P193 How did people with rheumatoid arthritis experience the COVID-19 pandemic? Interim qualitative results from the BIORA-PAIN study
Authors: Blundell Anna , Mein Gill , Koushesh Soraya , Omoruyi Adangebe , Harrison Abiola , Sedgwick Philip , Sofat Nidhi 
Published: April 2022

Abstract

Background/Aims
Over the last 12 months (September 2020-21), we have been conducting a clinical trial with two biologic agents comparing pain outcomes in rheumatoid arthritis (RA) (n = 26). Within the trial, we investigated how participants with RA taking immunosuppressive medication felt about their care and responded to the COVID-19 pandemic. Such information is important to guide healthcare providers.

Methods
Semi-structured interviews were conducted either face-to-face or virtually with participants who had recently been recruited to the Biologics for Rheumatoid Arthritis Pain (BIORA-PAIN) study and attended a South West London hospital. Participants had a DAS-28-CRP score of above 5.1 and were just starting on biological treatment. Seven interviews were conducted between April-September 2021, lasting between 23-60 minutes during which participants were asked how they managed their RA during the pandemic. All the responding participants were female, aged between 27-74 (mean 50.3 years), with a mixture of employment status and some living alone or with others. Interviews were recorded then transcribed verbatim and an interim thematic analysis was conducted.

Results
Four main themes were identified: the effect of lockdown; care of self; medical care; and support. Participants reported weight gain during lockdown due to being more sedentary and feeling less able to exercise, which increased stiffness. Despite reporting no official advice from doctors regarding shielding, most participants felt more vulnerable due to awareness of immunosuppression, but protective measures and vaccine uptake alleviated fears. Many sought advice from online resources, such as Versus Arthritis, and support groups which, as well as comfort, provided information enabling some participants to ask doctors specific questions about their care and medications. Most participants were wary of misinformation and chose to use trusted websites such as NHS and gov.uk or sources advised by doctors. There were varied reports of participants’ experiences of their care: most participants felt that their care was largely unaffected by the pandemic, with all participants feeling able to obtain current medication. However, some felt the COVID-19 restrictions slowed the progress of their care and felt unsupported whilst suffering worsening symptoms. Face-to-face appointments were preferred over telephone appointments, as participants felt doctors were unable to assess their pain and joints via phone call. Participants who lived alone suffered more mentally.

Conclusion
Participants in this study were wary of coronavirus in relation to their disease and many chose to shield whilst reporting no shielding guidance. Many participants looked for reliable sources to research their care and treatment, which have been increased by feeling less able to contact clinicians during the pandemic. Participants felt that routine treatment was possible via telephone but changes in their condition required face-to-face appointments.

Disclosure
A. Blundell: None. G. Mein: None. S. Koushesh: None. A. Omoruyi: None. A. Harrison: None. P. Sedgwick: None. N. Sofat: None.