POS1463-HPR IMPACT OF COVID-19 PANDEMIC ON DISEASE ACTIVITY AND EMOTIONAL WELL-BEING AMONG RHEUMATOID ARTHRITIS PATIENTS: A TELEMEDICINE STUDY

Abstract

Background: By the beginning of March 2020, the pandemic of the novel coronavirus disease (COVID-19) imposed severe lockdown measures opposing the viral spread, limiting non-COVID patients' access to hospitals. Previous reports suggest that Rheumatoid Arthritis (RA) patients may experience a worsening of self-reported disease activity following natural disasters. Moreover, RA patients are at increased risk of mood disorders, such as depression and anxiety. An increase of depressive symptoms, anxiety and suicidal rate has been recently reported as result of the lockdown in response to COVID-19. Objective(s): Aims of this study were to investigate the impact of the lockdown measures on disease activity and emotional well-being among patients affected by RA, through a telemedicine approach. Method(s): Patients followed in the "Early Arthritis Clinic" of our hospital were invited to participate to an online survey. They were asked also to invite their best friend (BF), matched for age and sex, to participate the survey, as control group. Moreover, clinical records from the same "Early Arthritis Clinic" cohort were used as pre-pandemic group. The online survey included demographic questions and, for RA patients, the evaluation of perceived pain (P-VAS) and disease activity (DA-VAS) on a scale of 1-10 as well as Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5), a validated self-reported disease activity measure. Both RA patients and BF responded also to validated, psychometric scales for stress vulnerability (Stress Vulnerability Scale-SVS), resilience (Resilience Scale-RS), depression (Zung's depression questionnaire-Zung-D) and anxiety (Zung's anxiety questionnaire-Zung-A) evaluation. Result(s): The cohort was composed by 76 RA patients who answered the survey, 32 BF and 170 RA patients from historical cohort. There were no differences in demographic characteristics, SVS, RS, Zung-D and Zung-A between RA patients and BF. RADAI-5 correlated positively with SVS (r=0,29;p=0,01), P-VAS (r=0,8;p<0,0001) and DA-VAS (r=0,8;p<0,0001) and negatively with RS (r=-0,23;p=0,04). Patients with higher disease activity showed higher classes of Zung-D (p=0,03) and SVS (p=0,006), and lower classes of RS(p=0,001). P-VAS was the only significant predictor of RADAI-5 (beta=0,83;CI=0,53-0,76;p<0,001), and the concordance between RADAI-5, P-VAS and DA-VAS was high (K=0,94;p<0,001). Compared with the historical cohort, RA patients involved in the survey showed higher frequencies of moderate and elevated disease activity classes (p<0,001;Figure 1) despite there were no differences in P-VAS and DA-VAS. Conclusion(s): These results suggest that lockdown did not affect differently emotional well-being of RA patients compared to healthy subjects. RA patients with elevated disease activity report higher stress and depressive symptoms, and SVS and RS may be useful to identify patients at higher risk. The higher self-reported disease activity measured through RADAI-5 may be the result of an overestimation of disease severity by patients, which depends mostly from pain. This should be considered in the assessment of disease activity through telemedicine. (Table Presented).