Background/Purpose: During the COVID-19 pandemic, individuals were encouraged to shelter in place, specifically those considered high risk for COVID-19. Rheumatoid arthritis (RA) patients are known to be particularly susceptible to infections. During the pandemic, RA patients were found to cancel appointments and alter medications. This study aimed to understand the impact of COVID-19 on RA patients’ diagnosis, treatment, and utilization during the pandemic.

Methods: This is a retrospective cohort study of RA patients insured by a large Commercial and Medicare health plan in the United States. To assess the impact of COVID-19 on newly diagnosed treatment and utilization rates, we compareda pre-COVID period (March 1 to December 31, 2019) to a COVID period (March 1 to December 31, 2020) to assess how COVID-19 impacted changes. We defined a new RA diagnosis as a patient with medical insurance but no paid claim for RA for at least six months before the initial claim with an RA diagnosis. We utilized both medical and pharmacy claims to identify utilization patterns.

Results: This study included 36,019 patients in 2019 and 35,880 patients in 2020. The newly diagnosed rate increased 6% (p = 0.002) for Medicare but not for Commercial patients. Infusion treatments decreased 7% (p=0.03) for Commercial but not for Medicare patients. During this time, there was a switch in infusion site of care from the hospital setting to the office setting of 3.1% (p=0.05) and 5.7% (p< 0.001) for Commercial and Medicare patients, respectively. There was also a switch from facility to office-based biologic drug administration for Commercial (1.8%, p= 0.03) and Medicare patients (2.6%, p = 0.08). From March to May 2020, there was an 18-19% decrease (p < 0.001) in new RA diagnoses for Commercial and Medicare patients with a rebound in the last six months of 2020. There was an 11-17% decrease (p < 0.001) in utilization among existing patients during this time. Having COVID-19 increased the odds of being newly diagnosed with RA by 1.37 in Medicare patients and 1.91 in Commercial patients (both p < 0.001).

Conclusion: During the COVID-19 pandemic, we observed higher RA incidence rates. Additionally, infusion treatments decreased and changed from the hospital to the office setting. While new RA diagnosis and utilization rates of existing RA patients declined during the pandemic’s height, both rates quickly rebounded in the last months of 2020. As a result, patients treated for COVID-19 were more likely to be newly diagnosed with RA, likely driving the higher incidence rates observed in this study. During the pandemic, some healthcare services were compromised to meet the demands of caring for COVID-19 patients. In some cases, patients canceled appointments or delayed care due to fear of exposure. The results of this study highlight the impact of a pandemic on healthcare.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/diagnosis-treatment-and-utilization-changes-in-rheumatoid-arthritis-patients-before-and-during-covid-19/