Abstract
Lockdowns imposed by governments worldwide as a way to limit the spread of severe atypical respiratory syndrome-coronavirus-2 (SARS-CoV2) have had heavy psychological and economic consequences. Arthritis patients are a vulnerable population at an increased risk of peritraumatic stress. This could be due to several reasons, including the fear of shortage of medicine and difficulty receiving periodical medical checks. In the present case-control study, psychological distress in patients with autoimmune arthritis during the coronavirus disease 2019 (COVID-19) pandemic were investigated. An electronic survey was conducted to gather information on the perceived change in the emotional state, general health (GH), fatigue, joint pain, and disease activity during the lockdown, in 100 patients with autoimmune arthritis and 100 controls. Mental health status was measured using the Depression, Anxiety and Stress Scale (DASS-21). The COVID-19 Peritraumatic Distress Index (CPDI) was used to assess the frequency of peritraumatic stress disorders related to COVID-19. Patients reported a significant worsening of perceived GH (36% vs. 7%; p < 0.001), a significantly higher mean CPDI score (p < 0.001) than controls. Using multivariate analysis, arthritis patients had significantly higher CPDI scores (+3.67 points; p = 0.019), independent of depression, anxiety, and stress symptoms, comorbidities, and sociodemographic and lifestyle characteristics. Logistic regression analysis showed that the risk of reporting worsened GH was 9-fold higher in patients than controls (p < 0.001). Patients with autoimmune arthritis are at higher risk of psychological distress related to COVID-19 pandemic; thus targeted intervention should be designed to strengthen coping capacity in this vulnerable population.
Highlights
At the end of December 2019, after a cluster of cases of pneumonia of unknown origin were reported in the city of Wuhan, Hubei province, China, a new disease—coronavirus disease 2019 (COVID-19)—was identified [1].Clinical manifestations of the disease are usually mild, and consist of fever, cough, and fatigue; 15–20% of patients can progress to severe or critic form that, require hospitalization, but can be complicated by Acute Respiratory Distress Syndrome (ARDS) with high mortality rate [2,3].Since the outbreak, the virus has rapidly become a global emergency, due to how quickly it can spread, its sudden and unpredictable worsening of clinical course, and lack of effective therapy and prophylaxis
Comorbidities were represented by blood hypertension and cardiovascular diseases, diabetes, and thyroid diseases, which were present in 23, 5, and 12 patients vs. 20, 2, and 6 controls, respectively, whereas autoimmune arthritis was present in all the patients and absent in controls
The interpretation that the main psychological consequences of COVID-19-induced lockdowns in arthritis patients may principally be ascribed to the representation that patients have of their-own illnesses, more than the objectives and demonstrated arthritis-associated risks of infection, and severity of COVID-19; it may even be supported by the lack of influence of comorbidities on the perception of general health worsening, underlying that the main driver of peritraumatic stress disorder is the worry by which the patients feel the disease more than the disease itself
Summary
At the end of December 2019, after a cluster of cases of pneumonia of unknown origin were reported in the city of Wuhan, Hubei province, China, a new disease—coronavirus disease 2019 (COVID-19)—was identified [1].Clinical manifestations of the disease are usually mild, and consist of fever, cough, and fatigue; 15–20% of patients can progress to severe or critic form that, require hospitalization, but can be complicated by Acute Respiratory Distress Syndrome (ARDS) with high mortality rate [2,3].Since the outbreak, the virus has rapidly become a global emergency, due to how quickly it can spread, its sudden and unpredictable worsening of clinical course, and lack of effective therapy and prophylaxis. The World Health Organization (WHO), declared a pandemic on 11 March 2020 [4] This new threat has led to worldwide fear over the virus, for the virulence and severity of the infectious agent, but for the characteristic of it, being an unknown invisible enemy, something that has never been encountered before. This aspect has been observed by recent studies questioning hastily published material. This was the case for the Angiotensin Converting Enzymes (ACE) receptor used by the virus to infect humans, and the possible interference by ACE2-inhibitors, which created worry in patients taking these drugs. It has led to serious consequences across the globe, especially in patients with chronic diseases (e.g., autoimmune diseases, asthma, chronic obstructive pulmonary disease (COPD), cancer, psychiatric and cardiovascular diseases, etc.), who are strongly dependent on the need to have easy access to hospitals for periodical checks or, even more, for emergency situations
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