Shielding behaviour in people with psoriasis or a joint condition during the COVID‐19 pandemic differs by treatment type

Linked Article: Mahil et al. Br J Dermatol 2021; 185:80–90. Public health measures such as social/physical distancing were introduced early in the pandemic to limit the spread of COVID‐19. Stricter measures referred to as ‘shielding’ (not leaving home and minimizing all face‐to‐face contact) were recommended in groups of people at higher risk of severe infection. Many people taking drugs that affect the immune system to treat psoriasis or a joint condition (e.g. rheumatoid arthritis) were advised to reduce their risk of developing COVID‐19 by shielding. We wanted to find out what factors influenced how much (or strictly) this advice was followed. To try and answer this important question, we invited people with psoriasis or a joint condition (whether or not they have had COVID‐19) to provide information about whether they shielded in the pandemic. We collected this information through a series of structured questions in web‐based surveys for people with psoriasis (PsoProtectMe) or a joint condition (CORE‐UK). The surveys also included questions about mental health (anxiety and depression) during the pandemic. In total, 3720 people (2869 with psoriasis and 851 with a joint condition) from 74 countries completed the PsoProtectMe and CORE‐UK surveys between May and September 2020. The average age of participants was 49 years and more women (2546, 68%) than men (1174, 32%) completed the survey. There were 1421 participants (38%) who reported taking medicines that affect the immune system to treat their psoriasis or joint disease. These were either targeted treatments such as ‘biologics’ (924 patients, 25%) or traditional immunosuppressants such as methotrexate (497, 13%). A greater proportion of people who were receiving targeted treatments reported shielding compared with those receiving no treatment or traditional tablet immunosuppressants. As expected, owing to public health guidance, individuals with additional health problems were more likely to shield. Individuals were also more likely to shield if they were male, had joint disease and had signs of anxiety or depression. In conclusion, we found that people taking targeted treatments such as biologics for their psoriasis or joint disease were more likely to shield. As a consequence, they may be less exposed to the virus and this may explain why people taking biologics have been reported to have a lower risk of severe COVID‐19 infection in other studies.