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04-09-2020 | COVID-19 | News

COVID-19: Strict adherence to social isolation rules may mask the risk in RMD patients

Claire Barnard

medwireNews: Patients with rheumatic and musculoskeletal diseases (RMDs) are almost twice as likely to adhere to COVID-19 social distancing regulations as the general population, suggests research conducted in the Netherlands.

“So far, results on the incidence and the outcomes of COVID-19 in these groups are reassuring,” say Femke Hooijberg (Amsterdam Rheumatology and Immunology Center) and study co-authors.

However, they point out that such studies “do not account for preventive measures taken by patients, despite suggestions that patients are aware that their infection risk might be increased,” and “[i]f patients subject themselves to stricter isolation measures than the general population, we might be falsely reassured.”

The team investigated adherence to Dutch government guidelines for strict social isolation – which recommended that the general population should stay at home as much as possible and keep 1.5 m away from other people – among 1455 patients with inflammatory arthritis and 414 healthy controls between 26 April and 27 May 2020.

In all, 46% of the RMD patients reported adherence to strict social isolation, compared with just 29% of the healthy controls, translating into an odds ratio (OR) of 1.8 after adjustment for age, sex, smoking status, BMI, and comorbidities.

Hooijberg et al say that this association remained significant when patients with rheumatoid arthritis (n=979), psoriatic arthritis (n=261), and ankylosing spondylitis (n=215) were analyzed separately, with ORs of 1.7, 2.0, and 2.4, respectively. Significant associations were also seen among RMD patients who were (n= 646) and were not (n=809) receiving biologic treatment compared with healthy controls, with corresponding ORs of 2.2 and 1.7.

The researchers note that sex significantly modified the association between the presence of RMDs and adherence to social distancing, with a higher “preference for strict isolation […] in women than in men.”

These results suggest that the lack of association between RMDs or immunosuppressive medication use and COVID-19 incidence seen in previous studies “might thus, in whole or in part, be caused by strict isolation measures taken by individual patients with inflammatory rheumatic diseases,” write Hooijberg and team in a comment to The Lancet Rheumatology.

“Therefore, the assessment of risk of COVID-19 in vulnerable patients should include an evaluation of isolation measures they have actually taken,” they recommend.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group

4 September 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Lancet Rheumatol 2020; doi:10.1016/S2665-9913(20)30286-1

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