Study Reveals Impact of COVID-19 on Inflammatory Arthritis Management

The COVID-19 pandemic has had both positive and negative effects on patients’ abilities to manage their inflammatory arthritis (IA), according to a study published in BMC Rheumatology.

The study found that the most common health care disruption was the replacement of face-to-face consultations with over-the-phone appointments.

Patients with IA have a higher risk of severe illness from COVID-19, and many believe lockdown restrictions and changes in health care provisions during the pandemic impacted patients’ abilities to effectively manage their condition.

To better understand the impact of COVID-19 on self-management behaviors and health care access for people with IA, researchers conducted semistructured telephone interviews with 21 patients with IA. Initial interviews took place between June and July 2020, with 9 follow-up interviews in November 2020. The 21 patients were aged between 24 and 79 years, with a mean (SD) age of 50.1 (15.8) years. The group was mostly female (71%) and White British (86%).

The researchers identified 4 initial themes:

• Impact of COVID-19 on medication adherence
• Impact of COVID-19 on physical activity
• Impact of COVID-19 on diet
• Impact of COVID-19 on health care access and delivery

Subthemes within these 4 themes focused on both positive and negative changes made to these areas, as well as behaviors. The follow-up interviews highlighted differences among the participants during both lockdown periods.

The interviews revealed that the majority of participants did not have any concerns about taking their medication during the pandemic and continued to take their prescribed medication as usual. Any patients who experienced COVID-19 symptoms or were in contact with someone with the virus understood the importance of stopping their immunosuppressants for a period of time.

Physical activity (PA) was both positively and negatively influenced by the pandemic.

“The initial lockdown provided an opportunity for some IA patients to engage more in PA, whilst for others the restrictions led to a decrease in their exercise levels,” the authors noted. “Whilst some participants were able to increase their PA when lockdown restrictions eased in August and continue with these behaviours throughout the second lockdown, some reported a further decrease in PA during the second lockdown period due to seasonal changes in the weather.”

Similarly, the COVID-19 pandemic influenced diets and eating behaviors in multiple ways. Some participants noted improvements in their diet due to an increased capability to plan and prepare healthy food, whereas others maintained prepandemic dietary behaviors. However, some patients said their diet got worse due to the emotional challenges of lockdown. The majority of participants had consistent dietary behaviors across the 2 lockdown periods.

Positive and negative experiences were also noted in the changes in health care services.

“The most commonly reported change was the introduction of telephone appointments to replace face-to-face consultations,” the authors said. “Remote approaches were applied to most healthcare services, including both rheumatology and [general practitioner] consultations.”

Some found these changes to be beneficial, noting that health care professionals were more receptive to their concerns and telephone consultations saved time for both the patient and the doctor. However, others—although understanding of why the changes were made—found them unhelpful.

“For example, some participants reported experiencing increased health-related anxiety as a result of their blood monitoring being cancelled or postponed,” the authors wrote. “Indeed, the lack of physical examination generated concerns for patients that decisions regarding their health were being made based on information from previous appointments.”

Regardless of positive or negative experiences, these findings suggested that the COVID-19 pandemic had a substantial impact on patients’ abilities to manage their IA condition.

“Healthcare professionals need to recognise the ongoing impact of COVID-19 on patient self-management and healthcare access to ensure that adequate understanding and support is available to patients who may have inadequate disease control as a result,” the authors said.

Reference

Caton E, Chaplin H, Carpenter L, et al. The impact of COVID-19 on self-management behaviours and healthcare access for people with infammatory arthritis. BMC Rheumatol. Published online October 18, 2021. doi:10.1186/s41927-021-00231-1