental illness, maybe at an increased risk of inaccessibility to medical care, accentuated stress, and consequent worsening of existent mental health disorders, or the onset of new mental health disorders such as anxiety, posttraumatic stress disorder, or depression. The objective of this review is to assess if there is an increased risk of mental health disorders in patients with RA during the COVID-19 pandemic. Telemedicine has bridged the transition to remote chronic care in the pandemic period, though certain accessibility and technological challenges are to be addressed. Decreased access to care amid lockdowns and a proposed triggering of disease activity in patients with autoimmune disorders may potentially herald a massive spike in incidence or flares of patients diagnosed with RA in the coming months. Such a deluge of cases may be potentially devastating to an overburdened healthcare system. Rheumatologists may need to prepare for this eventuality and explore techniques to provide adequate care during these challenging times. The authors found that there is a significant association between the adverse impact on the mental health of RA patients and the COVID-19 pandemic. However, more research is needed to highlight individual risk factors.

Impact of COVID-19 pandemic on patients with rheumatic diseases in Latin America

“…Due to the economic and social devastation due to COVID-19, many patients may be at an increased risk of having difficulty to access to medical care, accentuated stress, and worsening of mental health disorders, such as anxiety or depression. A recent review by Bathia et al found that there was a significant association between COVID-19 pandemic and the adverse impact on the mental health and daily living activities in rheumatology patients [32]. In our survey, 14.1% (41) of the patients who were receiving psychiatric medication to treat their comorbidities had to discontinue it.…”

Perceived Risk and Associated Shielding Behaviors in Patients With Rheumatoid Arthritis During the Coronavirus 2019 Pandemic

“…Hypertension was the most common comorbidity (142; 29%) and the median (IQR) CCI was 1.0 (1.0‐2.0). The median (IQR) number of health care visits within the MGB system in the last 6 months of 2019 (July 1, 2019, to December 31, 2019), preceding the pandemic, was 16 ( 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ). At the time of the survey, the mean (SD) disease activity was 74.6 (19.9).…”

“…Although shielding practices are critical to reducing risks of COVID‐19 and controlling the ongoing pandemic, they do come at substantial personal and societal costs. Indeed, previous studies of the general population and participants with rheumatic diseases have established the negative impacts of the pandemic on mental health, including anxiety and depression, likely driven in part by the need for shielding practices, which contribute to social isolation ( 24 , 25 , 26 , 27 , 28 , 29 ).…”

COVID-19 from a rheumatology perspective: bibliometric and altmetric analysis

“…That study also established a straight correlation between parents' and children's anxiety and depression scores. Bhatia et al [91] draw attention to the vicious circle uniting physical and mental wellbeing. Based on the systemic review data, patients with RA may suffer from aggravation of pain and disease activity in case of depression [92].…”