Impact of COVID-19 pandemic on appropriateness of diagnostic pathways of autoimmune diseases

Carbone, Teresa; Picerno, Valentina; Pafundi, Vito; Esposito, Ernesto; Leccese, Pietro; Padula, Angela; D'Angelo, Salvatore

OBJECTIVE: Early diagnosis of autoimmune rheumatic diseases (ARD) is key to achieving effective treatment and improved prognosis. The coronavirus disease 2019 (COVID-19) pandemic has led to major changes in clinical practice on a global scale. We aimed to evaluate the impact of the COVID-19 pandemic on rheumatological clinical practices and autoimmunity testing demands. METHODS: Data regarding first rheumatological visits and new diagnosis together with the autoimmunity laboratory testing volumes related to COVID-19 pandemic phase (January- December 2020), were collected from medical records and laboratory information system (LIS) of a regional reference hospital (Basilicata, Italy) and compared with those obtained during the corresponding period in 2019. RESULTS: A significant decrease in the 2020 autoimmunity laboratory test volume was found when compared with the same period in 2019 (9912 vs 14100, p<0.05). A significant decrease in first rheumatological visits and diagnosis (1272 vs 2336, p<0.05) was also observed. However, an equivalent or higher percentage of positive autoimmunity results from outpatients services were recorded during 2020 when compared to pre-pandemic state. Of note, COVID- 19 associated decline in new diagnosis mainly affected less severe diseases. In contrast, ARD with systemic involvement were diagnosed at the same levels as the pre-pandemic period. CONCLUSION: The COVID-19 pandemic has impacted on the access to health services. However, our study highlighted that during the outbreak, greater appropriateness of the requests of laboratory test and visits emerged as shown by a greater percentage of positive testing results and new diagnosis of more severe ARD compared to pre-pandemic period.