ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1673

Riding Multiple Waves of Uncertainty: Real World Canadian RA Patient Outcomes over 1 Year of COVID-19 Restrictions

Orit Schieir1, Susan Bartlett2, Marie-France Valois2, Louis Bessette3, Gilles Boire4, Glen Hazlewood5, Carol Hitchon6, Edward Keystone7, Janet Pope8, Diane Tin9, Carter Thorne10, Vivian Bykerk11 and CATCH Investigators12, 1Canadian Early Arthritis Cohort Study, Montréal, QC, Canada, 2McGill University, Montréal, QC, Canada, 3Centre de l'Ostoporose et de Rhumatologie de Qubec, Québec City, QC, Canada, 4Universite de Sherbrooke, Sherbrooke, QC, Canada, 5University of Calgary, Calgary, AB, Canada, 6University of Manitoba, Winnipeg, MB, Canada, 7Keystone Consulting Enterprises Inc., Toronto, ON, Canada, 8University of Western Ontario, London, ON, Canada, 9The Arthritis Program Research Group, Newmarket, ON, Canada, 10Southlake Regional Health Centre, Newmarket, ON, Canada, 11Hospital for Special Surgery, New York, NY, 12Mt Sinai Hospital, Toronto, ON, Canada

Meeting: ACR Convergence 2021

Keywords: , , , ,

Session Information

Date: Tuesday, November 9, 2021

Session Title: RA – Diagnosis, Manifestations, & Outcomes Poster IV: Outcomes, Trajectory of Disease, & Epidemiology (1645–1673)

Session Type: Poster Session D

Session Time: 8:30AM-10:30AM

Background/Purpose: During the COVID-19 pandemic, Canadians adults with RA faced considerable uncertainty due to greater risk of infection, hospitalization, changing access to RA medications, and very limited access to in-person RA care due to stringent pandemic-related restrictions. We examined trends in perceived stress, physical, emotional, and social health, perceived disease activity and flares prior to and during the first two waves of COVID-19 in adults with RA.

Methods: Participants were enrolled in the Canadian Early Arthritis Cohort with available data. Descriptive statistics examined trends in Perceived Stress and PROMIS-29 from 6 months pre-pandemic (9/19-2/20) through Waves 1 (3/20-6/20) and Wave 2 (10/20-1/21). Disease activity was assessed using the RA-FQ, a validated PRO; scores ≥20 are consistent with inflammatory flares.

Results: A total of 858 visits were collected from 3/16/20 through 1/31/21 and compared with 956 pre-pandemic visits. Participants were mostly white (86%) women (72%) with a mean age of 55 years. Pre-pandemic mean PROMIS-29 scores were in the normal range. Monthly trends showed that pandemic impacts were greatest in April 2020 (Fig 1) where mean PROMIS-29 scores worsened for all domains except Participation (mean Δ -0.4); the largest changes were in Depression (Δ+4.8) and Anxiety (Δ+4.2)(p’s< .01). Compared with pre-pandemic visits, by April higher proportions had moderate-severe Anxiety (12% vs 23%), Depression (11% vs 23%), Fatigue (18% vs 25%), Sleep Disturbance (10% vs 19%), Pain (23% vs 40%), Participation (15% vs 21%) and Disability (25% vs 34%) (all p’s< 0.05). By July 2020, mean PROMIS-29 scores had improved for Depression (Δ -4.5), Anxiety (Δ -3.2), Fatigue (Δ -2.0) and Perceived Stress (Δ -0.7). The proportions of patients with moderate-severe symptoms (≥60) were similar to pre-pandemic for all domains except Pain, Function, Participation, and Sleep where 29%, 34%, 21% and 17%, respectively, continued to have moderate-severe impairments. Wave 2 scores were higher than pre-pandemic, but lower than Wave 1, with the largest changes in depression (p=.02) and anxiety (p=.06).

Mean RA-FQ increased from the pre-pandemic period, peaking in April 2020 and Dec 2020-Jan 2021 (Fig 2). More patients had RA-FQ scores consistent with disease fIares in April (45%) and December (35%) than in the pre-pandemic period.

Conclusion: Stringent COVID-19 pandemic restrictions impacted care across Canada in Waves 1 and 2 resulting in considerable stress, higher perceived disease activity and flares, and meaningfully worse physical and emotional health. More than 1/3 experienced moderate-severe anxiety, depression, fatigue, sleep disturbance, pain, and disability.

Figure 1. PROMIS_29 scores prior to and during the COVID_19 pandemic in Canadian RA patients.

Disclosures: O. Schieir, None; S. Bartlett, Merck Canada, 2, 6, Pfizer Canada, 2, 6, Janssen Canada, 2, 6, PROMIS Health Organization, 4, American Thoracic Society, 4, Arthritis Health Professionals Association, 4, UCB, 1, RAND Corporation, 1; M. Valois, None; L. Bessette, Amgen, 2, 5, 6, Bristol-Myers Squibb, 2, 5, 6, Janssen, 2, 5, 6, Roche, 2, 5, 6, UCB, 2, 5, 6, AbbVie, 2, 5, 6, Pfizer, 2, 5, 6, Merck & Co, 2, 5, Celgene, 2, 5, 6, Sanofi, 2, 5, 6, Eli Lilly, 2, 5, 6, Novartis, 2, 5, 6, Gilead, 2, 5, 6, Sandoz, 2, 5, 6, Teva, 2, 6; G. Boire, Abbvie, 1, 6, 7, BMS, 6, 7, Janssen, 1, 5, 6, Eli Lilly, 1, 7, Amgen, 7, Novartis, 6, 7, Pfizer, 7, Sandoz, 6, 7, Viatris, 1, 6, Samsung Bioepis, 1; G. Hazlewood, None; C. Hitchon, Pfizer, 5, UCB Canada, 5; E. Keystone, AbbVie, 2, 6, Amgen, 2, 5, 6, Bristol-Myers Squibb Company, 2, Celltrion, 2, Gilead Sciences, 2, F. Hoffmann-La Roche, 2, 6, Janssen, 2, 6, Eli Lilly, 2, Merck, 2, 5, 6, Myriad Autoimmune, 2, Novartis, 6, Pfizer Inc, 2, 5, 6, PuraPharm, 5, Sandoz, 2, Sanofi-Genzyme, 2, 6, Samsung Bioepis, 2; J. Pope, AbbVie, 2, Amgen, 2, Bayer, 2, Bristol-Myers Squibb, 2, 5, Eli Lilly, 2, Merck, 2, Novartis, 2, Pfizer Inc, 2, Roche, 2, 5, Sanofi, 2, Seattle Genetics, 5, UCB, 2, 5, Actelion, 2, Sandoz, 2; D. Tin, None; C. Thorne, AbbVie, 1, Amgen Inc, 1, Celgene, 1, Eli Lilly, 1, Medexus/Medac, 1, 2, 6, Merck, 1, 2, Novartis, 1, 5, Pfizer, 1, 5, Sandoz, 1, Sanofi, 1, Centocor, 2; V. Bykerk, Amgen Inc., 2, 6, Bristol Myers Squibb, 2, 6, Gilead, 2, 6, Pfizer, 2, 6, Regeneron, 2, 6, Sanofi-Genzyme, 2, 6, UCB, 2, 6; C. Investigators, None.

To cite this abstract in AMA style:

Schieir O, Bartlett S, Valois M, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone E, Pope J, Tin D, Thorne C, Bykerk V, Investigators C. Riding Multiple Waves of Uncertainty: Real World Canadian RA Patient Outcomes over 1 Year of COVID-19 Restrictions [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/riding-multiple-waves-of-uncertainty-real-world-canadian-ra-patient-outcomes-over-1-year-of-covid-19-restrictions/. Accessed January 30, 2023.

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