OP0265-HPR IMPACT OF COVID-19 PANDEMIC ON RHEUMATOLOGY PATIENTS IN NORTHERN IRELAND – A WEB BASED CROSS-SECTIONAL SURVEY
Authors: McKee P. , Irvine A. , Riddell C. , Ball E. 
Published: May 2021

Background:

Concern for the susceptibility of rheumatology patients to severe COVID-19 illness has been raised since the start of the pandemic. Rheumatic disease and their immunosuppressant therapies placed many patients into the ‘clinically extremely vulnerable’ group when the UK’s shielding guidance commenced on 23 March 2020. The impact of DMARDs/glucocorticoids/biologics on COVID-19 remains under investigation 1. A recent study suggested caution may be required with rituximab and sulfasalazine in COVID-19 patients 2.

Objectives:

The objective of this study is to evaluate the impact of the COVID-19 pandemic on rheumatology patients in Northern Ireland by assessing demographics, rheumatic disease, medications, disease progress, shielding advice, access to primary & tertiary care and incidence of COVID-19 infection.

Methods:

A web-based cross-sectional survey was completed in Northern Ireland. The study duration was between 23rd November 2020 and 22nd January 2021. The questionnaire included consent, demographic details, medication history, comorbidities, disease course, patient experience, shielding advice, COVID-19 illness and hospitalisation. The survey was publicised by sending 6,032 Belfast Trust NHS patients a link via SMS, posters were displayed in rheumatology departments, and links made available via NHS/Versus Arthritis social media platforms.

Results:

There were 2,615 responses and of these 2,539 had been completed and were analysed. Most respondents were aged 45+ (78.27%) and female (N=1819). Rheumatoid arthritis (41%) and psoriatic arthritis (29%) were the most common diagnoses. Just over one third (35.27%, N=896) of patients were on biological drugs. Most patients were taking methotrexate (28.04%) followed by hydroxychloroquine (15.20%) and adalimumab (12.52%). The majority (79.6%) continued treatment during the pandemic. There was evidence of disease ‘flaring’ in 30.75% of patients who had stopped treatment. Of the respondents surveyed 7.8% (N=198), tested positive for Covid-19 and of these 77.55% reported that they had received adequate shielding advice, primarily from GP or UK government sources. Only 11.11% (N=22) of those who tested positive for Covid-19 required hospital admission and 2 patients required intensive care support. Both patients requiring ICU were not on immunosuppression. Less than one third of patients testing positive for COVID-19 were on biological drugs (30.3%, N=60). Cardiovascular disease was the most prevalent comorbidity. Of the 22 patients hospitalised with COVID-19, 13.64% (N=3) were on solitary sulphasalazine therapy.

Conclusion:

The survey showed low levels of COVID-19 hospitalisation despite most patients continuing DMARD/biologic/glucocorticoid therapy. This has been replicated in other studies 1, however data continues to be gathered on the safety of some biologic drugs particularly rituximab 2. Most of our patients received clear understandable shielding guidance from a variety of sources. Many patients expressed fear of mortality, isolation and mental health issues. The survey findings indicated that stopping medication can have a negative impact on disease control.

References:

[1]Robinson PC, Yazdany J. The COVID-19 Global Rheumatology Alliance: collecting data in a pandemic. Nat Rev Rheumatol. 2020 Jun;16(6):293-294.

[2]Strangfeld A, Schäfer M, Gianfrancesco MA, et al. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Annals of the Rheumatic Diseases Published Online First: 27 January 2021. doi: 10.1136/annrheumdis-2020-219498

Disclosure of Interests:

None declared