Impact of the First Three Waves of the Covid-19 Pandemic on Everyday Restrictions and Clinical Care of Patients with Spondyloarthritis Across Europe - Results from the EuroSpA Collaboration

Brigitte Michelsen¹, Bente Glintborg², Kim Lauper³, Bjorn Gudbjornsson⁴, Lykke Ørnbjerg⁵, Gerdur Maria Gröndal⁶, Karin Laas⁷, Sigrid Vorobjov⁸, Dan Nordstrom⁹, Heikki Relas⁹, Adrian Ciurea¹⁰, Burkhard Moeller¹¹, Isabel Castrejon¹², Lucia Otero-Valera¹³, Ziga Rotar¹⁴, Katja Perdan Pirkmajer¹⁵, Anne Gitte Loft¹⁶, Jakub Zavada¹⁷, Karel Pavelka¹⁸, Eirik Kristianslund¹⁹, Tore Kvien²⁰, Marleen van de Sande²¹, Pasoon Hellamand²², Florenzo Iannone²³, Roberto F. Caporali²⁴, Ana Maria Rodrigues²⁵, Maria Jose Santos²⁶, Catalin Codreanu²⁷, Corina Mogosan²⁸, Merete Hetland⁵ and Mikkel Østergaard²⁹, ¹Rigshospitalet Glostrup; Diakonhjemmet Hospital; Sørlandet Hospital, Copenhagen, Denmark, ²Rigshospitalet Glostrup, University of Copenhagen, Virum, Denmark, ³Geneva University Hospitals, Genève, Switzerland, ⁴Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland, ⁵Copenhagen Center for Arthritis Research, Rigshospitalet, Copenhagen, Denmark, ⁶Landspitali University Hospital; University of Iceland, Reykjavik, Iceland, ⁷Department of Rheumatology, East-Tallinn Central Hospital, Tallinn, Estonia, ⁸National Institute for Health Development, Tallinn, Estonia, ⁹Helsinki University Hospital, Helsinki, Finland, ¹⁰University Hospital Zurich, Zürich, Switzerland, ¹¹Inselspital - University Hospital Bern, Bern, Switzerland, ¹²Hospital Universitario Gregorio Marañón, Madrid, Spain, ¹³Spanish Society of Rheumatology, Madrid, Spain, ¹⁴University Medical Centre Ljubljana, Ljubljana, Slovenia, ¹⁵University Medical Centre Ljubljana; University of Ljubljana, Ljubljana, Slovenia, ¹⁶Aarhus University, Horsens, Denmark, ¹⁷Institute of Rheumatology; Charles University, Prague, Czech Republic, ¹⁸Institut of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Praha, Czech Republic, ¹⁹Diakonhjemmet Hospital, Oslo, Norway, ²⁰Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway, ²¹Amsterdam UMC, University of Amsterdam, Department of Rheumatology & Clinical Immunology and Department of Experimental Immunology, Amsterdam Infection & Immunity Institute; Amsterdam Rheumatology & Immunology Center (ARC), Academic Medical Center, Amsterdam, Netherlands, ²²Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands, ²³Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy, ²⁴Department of Clinical Sciences and Community Health, University of Milan, and Department of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO, Milano, Italy, ²⁵Sociedade Portuguesa de Reumatologia; Nova Medical School; Hospital dos Lusíadas, Lisbon, Portugal, ²⁶Hospital Garcia de Orta, Almada, Lisboa, Portugal, ²⁷Center for Rheumatic Diseases, Bucharest, Romania, ²⁸University of Medicine and Pharmacy, Bucharest, Romania, ²⁹Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet; University of Copenhagen, Copenhagen, Denmark

Meeting: ACR Convergence 2023

Keywords: Access to care, COVID-19, spondyloarthritis

Session Information

Date: Tuesday, November 14, 2023

Title: (1840–1861) Health Services Research Poster III

Session Type: Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: The Covid-19 pandemic constituted major challenges for health-care services worldwide. We aimed to compare Covid-19 restrictions across Europe during the first three waves of the pandemic, as well as the consultation and follow-up practices of patients with spondyloarthritis before and during the pandemic.

Methods: Rheumatologists completed a Research Electronic Data Capture (REDCap) survey in 13 observational registries in the European Spondyloarthritis Research Collaboration Network (EuroSpA) between July 1^st and October 27,^th 2022: ATTRA (Czech Republic), DANBIO (Denmark), ESRBTR (Estonia), ROB-FIN (Finland), ICEBIO (Iceland), GISEA (Italy), ARC (Netherlands), NOR-DMARD (Norway), Reuma.pt (Portugal), RRBR (Romania), biorx.si (Slovenia), BIOBADASER (Spain), and SCQM (Switzerland), answering questions on Covid-19 restrictions in their individual countries and the impact of Covid-19 on consultation and follow-up of routine care patients with spondyloarthritis in their registries. The survey covered the period from the start of the pandemic in the different countries, until 1^st of March, 2022.

Results: The first case of Covid-19 in each country was reported between 31^st of January 2020 in Spain and 4^th of March 2020 in Slovenia. Use of facemask in public was mandatory in all countries during the peak of the pandemic, but use of filtering facemask (type P2 or P3) only in four countries (Table 1). All countries except for Iceland had a nationwide total lockdown. Most countries had nationwide curfews, which occasionally applied to specific periods throughout the day. All countries had social distancing varying between one and two meters from others in public. This was mandatory at some time-point during the pandemic in all countries, except in Finland and Portugal, where it was recommended.

Before the pandemic, only four countries/registries had alternative modes of consultation in addition to the usual routine care physical consultations (Table 2). However, during the pandemic, nine registries initiated other modes of routine care consultations, the most common being phone consultations. The new modalities of consultations were not mandatory in any registry, except for mandatory non-urgent remote consultations in Switzerland during the first wave of the pandemic (phone or video, Table 3). In addition, in Spain, phone consultations and consultations between primary care physicians and rheumatologists were mandatory at some hospitals.

In every registry, rheumatologists reported an increased patient relocation from physical to remote consultations during the pandemic. At the peak of the pandemic, most of the patients were assessed remotely; however, this mainly applied to follow-up patients. More patients and healthcare providers canceled appointments during the pandemic than before. Furthermore, in all registries, staff was translocated to other duties and patients had fewer follow-up consultations than usual.

Conclusion: The Covid-19 pandemic had far-reaching consequences across Europe, not only due to nationwide restrictions, but also as a result of its negative impact on the accessibility of rheumatological care and follow-up.

Table 1 Restrictions during the Covid_19 pandemic across European countries/registries

Table 2 Routine care consultations in the registries before and during the Covid_19 pandemic

Table 3 Changes of follow-up and delays in the registries during the Covid_19 pandemic

Disclosures: B. Michelsen: Novartis, 5; B. Glintborg: AbbVie/Abbott, 5, Bristol-Myers Squibb(BMS), 5, Sandoz, 5; K. Lauper: Eli Lilly, 5, Pfizer, 2; B. Gudbjornsson: Nordic-Pharma, 6, Novartis, 2, 6; L. Ørnbjerg: Novartis, 5; G. Gröndal: None; K. Laas: None; S. Vorobjov: None; D. Nordstrom: AbbVie/Abbott, 2, BMS, 2, Lilly, 2, MSD, 2, Novartis, 2, Pfizer, 2, UCB, 2; H. Relas: None; A. Ciurea: None; B. Moeller: None; I. Castrejon: Bristol Myers Squibb, 1, 6, Galapagos, 2, GlaxoSmithKline, 1, 6, Lilly, 1, 6, Merck Sharp & Dohme, 6, Pfizer, 1, 2, 6; L. Otero-Valera: None; Z. Rotar: None; K. Perdan Pirkmajer: None; A. Loft: Ucb, 1, 6, 12, Congress participation; J. Zavada: None; K. Pavelka: Abbvie, 2, 6, Amgen, 2, 6, Bristol-Myers Squibb(BMS), 2, 6, Egis, 2, 6, MSD, 2, 6, Pfizer, 2, 6, Roche, 2, 6, UCB, 2, 6; E. Kristianslund: None; T. Kvien: AbbVie/Abbott, 1, 2, 6, Bristol-Myers Squibb(BMS), 5, Galapagos, 2, 5, Gilead, 2, grunenthal, 6, Janssen, 2, 6, Novartis, 5, Pfizer, 2, 5, sandoz, 2, 6, UCB, 2, 5, 6; M. van de Sande: AbbVie, 2, Eli Lilly, 5, Janssen, 6, Novartis, 2, 5, 6, UCB Pharma, 2, 5, 6; P. Hellamand: Novartis, 12, Research grant to employer (not to me); F. Iannone: Abbvie, 2, 5, BMS, 2, 5, Janssen, 2, 5, Lilly, 2, 5, MSD, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, Roche, 2, 5, UCB, 2, 5; R. Caporali: AbbVie, 2, 6, Amgen, 2, 6, BMS, 2, 6, Celltrion, 2, 6, Fresenius Kabi, 2, Galapagos, 2, 6, Janssen, 2, 6, Lilly, 2, 6, MSD, 2, 6, Novartis, 2, 6, Pfizer, 2, 6, Roche, 2, Sandoz, 2, 6, UCB, 2, 6; A. Rodrigues: AbbVie/Abbott, 5, Amgen, 5, 6, Novartis, 5, Pfizer, 5; M. Santos: None; C. Codreanu: AbbVie/Abbott, 2, 6, Amgen, 1, 6, Boehringer-Ingelheim, 1, 6, Eli Lilly, 1, 6, Novartis, 1, 6, Pfizer, 1, 6; C. Mogosan: None; M. Hetland: AbbVie/Abbott, 1, 5, Bristol-Myers Squibb(BMS), 5, Danbio, 12, Chari of Danbio registry, Eli Lilly, 5, MEDAC, 6, Novartis, 5, Pfizer, 5, 6, Sandoz, 5, 6; M. Østergaard: AbbVie, 2, 5, 6, Amgen, 5, Boehringer-Ingelheim, 2, 6, Bristol-Myers Squibb(BMS), 2, 5, 6, Celgene, 2, 5, 6, Eli Lilly, 2, 6, Galapagos, 2, 6, Gilead, 2, 6, Hospira, 2, 6, Janssen, 2, 6, MEDAC, 6, Merck, 2, 5, 6, Novartis, 2, 5, 6, Novo Nordisk, 2, 6, Orion, 2, 6, Pfizer, 2, 6, Regeneron, 2, 6, Roche, 2, 6, Sandoz, 2, 6, Sanofi, 2, 6, UCB, 2, 6.

To cite this abstract in AMA style:

Michelsen B, Glintborg B, Lauper K, Gudbjornsson B, Ørnbjerg L, Gröndal G, Laas K, Vorobjov S, Nordstrom D, Relas H, Ciurea A, Moeller B, Castrejon I, Otero-Valera L, Rotar Z, Perdan Pirkmajer K, Loft A, Zavada J, Pavelka K, Kristianslund E, Kvien T, van de Sande M, Hellamand P, Iannone F, Caporali R, Rodrigues A, Santos M, Codreanu C, Mogosan C, Hetland M, Østergaard M. Impact of the First Three Waves of the Covid-19 Pandemic on Everyday Restrictions and Clinical Care of Patients with Spondyloarthritis Across Europe – Results from the EuroSpA Collaboration [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/impact-of-the-first-three-waves-of-the-covid-19-pandemic-on-everyday-restrictions-and-clinical-care-of-patients-with-spondyloarthritis-across-europe-results-from-the-eurospa-collaboration/. Accessed .

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