key: cord-280984-2j8ckz14
authors: Roux, CH; Brocq, O; Gerald, F; Pradier, C; Bailly, L
title: Impact of home confinement during the COVID‐19 pandemic on medication use and disease activity in spondyloarthritis patients
date: 2020-06-17
journal: Arthritis Rheumatol
DOI: 10.1002/art.41397
sha: 
doc_id: 280984
cord_uid: 2j8ckz14

Home confinement, imposed as part of the social distancing measures in the fight against the coronavirus disease 2019 (COVID‐19), poses several problems for patients with spondyloarthritis (SpA), including the lack of physical activity, psychological factors, and the confusion related to the prescriptions of NSAIDs. We investigated the impact of confinement on the medication intake and disease activity in SpA patients in a questionnaire‐based survey.

the prescriptions of NSAIDs 2 . We investigated the impact of confinement on the medication intake and disease activity in SpA patients in a questionnaire-based survey.

A questionnaire was administered between 10-21 April, 2020 to 1656 members of a private social network of the "Association contre les spondylarthrites" (ACS). The questionnaire, created using A written explanation of the study aim was provided with the questionnaire. The study protocol was approved by the national ethics commission (Clinical trial number: NCT04355923).

Overall, 609 (37%) of 1656 members of the ACS association responded to the questionnaire. The characteristics and detailed response on treatment modification are shown in Table 1 . 

This article is protected by copyright. All rights reserved Furthermore, NSAIDs were more often discontinued when patients experienced disease aggravation. However, it is difficult to say whether this worsening was linked to the imposed confinement, specifically the psychological aspects of this situation, or the suspension or reduction of NSAIDs. Psychological factors may play an important role in SpA patients. 5 Fewer patients decreased or suspended treatment with bDMARDs in our study. Paradoxically, the increased

This article is protected by copyright. All rights reserved infection risk in patients receiving bDMARDs is well known, and patients have probably been informed of this risk during treatment initiation. 6, 7 Another explanation of the worsening of symptoms could be the reduced physical activity resulting from home confinement. In SpA, exercise can reduce disease activity and, consequently, is part of our recommendations for optimal treatment. 8

In our patient population, COVID-19 occurrence was associated with a SpA treatment modification. We did not find a link between the NSAIDs intake or biologic treatment and COVID-19. When considering both the confirmed and suspected cases of COVID-19, we found 31 (13 suspicious and 18 confirmed) cases, which is more substantial than the 8 (4 confirmed highly suggestive) of 320 cases reported by Monti et al. in their chronic arthritis cohort 9 .

However, it is impossible to compare the prevalence as the population, methodology, and period are different, 9 . It is important to emphasize that a majority of our patients were administered

NSAIDs. These results are interesting because they provide real life data.

Our findings have to be interpreted within the limitations of the study. The most important limitation is that our results are based on self-declarations. We could not verify the positivity of the tests where patients declared themselves to have confirmed COVID-19. However, this is the first study providing information on therapy compliance during home confinement and the frequency of COVID-19 in SpA patients. The size of our cohort reinforces the importance of our results.

Thus, this survey shows that home confinement linked to the COVID-19 pandemic is associated with worsening of the disease and a reduction or suspension of medication intake, in particular NSAIDs, in SpA patients. It has considerable clinical implications, given that home confinement is likely to recur in the future. Patients need to be educated about the current evidence on NSAIDs drugs and ways to stay physically active at home.

Efficacy of high intensity exercise on disease activity and cardiovascular risk in active axial spondyloarthritis: a randomized controlled pilot study

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American College of Rheumatology Guidance for the Management of Adult Patients with Rheumatic Disease During the COVID-19 Pandemic

American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis

Predicting response to anti-TNFα therapy among patients with axial spondyloarthritis (axSpA): results from BSRBR-AS. Rheumatology (Oxford)

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Risk of infections using anti-TNF agents in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: a systematic review and meta-analysis

update of the ASAS-EULAR management recommendations for axial spondyloarthritis

Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies

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