Isolation, behavioral changes and low seroprevalence of SARS‐CoV‐2 antibodies in patients with Systemic Lupus Erythematosus or Rheumatoid arthritis

Ammitzbøll, Christian; Andersen, Jakob Bøgh; Vils, Signe Risbøl; Mistegaard, Clara Elbæk; Mikkelsen, Susan; Erikstrup, Christian; Thomsen, Marianne Kragh; Hauge, Ellen‐Margrethe; Troldborg, Anne

OBJECTIVES: Patients with chronic rheumatic diseases (CRD), such as Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA), require special attention during the COVID‐19 pandemic, as they are considered at risk of severe infections. We assessed the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antibodies in patients with SLE and RA and patient behavior, disease‐related symptoms, and mental health. METHODS: More than 900 participants were included: 405 patients with RA or SLE (CRD‐patients) and 513 blood donors. All participants had blood SARS‐CoV‐2 total antibodies measured (sensitivity 96.7%, specificity 99.5%) and answered a questionnaire concerning behavior, anxiety, and symptoms of depression (PHQ‐9). The CRD patients were further asked about physical activity, adherence to medication, and disease‐related symptoms. RESULTS: CRD‐patients had a significant lower seroprevalence of SARS‐CoV‐2 antibodies (n=1/365, 0.3%) compared to blood donors (n=10/513, 1.9%) (p=0.03). Almost 60% of patients were unable to exercise as usual, increased pain was experienced by 34% of patients and increased disease activity by 24%. Almost 10% of patients reduced or discontinued their immunosuppressive treatments at their own initiative. Symptoms of moderate depression were present in 19% of patients compared to 6,8% blood donors (p<0.001). CONCLUSIONS: Low seroprevalence in patients with CRDs indicates successful mitigation of exposure to SARS‐CoV‐2. However, this appears to occur at the expense of physical activity, experience of increased pain, disease activity, and symptoms of depression. There is a need for care providers to be aware of these negative side‐effects and for further studies to investigate the possible long‐term consequences.