Regarding habits, 24.6% increased smoking, 18.2% raised their alcohol consumption, and 45.6% were unable to continue exercising. Self-reported disease activity was high (5.32.7) and 75.6% reported elevated pain. Half the patients (49.0%) reported poor well-being (WHO-5) and 46.6% that their health had changed for the worse during lockdown. According to HADS, 57.3% were at risk of anxiety and 45.9% of depression.
la portuese de pain dvdrip 24
REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville (Spain), together with a multidisciplinary team including rheumatologists, psychologists, health researchers, patient research partners, and patient organisations from seven European countries, with the support of Novartis Pharma AG. Patient research partners, together with health researchers and rheumatologists, were involved in all steps of the REUMAVID project including study design, translation of the questionnaire, launching the survey, sample recruitment, and interpretation and dissemination of the results.
Visual Analogue Scale (VAS) for disease activity and Patient Acceptable Symptom Scale: two different scales ranging from 0 to 10 were introduced in the questionnaire to evaluate disease activity and pain. The use of this form of evaluation has been validated in international studies of different RMDs such as RA, AS, chronic back pain, hand OA, and hip and knee OA.15
Of the total of 1800, 558 participants were from the UK (31.0%), 464 from Spain (25.8%), 264 from Portugal (14.7%), 229 from France (12.7%), 127 from Italy (7.1%), 101 from Cyprus (5.6%), and 57 from Greece (3.1%). As shown in the European map, there was a female predominance in all the countries (figure 2).
With regards to medication, before the first lockdown, REUMAVID participants were receiving biologics (53.5%, n=963), non-steroidal anti-inflammatory drugs (NSAIDs) (39.2%, n=705), painkillers (33.3%, n=600), methotrexate (21.8%, n=393), and oral corticosteroids (18.6%, n=335). Of the 1707 participants answering this question, 15.8% (n=269) had their treatment changed. Participants could provide more than one reason for treatment change. Of the total of 281 answers provided, most of the cases were due to a decision by their healthcare team (65.5%, n=184), concerns about the increased risk of contracting COVID-19 (24.6%, n=69), inability to go to hospital for treatment (5.0%, n=14), followed by the inability to receive infusions in hospital (3.2%, n=9), and the shortage of available treatments (1.8%, n=5).
Despite the low COVID-19 incidence in this population, nearly half of participants (46.6%; n=832) declared that their health worsened during lockdown. In addition, nearly half reported poor well-being according to the WHO-5 and three out of four declared high levels of pain. 21.2% (n=252) of patients presented sleep disorders. Moreover, mental health was also poor, with 57.3% (n=1013) at risk of anxiety (32.7% cases and 24.6% probable cases) and 45.9% (n=811) at risk of depression (21.1% cases and 24.8% probable cases), according to the HADS. Further characteristics on health status and well-being of REUMAVID participants are showed in table 4.
Online supplemental table 2 shows the main sociodemographic and clinical characteristics of each of the rheumatic diseases, highlighting higher disease activity and pain in patients with gout and peripheral spondyloarthritis, higher risk of anxiety in patients with systemic sclerosis (or scleroderma) and FM, and higher risk of depression in patients with polymyalgia rheumatica and FM.
With all of this in mind, it is not surprising that the COVID-19 pandemic and lockdown have negatively affected the health of patients with RMDs in this study. High levels of disease activity and pain, poor well-being and worsening health status were consistently reported. Furthermore, 57.3% (n=1013) of REUMAVID participants were at risk of anxiety (32.7% cases and 24.6% probable cases) and 45.9% (n=811) at risk of depression (21.1% cases and 24.8% probable cases), according to the HADS. These prevalences of anxiety and depression cases obtained in the present study are higher overall than those reported in prepandemic studies, using the same scale (HADS), and cut-off point among patients with RMDs without other complications or stressors as in our study. It is important to highlight that patients with FM tend to present higher rates of anxiety and depression. Thus, a multicentre study in Spanish patients with FM found anxiety cases from 18% to 26% and depression cases from 22% to 26%.19 However, in relation to RA, a single-centre study including 150 Canadian patients with RA found rates of 13.4% for anxiety cases and 9.3% for depression cases.20 Another study on Chinese patients with axSpA found rates of 15.6% for anxiety cases and 10.6% for depression cases.21 2ff7e9595c
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