The Impact of COVID-19 on Clinical Care, Self-management and Mental Health of Patients with Inflammatory Arthritis

Overview

Journal Rheumatol Adv Pract

Publisher Oxford University Press

Specialty Rheumatology

Date 2022 Jan 19

PMID 35043091

Authors

Melissa Sweeney

Lewis Carpenter

Savia de Souza

Hema Chaplin

Hsiu Tung

Emma Caton

James Galloway

Andrew Cope

Mark Yates

Elena Nikiphorou

Sam Norton

Affiliations

Soon will be listed here.

Abstract

Objectives: The coronavirus disease 2019 (COVID-19) lockdown and ongoing restrictions in the UK affected access to clinical care, self-management and mental health for many patients with inflammatory arthritis. The aim of this study was to determine the impact of lockdown on inflammatory arthritis clinical care, self-management, disease outcomes and mental health.

Methods: In total, 338 people with inflammatory arthritis participated in a prospective study, completing a series of online questionnaires. The questionnaires assessed demographics, inflammatory arthritis condition and management, clinical care, quality of life and mental health. Visual analogue scales (VASs) were completed at each assessment. Linear regression, controlling for confounders, was conducted to determine factors associated with physical and mental health outcomes.

Results: More than half of participants reported worsening VAS by >10 points for patient global assessment (PGA), pain, fatigue and emotional distress during the initial lockdown. Changes in clinical care were associated with worse PGA ( = 8.95, = 0.01), pain ( = 7.13, = 0.05), fatigue ( = 17.01, < 0.01) and emotional distress ( = 12.78, < 0.01). Emotional distress and depression were also associated with worse outcomes in PGA, pain and fatigue, whereas loneliness was not. In contrast, physical activity seemed to mitigate these effects. Loneliness did not show any associations with outcomes. Over time, these effects decreased or disappeared.

Conclusion: Changes to clinical care owing to lockdown were associated with worse disease outcomes in patients with inflammatory arthritis. There has also been a clear impact on mental health, with possibly complex relationships between mental health and psychosocial factors. Physical activity emerged as a key influence on disease outcomes and mental health.

Citing Articles

Self-management behaviors do not affect remission but mediate between mental health and disease outcomes in a longitudinal study of rheumatoid arthritis.

Sweeney M, Carpenter L, de Souza S, Caton E, Galloway J, Cope A Rheumatol Int. 2025; 45(2):31.

PMID: 39821463 PMC: 11741988. DOI: 10.1007/s00296-024-05761-8.

Examining the Trajectory of Health-Related Quality of Life among Coronavirus Disease Patients.

Li J, Wisnivesky J, Lin J, Campbell K, Hu L, Kale M J Gen Intern Med. 2024; 39(10):1820-1827.

PMID: 38169022 PMC: 11282031. DOI: 10.1007/s11606-023-08575-9.

Mental health, quality of life and self-management behaviours: online evaluation of inflammatory arthritis patients over 1 year of COVID-19 lockdowns.

Sweeney M, Carpenter L, de Souza S, Chaplin H, Tung H, Caton E Rheumatol Adv Pract. 2023; 8(1):rkad103.

PMID: 38089501 PMC: 10713280. DOI: 10.1093/rap/rkad103.

Ongoing shielding behavior one year post COVID-19: results from a longitudinal study of patients with inflammatory arthritis.

Sweeney M, Carpenter L, de Souza S, Chaplin H, Tung H, Caton E Rheumatol Int. 2023; 44(1):67-71.

PMID: 37691070 PMC: 10766775. DOI: 10.1007/s00296-023-05430-2.

Fibromyalgia and mental health in rheumatoid arthritis: a cross-sectional prevalence study from the COVID-19 pandemic.

Upadhyaya S, Malgutte D, Handa R, Gupta S, Kumar A, Budumuru S BMJ Open. 2023; 13(6):e069014.

PMID: 37321814 PMC: 10276963. DOI: 10.1136/bmjopen-2022-069014.

References

Shigemura J, Ursano R, Morganstein J, Kurosawa M, Benedek D . Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: Mental health consequences and target populations. Psychiatry Clin Neurosci. 2020; 74(4):281-282. PMC: 7168047. DOI: 10.1111/pcn.12988. View

Sturgeon J, Finan P, Zautra A . Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways. Nat Rev Rheumatol. 2016; 12(9):532-42. PMC: 5449457. DOI: 10.1038/nrrheum.2016.112. View

Lati C, Guthrie L, Ward M . Comparison of the construct validity and sensitivity to change of the visual analog scale and a modified rating scale as measures of patient global assessment in rheumatoid arthritis. J Rheumatol. 2010; 37(4):717-22. PMC: 2959173. DOI: 10.3899/jrheum.090764. View

Maguire S, OShea F . Social isolation due to the COVID-19 pandemic has led to worse outcomes in females with inflammatory arthritis. Ir J Med Sci. 2020; 190(1):33-38. PMC: 7354357. DOI: 10.1007/s11845-020-02307-2. View

Caton E, Chaplin H, Carpenter L, Sweeney M, Tung H, de Souza S . The impact of COVID-19 on self-management behaviours and healthcare access for people with inflammatory arthritis. BMC Rheumatol. 2021; 5(1):58. PMC: 8522124. DOI: 10.1186/s41927-021-00231-1. View

Picchianti Diamanti A, Cattaruzza M, Di Rosa R, Del Porto F, Salemi S, Sorgi M . Psychological Distress in Patients with Autoimmune Arthritis during the COVID-19 Induced Lockdown in Italy. Microorganisms. 2020; 8(11). PMC: 7698862. DOI: 10.3390/microorganisms8111818. View

Paxton A, Strycker L, Toobert D, Ammerman A, Glasgow R . Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals. Am J Prev Med. 2010; 40(1):67-71. DOI: 10.1016/j.amepre.2010.10.009. View

Zhao S, Miller N, Harrison N, Duffield S, Dey M, Goodson N . Systematic review of mental health comorbidities in psoriatic arthritis. Clin Rheumatol. 2019; 39(1):217-225. DOI: 10.1007/s10067-019-04734-8. View

Groarke J, Berry E, Graham-Wisener L, McKenna-Plumley P, McGlinchey E, Armour C . Loneliness in the UK during the COVID-19 pandemic: Cross-sectional results from the COVID-19 Psychological Wellbeing Study. PLoS One. 2020; 15(9):e0239698. PMC: 7513993. DOI: 10.1371/journal.pone.0239698. View

10.

Wasserman A . Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2011; 84(11):1245-52. View

11.

Cadena J, Vinaccia S, Perez A, Rico M, Hinojosa R, Anaya J . The impact of disease activity on the quality of life, mental health status, and family dysfunction in colombian patients with rheumatoid arthritis. J Clin Rheumatol. 2006; 9(3):142-50. DOI: 10.1097/01.RHU.0000073434.59752.f3. View

12.

Killgore W, Cloonan S, Taylor E, Dailey N . Loneliness: A signature mental health concern in the era of COVID-19. Psychiatry Res. 2020; 290:113117. PMC: 7255345. DOI: 10.1016/j.psychres.2020.113117. View

13.

Felson D, Smolen J, Wells G, Zhang B, van Tuyl L, Funovits J . American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis Rheum. 2011; 63(3):573-86. PMC: 3115717. DOI: 10.1002/art.30129. View

14.

Spitzer R, Kroenke K, Williams J, Lowe B . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166(10):1092-7. DOI: 10.1001/archinte.166.10.1092. View

15.

Hill J, Kang S, Benedetto E, Myers H, Blackburn S, Smith S . Development and initial cohort validation of the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways. BMJ Open. 2016; 6(8):e012331. PMC: 4985936. DOI: 10.1136/bmjopen-2016-012331. View

16.

Rathbun A, Reed G, Harrold L . The temporal relationship between depression and rheumatoid arthritis disease activity, treatment persistence and response: a systematic review. Rheumatology (Oxford). 2012; 52(10):1785-94. DOI: 10.1093/rheumatology/kes356. View

17.

Tison G, Avram R, Kuhar P, Abreau S, Marcus G, Pletcher M . Worldwide Effect of COVID-19 on Physical Activity: A Descriptive Study. Ann Intern Med. 2020; 173(9):767-770. PMC: 7384265. DOI: 10.7326/M20-2665. View

18.

Russell D . UCLA Loneliness Scale (Version 3): reliability, validity, and factor structure. J Pers Assess. 1996; 66(1):20-40. DOI: 10.1207/s15327752jpa6601_2. View

19.

Schieir O, Thombs B, Hudson M, Taillefer S, Steele R, Berkson L . Symptoms of depression predict the trajectory of pain among patients with early inflammatory arthritis: a path analysis approach to assessing change. J Rheumatol. 2009; 36(2):231-9. DOI: 10.3899/jrheum.080147. View

20.

Rausch Osthoff A, Niedermann K, Braun J, Adams J, Brodin N, Dagfinrud H . 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018; 77(9):1251-1260. DOI: 10.1136/annrheumdis-2018-213585. View