The routine health care of patients with rheumatic diseases during the pandemic of COVID-19

Mariem, S.; Yasmine, M.; Miladi, S.; Fazaa, A.; Souebni, L.; Ouenniche, K.; Kassab, S.; Chekili, S.; Ben Abdelghani, K.; Laatar, A.

Background: The coronavirus pandemic poses a great threat to patients with rheumatic diseases (RD). Because of the state of immunodepression, they are perceived as vulnerable and at high risk of contracting the virus. This may lead to a delay in the health care routine. Objectives: The aim of our study was to assess the routine of patients with rheumatic diseases in the era of covid-19. Methods: We conducted a prospective study after the outbreak of Covid-19 including patients with RD: rheumatoid arthritis (RA) and Spondylarthritis (SpA). All of them were invited to answer a questionnaire about adherence to protective measures, health services, hospital visits, treatment modalities, as well as the level of satisfaction with the medical support or information received for COVID-19. We also evaluated the post-traumatic state (PTS) with the Impact of Event Scale-Revised (IES-R). A cut-off point fixed at 33 provided the best diagnostic accuracy for PTS. The level of significance was fixed at 0.05. Results: The study included 60 patients with a female predominance (sex ratio=1.7). The mean age was 51.3 ± 13.1 years [18-75] and the mean disease duration was 11.9 ±5.6 [1-23] years. Forty-two patients had RA and 18 patients had SpA. The majority of respondents were women (63.3%), married (81.7%), with a household size of 3-5 people (67.9%). The mean DASS depression and anxiety subscale was 9.5 ±7.6 [2-32] and 12.6 ± 8.2 [1-35] respectively. PTS was found in 25% of cases. Twenty-two patients stopped working in the second outbreak. The adherence to protective measures was as follows: compliance with lock-down (92.5%), adherence to stay home warnings (82%), wearing masks (96.3%), social distancing (68%), and washing hands immediately after sneezing (59.3%). Information was mainly sourced from both social media and the Internet in 78.2% of cases. Most of the patients were satisfied with the information provided and only 5 demanded more information about vaccination protocol. Of the patients having direct contact with a person affected with Covid-19 (20%), seven patients experienced symptoms. Three patients were diagnosed with SARS-COV2 and three other patients were hospitalized because of flares. The majority of the respondents (98.2%) had confidence in their own doctors' ability to recognize Covid-19. The majority of patients (91%) were afraid of getting sick and 83.1% feared stigma and discrimination after the infection. Fifty patients did attend their consultation appointment and 13.3% had a phone consultation. About a third of patients (26.7%) of patients experienced a delay in treatment. A positive correlation was found between marital status and the fear of other family members getting Covid-19 (p=0.029). Patients who did not consult experienced more PTS and severe anxiety than those who did not delay hospital visits (p=0.07, p=0.04 respectively). Conclusion: Our study showed that during the outbreak of Covid-19, patients with RD exhibited a high level of protection towards the virus. Despite these precautionary measures, a delay in hospital routine was observed.