RESUMO
Background: Many measurement tools are designed to assess disease activity for Rheumatoid Arthritis (RA) patients. One of the most used tools is the Disease Activity Score-DAS28 which assesses the number of painful joints, erythrocyte sedimentation, and a patient's global assessment. The assessment is performed by a clinician and requires laboratory exams. Unfortunately, from March to August 2019, Colombia had one of the strictest responses to the COVID-19 pandemic according to the COVID-19 stringency Index(1). One of the main restrictions was the preventive isolation of older populations, especially those with comorbidities. These restrictions challenged the rheumatology practice because face-to-face consultations were not possible. Due to the above, measurements like the PAS-II score should be used to assess disease activity during the pandemic. Objectives: To describe disease activity according to the Patient Activity Score-PAS-II score patients with RA and compare its results to the most recent DAS28 assessment before the COVID-19 pandemic. Methods: We conducted a descriptive study;patients were followed during the COVID-19-lockdown in a video consultation. The PAS-II score was applied to assess disease activity as an alternative to the DAS28 assessment. The patients were part of an educational program, clinical charts were reviewed to collect the study variables. We collected demographic data and DAS28 before the pandemic started. We present a descriptive analysis of DAS28 severity and the results obtained by the PASS-II score. Results: The educational program enrolled 250 participants;196 patients had complete data. 93% of participants were women, mean age was 64 years IQR (54-67). 43% of participants were married or had a civil union, 26% were single, 20% divorced, and 11% were widowed. Regarding educational level, 25% had fnished elementary school and 39% high school;the remaining 36% had higher education. When we compared the last DAS28 assessed by a rheumatologist between January, and March 2019, 67% of patients were in remission, while in July 2019, the PASS-II score reported that 7% of patients were in remission and 75% had low or minimal activity. Figure 1-Table 1. Conclusion: The PASS score is a helpful tool to assess disease activity in patients with RA, especially in situations where the patient cannot see a rheumatologist in a face-to-face consultation;however, patients in severe disease activity should not delay the consultation with a clinician. As other studies have demonstrated, patient-reported outcome measures should be adopted in clinical practice as an alternative for treat-to-targe strategies(2). Further studies should be conducted to assess the impact of the pandemic in countries with high levels of restrictions in the course of RA.
RESUMO
Objectives: The new coronavirus disease became a public health emergency that has not been seen for generations. The COVID-19 disease leads to an excessive immune activation and cytokine response and constitutes a considerable risk and a challenge for patients with inflammatory conditions such as rheumatic diseases. Patients with rheumatoid arthritis (RA) due to their age and comorbidities were the first to be in continuous lockdown due to their risk and current circumstances. This new normality has caused barriers to accessmedical care and a radical change in their daily life, especially during the beginning of the pandemic. The aim of this study is to describe the practices and behaviors of patients with rheumatoid arthritis during the first lockdown due to the COVID-19 pandemic in Bogotá, Colombia. Methods: In this study, we conducted a telephone survey.We included respondents who participated in an educational program for patients with rheumatoid arthritis. We asked about their behaviors around COVID-19 during the first lockdown established in Colombia, adherence to pharmacological treatment and compliance to a newly implemented telemedicine model. We also asked about COVID-19 related symptoms two weeks before the survey. Results: We included 296 participants. The mean age of the respondents was 60 years IQR (54-66), 95% were female. 86% of patients were receiving more than one conventional DMARD. See Table 1. Although the telemedicine model was entirely new to them, 75% participated in a tele rheumatology consultation. In general, at the beginning of the pandemic, patients were compliant with the COVID-19 prevention measurements. However, we found that 3.5% of patients reported having been less adherent to pharmacological therapy due to information received through media or social networks. Only one patient tested positive for having SARS-COV-2 and reported only flu symptoms without any complications. Patients reported the need to have information and education about the relationship between rheumatoid arthritis and COVID-19. Conclusion: Patients with rheumatoid arthritis have experienced drastic changes in their lives and adapted to new ways to receive medical care. Patients with RA need support and education. As other forms of education, for example, for college students new teaching methods have been implemented, programs for patients should follow the same model.
RESUMO
Background: The new coronavirus disease has become a public health emergency that has not been seen for generations. Covid-19 disease leads to an extreme immune activation and cytokine response and constitutes a big risk and a challenge for patients with inflammatory conditions such as rheumatoid arthritis (RA). During the Covid-19 pandemic, rheumatologists and health-care professionals have faced many challenges to provide an adequate follow-up and treatment to RA patients;one of them, has been the establishment of lockdown for populations older than 60 years and the limitation of having face-to-face consultations, moving us to telemedicine activities. On the other hand, in our center an education program for patients with RA had been established in the second semester of 2019, which due to the epidemiological risk control measures, it was necessary to interrupt when we only had 5-6 months of a project that was planned for 2 years;it was mandatory to pause it and implement virtual education alternatives;this educational program for RA patients was also moved to virtual mode later. Objectives: To describe possible changes in the practices and behaviors of patients with rheumatoid arthritis (RA) during the lockdown that started in March 2020 in Colombia due to the Covid-19 pandemic, who previously partially attended to an educational program on RA. Methods: We included patients who attended previously a face-to-face educational program, that aims to teach and empower patients in all aspects related to RA. After the lockdown, the educational program had to stop abruptly while an online strategy was developed later;meanwhile the patients did not have any educational activity for 3-4 months. For this study, patients answered to a telephonic survey in July 2020;the survey included questions about their practices related to the Covid-19 pandemic, SARS-Cov-2 symptoms, adherence to rheumatoid arthritis treatment, virtual rheumatology consultations compliance and, the influence of news on their adherence. Results: A total of 260 patients took part in the survey;mean age of the respondents was 60 years IQR (54-66), 93% were female. In July 2020 88% of patients had accessed a telemedicine-based and 12% a face-to-face rheumatology consultation;only 3.5% of patients reported having been less adherent to pharmacological therapy due to information received through media or social networks. Regarding the prevention measures taken during the pandemic, 98% reported to have stayed in their houses since the lockdown was stablished in Colombia, and have implemented or increased hand washing from one or none to more than three times per day. Also 8% of respondents lived with people who were at bigger risk of having SARS-CoV-2 (i.e. health care professionals, workers at public transportation, and supermarkets among others), the main measurement taken was to be completely separate from the person at risk to avoid contagion and maintaining hygiene measures and physical distancing (Fig 1). Only one patient was positive for SARS-CoV-2, due to a possible contagion from a relative at home and reported only flu-like symptoms without any complications. Patients highlighted the necessity to return to the educational on RA program agreeing to attend to an online modality. Patients highlighted the need for educational sessions focused on the relationship between rheumatoid arthritis, its treatment, and Covid-19. Conclusion: An educational on RA program shows to be helpful tool to maintain high adherence rates to the RA treatment despite of the new challenges associated to the pandemic and despite being incomplete due to lack of time;patient-centered education programs should continue to address the patient's concerns and beliefs about their disease and the Covid-19 issues.