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Diagnosis of Rheumatic Diseases Unaffected by COVID-19

"Understanding the effects of the pandemic on specific areas of health care is crucial for future planning in both the immediate and longer term," stated investigators.

Greater numbers of positive test results and diagnoses of severe autoimmune rheumatological diseases (ARDs) were observed during the COVID-19 pandemic, despite its impact on healthcare access, when compared with the pre-pandemic period, according to a study published in The Journal of Rheumatology.1

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“As early diagnosis of ARDs is important in order to improve long-term outcomes, the situation has been extremely challenging for laboratory staff, clinical rheumatologists, and rheumatological patients themselves,” investigators explained. “Data regarding the effect of the COVID-19 outbreak on the number of autoimmunity tests performed and on rheumatological diagnoses of ARD are lacking. Understanding the effects of the pandemic on specific areas of health care is crucial for future planning in both the immediate and longer term.”

Medical records and laboratory information from San Carlo Hospital, located in Basilicata, Italy, were collected between January and December 2020 and compared with the equivalent period in 2019. Data, such as first rheumatological visits, new diagnoses, autoimmunity laboratory testing volumes, and differences (%) during both periods were calculated and compared. Positive results for each serological marker in outpatient autoimmunity tests were recorded.

ARD diagnosis was determined by bloodwork, physical examinations, serological tests, and medical history. Rheumatic diseases observed included rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (ax-SpA), systemic lupus erythematosus (SLE), osteoarthritis (OA), vasculitis, and fibromyalgia (FM). Only samples from outpatient services were entered into the analysis.

There was a significant reduction in autoimmunity tests during the pandemic period when compared with the previous year (9912 vs 14100, respectively). During 2020, 70% of tests were ordered by general practitioners (GPs), followed by other specialists (20%), and rheumatologists (10%). There were 1.5 times fewer samples for antinuclear antibodies (ANA), anti-extractable nuclear antigen (anti-ENA), anti-double-stranded DNA (anti-dsDNA), rheumatoid factor (RF), anti-neutrophil cytoplasmic antibody

(ANCA), and anti-citrullinated protein/peptide antibody (ACPA) during 2020. The biggest reduction in volume occurred during March and April 2020.

While there were higher percentages of positive autoimmunity results during the pandemic period, there was a significant decrease in the absolute number of positive ANA and RF tests when compared with the previous year (ANA: 552 vs 730; RF: 202 vs 275; P < 0.05).

Rheumatological visits decreased by 48% in 2020 when compared with the pre-pandemic period (1272 vs 2336; P < 0.05), with the biggest dip observed in March, April, and May.

There was a notable reduction in new diagnoses of less severe conditions during the pandemic, including PsA, OA, and FM. However, there was an increase in SLE and Sjögren syndrome. ARDs with systemic involvement were diagnosed at similar rates in both years.

Limitations included the descriptive nature of the study and using information from a singular health center. As GPs ordered the majority of tests, investigators could not determine the influence they had on both referrals and laboratory tests during the 2 study periods. Additionally, asymptomatic COVID-19 infections may have influenced autoimmunity response and autoantibody production. This aspect was not explored. Lastly, very severe cases of ARDs that necessitated emergency care were not accounted for.

“Our data could be useful to better manage the appropriateness of the ARD diagnostic pathway in daily clinical practice as well as in a future pandemic setting,” investigators concluded. “Although there were challenges for clinical practice during the COVID-19 pandemic, safe and high-quality healthcare was maintained for patients with severe ARDs.”

Reference:

Carbone T, Picerno V, Pafundi V, et al. Impact of the COVID-19 Pandemic on the Appropriateness of Diagnostic Pathways of Autoimmune Rheumatic Diseases [published online ahead of print, 2021 Oct 15]. J Rheumatol. 2021;jrheum.210611. doi:10.3899/jrheum.210611