Impact of COVID-19 pandemic on the management of patients with rheumatoid arthritis: a survey of rheumatologists in six European countries


 
 
 We aimed to describe, from the perspective of rheumatologists in Europe, how the COVID-19 pandemic has impacted their management of people with rheumatoid arthritis (RA) and the continuing medical education of physicians.
 
 
 
 Rheumatologists participating in the Adelphi RA Disease Specific Programme™ in six European countries were contacted in August and September 2020 for a telephone survey. Rheumatologists were asked seven attitudinal questions on changes to patient management, prescription behaviour, and continuing education due to COVID-19. Results were summarised with descriptive statistics.
 
 
 
 The telephone survey was completed by 284 rheumatologists. The most commonly reported changes to patient management were increased utilisation of video/telephone consultations (66.5% of respondents), fewer visits (58.5%), and limiting physical contact (58.1%). Furthermore, 67.9% of rheumatologists who indicated prescribing behaviour had changed switched their patients to self-administered medication and 60.7% reported not starting patients on targeted synthetic disease-modifying antirheumatic drugs (DMARDs), biologic originator DMARDs, or biosimilar DMARDs. In total, 57.6% of rheumatologists believed changes in management would persist. Rheumatologists reported that 38.0% of patients expressed concerns about how COVID-19 would impact treatment, including access to treatment and the risk of infection. The biggest impact on rheumatologist education was a switch to online training and conferences.
 
 
 
 All countries saw changes in patient management and prescribing behaviour, including the rapid uptake of telemedicine. It is important that the international rheumatology community learns from these experiences to better prepare for future pandemics and to address ongoing rheumatologist shortages.
 
 
 
 What does this mean for patients ?
 We asked rheumatologists a series of questions to find out how COVID-19 affected the way they interact with their patients with rheumatoid arthritis. We found that rheumatologists switched to online or telephone appointments in most countries to obey social distancing rules. Rheumatologists also reduced prescription of advanced medicines, most likely as a response to patient fears that such therapies may increase infection risk. There were differences between countries in changes made to patient treatment likely caused by differences in COVID-19 case numbers and where patients saw their doctor. We also found that doctor education moved mostly online. These results will help guide doctors in case of future pandemics as well as helping to plan future studies into how online appointments may be best used, who they are suitable for, and how they may be used to ensure patients can see a rheumatologist when they need to. They also highlight a need for continued monitoring of patients to ensure medication changes do not reduce effectiveness of treatment in the long-term.
