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Influence of COVID-19 pandemic on decisions for the management of people with inflammatory rheumatic and musculoskeletal diseases: a survey among EULAR countries
  1. Christian Dejaco1,2,
  2. Alessia Alunno3,
  3. Johannes WJ Bijlsma4,
  4. Annelies Boonen5,
  5. Bernard Combe6,
  6. Axel Finckh7,
  7. Pedro M Machado8,
  8. Ivan Padjen9,
  9. Francisca Sivera10,11,
  10. Tanja A Stamm12,
  11. Frank Buttgereit13
  1. 1 Rheumatology, Medical University of Graz, Graz, Austria
  2. 2 Rheumatology, Hospital of Brunico (SABES-ASDAA), Brunico, Italy
  3. 3 Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy
  4. 4 Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
  5. 5 Internal Medicine, Division of Rheumatology, and School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
  6. 6 Department of Rheumatology, CHU Montpellier, Montpellier University, Montpellier, France
  7. 7 Department of Medicine, Division of Rheumatology, University Hospital of Geneva, Geneve, Switzerland
  8. 8 Department of Rheumatology, University College London & University College London Hospitals & Northwick Park Hospital, London, UK
  9. 9 Division of Clinical Immunology and Rheumatology, University Hospital Centre Zagreb and University of Zagreb, School of Medicine, Zagreb, Croatia
  10. 10 Medicine, Miguel Hernandez University of Elche Faculty of Medicine, Sant Joan D'Alacant, Spain
  11. 11 Rheumatology, Hospital General de Elda, Elda, Spain
  12. 12 Center for Medical Statistics, Informatics and Intelligent Systems, Section for Outcomes Research, Medical University of Vienna, Wien, Austria
  13. 13 Rheumatology and Immunology, Charite Medical Faculty Berlin, Berlin, Germany
  1. Correspondence to Dr Christian Dejaco, Rheumatology, Medical University of Graz, Graz 8010, Austria; christian.dejaco{at}


Objectives To investigate how the first wave of COVID-19 pandemic influenced decisions of rheumatologists and health professionals in rheumatology regarding the management of patients with inflammatory rheumatic and musculoskeletal diseases (RMDs).

Methods An English-language questionnaire was developed by a EULAR working group and distributed via national rheumatology societies of EULAR countries, EMEUNET and individual working group members. Responses were collected using an online survey tool. Descriptive statistics were calculated.

Results We analysed 1286 responses from 35/45 EULAR countries. Due to containment measures, 82% of respondents indicated cancellation/postponement of face-to-face visits of new patients (84% of them offering remote consultation) and 91% of follow-up visits (96% with remote consultation). The majority of respondents (58%) perceived that the interval between symptom onset and first rheumatological consultations was longer during containment restrictions than before. Treatment decisions were frequently postponed (34%), and the majority (74%) of respondents stated that it was less likely to start a biological disease modifying anti-rheumatic drug (DMARD)/targeted synthetic DMARD during the pandemic, mainly because of patients’ fear, limited availability of screening procedures and decreased availability of rheumatological services. Use of (hydroxy)chloroquine (HCQ) and tocilizumab (TCZ) for the COVID-19 indication was reported by 47% and 42% of respondents, respectively, leading to a shortage of these drugs for RMDs indications according to 49% and 14% of respondents, respectively.

Conclusion Measures related to containment of COVID-19 pandemic led to a perceived delay between symptom onset and a first rheumatological visit, postponement of treatment decisions, and shortage of HCQ and TCZ, thereby negatively impacting early treatment and treat-to-target strategies.

  • epidemiology
  • arthritis
  • rheumatoid
  • autoimmune diseases
  • health services research

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  • Handling editor Désirée van der Heijde

  • Twitter @pedrommcmachado, @FranciscaSivera

  • Contributors All authors designed the study and contributed to data collection. CD analysed the data and drafted the first version of the manuscript. All coauthors critically interpreted the results, discussed the findings together, critically reviewed the manuscript and approved its final version.

  • Funding This study was funded by the European League against Rheumatism (EULAR), project number EPI025.

  • Competing interests CD received consulting/speaker’s fees from Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche and Sanofi, all unrelated to this manuscript. AA has nothing to disclose. JWJB received honoraria from Lilly, Roche, Abbvie, Galapagos, SUN all unrelated to this manuscript. AB received research granst form Abbvie and Celgene, and consultation/speakers fees from Eli Lilly, Novartis, UCB and Galapagos all to here department and all unrelated to this manuscript. BC received honoraria from AbbVie; BMS; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; Sanofi; and research grants from Novartis, Pfizer and Roche; all unrelated to this manuscript. AF has nothing to disclose. PMM received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this manuscript. IP received honoraria from Novartis, Sanofi, Abbvie, Sandoz and Roche, all unrelated to this manuscript. FS has nothing to disclose. TAS has nothing to disclose. FB received consulting/speaker’s fees from Abbvie, Lilly, Horizontherapeutics, Pfizer and Roche/Chugai, all unrelated to this manuscript.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The data will be shared if there is a reasonable request for it.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.