POS1173 A SHORT DELAY IN ARTHRITIS CARE IS ASSOCIATED WITH HIGHER DISEASE ACTIVITY - LESSONS FROM THE CORONAVIRUS DISEASE 19 (COVID-19) PANDEMIC
Authors: A. Giollo, E. Bertoldo, C. Benini, O. Viapiana, L. Idolazzi, G. Adami, A. Fassio, D. Gatti, M. Rossini
Journal: Annals of the Rheumatic Diseases (2021)

Background: Although disease activity is a significant outcome in rheumatology, few studies have investigated the relationship between routine care of rheumatic conditions and disease activity control. Objectives: To determine the association between delay in routine care of chronic inflammatory arthritides (CIAs) and disease activity during the first wave of coronavirus disease 19 pandemic in Verona, Italy. Methods: This study enrolled patients with an established diagnosis of rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) and undifferentiated arthritis (UA). Between 01/04/2020 and 30/06/2020, participants were emailed an online questionnaire. Items comprised multiple or single-choice questions evaluating routine rheumatology care disruptions/delays and disease characteristics, treatments, comorbidities, and demographics. Compliance to anti-rheumatic medications was evaluated with I-CQR5. Disease activity was assessed with RAPID3, and active disease was defined as a RAPID3 score&gt;1. Study period referred to the time between the last rheumatology assessment and the date of enrolment. Results: Of 1210 patients contacted, 450 participated, of whom 219 CIAs patients were included (RA 55.3%, PsA 35.2%, AS 15.1%, UA 3.7%). One hundred twenty-five patients (57.1%) had their routine clinical assessment delayed (median days 68.4; IQR 66.8, 85.9). Patients in this group had significantly higher MDHAQ (p=0.001) and RAPID3 (p=0.031) scores, while they did not differ for disease severity, medications or compliance. Most (87.7%) reported good compliance to therapy; only 5.9% had difficulties in supplying anti-rheumatic medications, and 13.2% discontinued medications for at least four weeks for any reason. However, several patients (37.9%) reported moderate-to-high worse disease activity perception due to routine care delay, and 31.1% self-reported a disease flare (median RAPID3 score 3.8; IQR 2.0, 5.4). One hundred one patients (46.1%) had high disease activity, while only 15.1% were in remission. In logistic regression, active disease was significantly associated with delay of scheduled routine care visit, independent of disease duration, time from last rheumatology assessment, therapy with b/tsDMARDs, and compliance (Table 1, Figure 1 below). Table 1. Predictor Active (n=186 ) Remission (n=33 ) OR P-value 95% CI Inf. 95% CI Sup. Routine care delay (yes vs no ) 113 (60.8%) 12 (36.4%) .030 2.459 1.091 5.543 Disease duration (years) 10 (4.0, 20.0) 10.5 (7.0, 19.8) .695 1.007 .972 1.044 Time since last rheumatology assessment (days) 68.4 (66.8, 75.8) 71.2 (66.9, 74.9) .854 1.002 .978 1.027 b/tsDMARDs (yes vs no) 105 (56.5%) 15 (45.5%) .653 1.202 .538 2.687 I-CPR5 (likely low vs likely high adherent) 36 (19.4%) 10 (30.3%) .187 .563 .240 1.321 Figure 1. Conclusion: In patients with established CIAs, a relatively short delay in routine assessment by a rheumatologist resulted in higher disease activity. Frequent rheumatology referrals appear to be a critical factor for disease activity control in CIAs. Disclosure of Interests: None declared.