Rheumatic Disease-Related Symptoms during the Height of the COVID-19 Pandemic

Abstract

Background: Systemic rheumatic diseases are characterized by diverse symptoms that are exacerbated by stressors. Questions/Purposes: Our goal was to identify COVID-19-related stressors that patients associated with worsening rheumatic disease symptoms. Methods: With approval of their rheumatologists, patients at an academic medical center were interviewed with open-ended questions about the impact of COVID-19 on daily life. Responses were analyzed with qualitative methods using grounded theory and a comparative analytic approach to generate categories of stressors. Results: Of 112 patients enrolled (mean age 50 years, 86% women, 34% non-white or Latino, 30% with lupus, 26% with rheumatoid arthritis), 2 patients had SARS-CoV-2 infection. Patients reported that coping with challenges due to the pandemic both directly and indirectly worsened their rheumatic disease symptoms. Categories associated with direct effects were increased fatigue (i.e., from multitasking, physical work, and taking precautions to avoid infection) and worsening musculoskeletal and cognitive function. Categories associated with indirect effects were psychological worry (i.e., about contracting SARS-COV-2, altering medications, impact on family, and impact on job and finances) and psychological stress (i.e., at work, at home, from non-routine family responsibilities, about uncertainty related to SARS-CoV-2, and from the media). Patients often reported several effects coalesced in causing more rheumatic disease symptoms. Conclusion: Coping with the COVID-19 pandemic was associated with rheumatic disease-related physical and psychological effects, even among patients not infected with SARS-CoV-2. According to patients, these effects adversely impacted their rheumatic diseases. Clinicians will need to ascertain the long-term sequelae of these effects and determine what therapeutic and psychological interventions are indicated.

Updated APLAR consensus statements on care for patients with rheumatic diseases during the COVID‐19 pandemic

“…Individuals in New York City surveyed during the heightened phase of implementing transmission prevention measures reported worsening of their RMD with the changes to their daily lives regardless of SARS‐CoV‐2 infection status. Fatigue from multitasking and adherence to isolation measures may have directly contributed to disease flares 89 . Stress from uncertainties in finances, exposure to infection, and changes to RMD medication, among other issues, were indirect contributors 89 .…”

“…Fatigue from multitasking and adherence to isolation measures may have directly contributed to disease flares 89 . Stress from uncertainties in finances, exposure to infection, and changes to RMD medication, among other issues, were indirect contributors 89 . One study which used the Short Form 12‐item Health Survey to specifically measure QoL in a UK cohort of RMD patients, showed a worsening of physical and mental functioning during the pandemic.…”

Modifications in Systemic Rheumatic Disease Medications: Patients’ Perspectives During the Height of the COVID‐19 Pandemic in New York City

“…Although our study took place during a brief period, some patients already reported worsening symptoms and flares that they attributed to suboptimal medications and to emotional and physical upheaval caused by the pandemic (22). Glucocorticoids were often used in response because they reversed symptoms quickly and were familiar to patients.…”

Effects of the COVID-19 pandemic on psychology and disease activity in patients with ankylosing spondylitis and rheumatoid arthritis

“…However, patients with rheumatological diseases, who are prone to psychological disorders, are likely to be easily psychologically affected by the COVID-19 outbreak. Recent studies have shown that patients with RA, Axial Spondyloarthritis, Lupus, and Behçet Disease were severely affected by the COVID-19 pandemic [18][19][20][21].…”

“…To our knowledge, ours is the first study evaluating the psychological well-being of AS patients using the PGWB score.Many patients with rheumatological diseases are likely to be psychologically affected by the ongoing COVID-19 pandemic. Mancuso et al reported that the psychiatric complaints of patients with rheumatological diseases (a total of 112 patients with Systemic Lupus Erythematosus (SLE), RA, and Spondyloarthritis) increased significantly during the pandemic[18]. On the other hand,…”