medwireNews: At the EULAR 2022 Congress in Copenhagen, Denmark, two experts debated whether COVID-19 will have a lasting effect on rheumatology clinical practice.
Session co-chair Laure Gossec (Sorbonne Université, Paris, France) opened proceedings with an audience poll, in which approximately two-thirds of participants voted “yes,” to say that COVID-19 would continue to have an impact on rheumatology practice in the coming years. However, when the question was changed to “do you think the COVID-19 pandemic will have a negative impact on rheumatology practice?” at the end of the session, the results were reversed, with just one-third of audience members anticipating long-term negative consequences.
So how might the pandemic affect rheumatology practice over the next few years? Philip Conaghan (University of Leeds, UK) presented evidence for a lasting negative impact, whereas Maria-Antonietta D’Agostino (Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy) was more optimistic, and argued that the pandemic would not adversely impact clinical practice in the long term.
A lasting impact on patients?
Both experts agreed that the pandemic had a short-term negative impact on patients with rheumatic and musculoskeletal diseases (RMDs), with problems ranging from delayed or missed diagnoses to lack of assessment of disease activity and treatment interruptions.
Conaghan believes that patients have been “impacted in many ways that will last for years,” and pointed out that delayed diagnosis and treatment cessation or interruption could lead to lasting joint pain. Citing results from the REUMAVID study showing that 25% of 1800 RMD patients reported increased smoking and almost 20% increased alcohol consumption during the early phase of the pandemic (April–July 2020), he said that the impact of these harmful health behaviors will be felt “for years to come.” He shared findings from the COVID-19 Global Rheumatology Alliance showing a reduction in employment among RMD patients during the pandemic, which could have long-term consequences “for healthcare access, medication affordability, mental health, and disease activity.”
Conaghan also talked about the impact of immunomodulatory therapy on infection risk and COVID-19 vaccine effectiveness, and noted that rheumatology healthcare professionals (HCPs) are “going to have to deal with vaccines in our immunosuppressed patients” in the long term, as the pandemic continues.
D’Agostino, however, said that with the exception of corticosteroids and rituximab, immunosuppressive drugs are likely to have a “limited impact” on COVID-19 infection risk and outcomes. She pointed out the favorable safety profile of COVID-19 vaccines in RMD patients, and said that treatments belonging to the Janus kinase inhibitor and tumor necrosis factor inhibitor classes “do not seem to significantly impact proportions of patients achieving seroprotection” after vaccination.
While the presenters were in agreement that long COVID poses a significant challenge for the future, D’Agostino said that vaccines may have a positive effect on the condition, and pointed to recent guidance on how COVID-19 can be optimally managed in people with RMDs to reduce the risk for poor outcomes.
Telemedicine is here to stay
One of the major ways in which the COVID-19 pandemic has impacted clinical practice is through the rise of telemedicine, which both speakers concurred is here to stay in some capacity. D’Agostino believes that remote care could have a positive impact on rheumatology practice when used in certain situations, giving the examples of faster disease monitoring and modification of medication doses.
On the other hand, Conaghan said that while telemedicine does present opportunities, it also poses a number of challenges for the rheumatology community, including potential problems with data security and not being appropriate for certain patient groups such as people with learning difficulties or lack of access to technology, and those who require physical examination.
Will the pandemic continue to impact medical professionals?
In addition to the lasting negative impact of COVID-19 on RMD patients, Conaghan expects to see enduring issues for rheumatologists and other care providers.
He mentioned “a number of surveys” that highlighted physical and mental health issues in HCPs as a result of the pandemic, stressing that “the burnout issue can’t be underestimated,” and “we’re losing staff at a time when we can least afford to.” Conaghan thinks that the pandemic will have a lasting impact on rheumatology trainees in particular; he outlined research from the COVID-19 Global Rheumatology Alliance demonstrating a “substantial impact” on training experiences as HCPs were reallocated to COVID-19 patient care, as well as a negative effect on research.
“Research funding was repurposed to COVID, and the pots for non-COVID funding just dried up, so that will affect the research output for the next 5–10 years,” he added.
D’Agostino, however, struck a more positive note, praising the resilience of rheumatologists.
“We were touched by the pandemic [and] we had burnout, but now we are here and I think the rheumatology field [always has] ideas for thinking outside the box” to try and solve problems, she said.
Moreover, she feels that “the pandemic has taught us how to better treat our patients,” and the “increased awareness of rheumatic diseases” among HCPs as a result of long COVID and vaccine-induced RMDs “will improve our way of treating these patients.”
D’Agostino concluded that “COVID-19 will not have a negative impact on rheumatology practice in future years,” because many of the changes that have occurred as a result of the pandemic “may be considered as having a positive impact.”
Summing up the debaters’ arguments, co-chair Zoltán Szekanecz (University of Debrecen, Hungary) said that “there are pros and cons still ongoing” in terms of how the pandemic has affected rheumatology practice, “and we will see what’s happening in the next 2 or 3 years.”
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