How Did COVID-19 Pandemic Affect Rheumatology Out-Patients Practice? A Single-Center Experience from Turkey

Abstract

OBJECTIVE: It is believed that patients with the rheumatic disease have an increased risk of infection due to immune system dysregulation, immunosuppressive treatment, and concomitant comorbidities. In this study, our aim was to detect the frequency of Covid-19 infection among our rheumatology out-patients and to investigate how patient follow-up differed during Covid-19 pandemic. METHODS: The patients with inflammatory rheumatic diseases registered in our rheumatology clinic were assessed. The demographic information, diagnosis, medication, whether patients could attend their routine follow-up, treatment changes, access to drugs during the pandemic, number of Covid-19 infection positive patients were recorded. RESULTS: Of 232 patients, 83 (35.8%) had rheumatoid arthritis, 77 (33.2%) spondyloarthropathy, 72 (31%) other rheumatic diseases. 37% (86) were on methotrexate/leflunomide/sulfasalazine, 36.2% (84) were on biological agent, 32.3% (75) of the patients were on hydroxychloroquine (HCQ), and 35.8% (83) were on glucocorticoids. 56% patients on HCQ experienced problems in medication supply. Only 55 patients (23.7%) presented for their routine follow-up appointment, 22 of the patients (9.5%) changed their treatment without consulting the doctor. While 48 (57.1%) of the patients on biological agents continued their treatment, 36 patients (42.9%) have interrupted the treatment with doctor’s recommendation or on their own initiative. There were 7 patients diagnosed with Covid-19, none of them had severe respiratory complications or death. CONCLUSIONS: During the pandemic, numerous patients with rheumatic diseases are left without monitoring. Of the patients, 56% using HCQ experienced problems in medication supply. There is no increased risk detected in rheumatology patients related to severe Covid-19 infection. In this period, encouraging and supporting patients to continue rheumatologic treatment if there is no suspected infection or diagnosis will decrease the exacerbation of the disease.FUNDING STATEMENT: No specific funding was received from any funding bodies in the public, commercial or not-for-profit sectors to carry out the work described in this manuscriptDECLARATION OF INTERESTS: The authors have declared no conflicts of interest.ETHICS APPROVAL STATEMENT: This study was planned as a cross-sectional study and approvals from Clinic Research Ethical Committee of our university (25901600-604.01.01-17/415) and General Directorate of Health Services of Turkey were obtained. Before the treatment, the patients were informed about the study and voluntary consent form was signed by the patients.