Background/Purpose: To investigate the perceptions and behaviors of rheumatologists in the United States (US) regarding the risk of COVID-19 for their autoimmune patients and the subsequent management of immunosuppressive and anti-inflammatory medications. 

Methods: We administered an online survey to a convenience sample of rheumatologists in the US from 4/8/20-5/4/20 via social media and group emails. Survey respondents provided demographic information such as, age, gender, state of practice, and practice type. We asked questions about what they perceived their rheumatic patients COVID-19 risk to be, and furthermore what their management of immunosuppressive (steroids, biologics) and non-steroidal anti-inflammatory (NSAID) medications has been during the pandemic. Descriptive analyses were performed.

Results: 271 respondents completed the survey nationally. 48% of respondents either agreed or strongly agreed with the statement “Patients with rheumatic diseases are at a higher risk of COVID-19 irrespective of their immunosuppressive medications”.(Figure 1) 50% disagreed or strongly disagreed with the statement “The pandemic has led you to reduce the use/dosage/frequency of biologics”, while 56% agreed or strongly agreed with the statement “The pandemic has led you to reduce the use/dosage/frequency of steroids”. A third of respondents indicated that at least 10% of their patients had self-discontinued or reduced at least one immunosuppressive medication to mitigate their risk of COVID-19. Responses to these questions as well as to questions regarding NSAID prescription patterns were significantly different in the Northeast region of US compared to other regions.(Figure 2)

Conclusion: In this national sample of rheumatologists, there are variations regarding perceptions of patients’ risk of COVID-19, and how to manage medications such as NSAIDs, biologics and steroids during the pandemic. These variations are more pronounced in geographical areas where COVID-19 disease burden was higher. Limitations include difficultly to obtain a survey response rate; this was an online survey advertised through social media and email campaigns, so we cannot estimate how many rheumatologists had the opportunity to participate. Of those who the survey reached, the rheumatologists who chose to respond may reflect a respondent bias.

Figure 1. 1a) Responses to whether rheumatologists think their patients are at higher risk for COVID-19 1a) Responses to whether rheumatologists are altering biologic regimes during the pandemic 1c) Responses to whether rheumatologists are altering corticosteroid regimes during the pandemic

Figure 2: 2a) Responses to whether rheumatologists are recommending patients with no COVID-19 symptoms to decrease or avoid NSAIDs. 2b) Responses to whether rheumatologists are recommending patients with COVID-19 symptoms to decrease or avoid NSAIDs

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/geographical-variations-in-covid-19-perceptions-and-patient-management-a-national-survey-of-rheumatologists/