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We read with a great interest the comment from Ciurea et al 1 recently published in Annals of Rheumatic Diseases about the impact of confinement measures lead by the COVID-19 pandemic on disease management of inflammatory rheumatic diseases.
In their study, they analysed the data from an e-cohort of patients with inflammatory rheumatism, included in a Swiss National Registry and using an app to assess drug adherence and disease activity during the Swiss confinement period. We report here the results of a survey performed on patients followed in a French e-cohort of patients with rheumatoid arthritis (RA) during the first French confinement period.
Since February 2020, France has been hardly hit by the COVID-19 pandemic, leading to national confinement between 17 March and 11 May. During this period, the population was forced to stay indoors, except for essential activities (food shopping, running,…). Also, when they were forced to go out, they were encouraged to respect isolation measures: keep 1-metre distance between each other and washing hand frequently and respiratory hygiene (coughing into the elbow, use disposable tissues). At that time, the use of the mask was not recommended except in symptomatic patients (mandatory in public transport since 11 May and generalised on 28 August).
Since September 2016, the multicentric French arthritis rheumatoid and anti-tnf (ART) Registry (NCT03062865) is recruiting patients with RA initiating an anti-tumour necrosing factor (TNF). Patients are prospectively followed during 5 years whatever therapeutic changes. At the inclusion, patients are proposed to be included in an e-cohort to complete monthly online questionnaires about safety and efficacy.
On June 2020, in a cross-sectional study, we designed and sent a specific online survey to the 326 patients with RA participating to the e-cohort, to assess the impact of first peak of the COVID-19 pandemic and confinement period on patients with RA. This questionnaire focused on whether participants followed the self-isolation measures and hygiene prevention measures, but also on RA management. Among them, 169 (52%) completed the questionnaire: 72% of women, mean age of 54 years. Thus, we cannot exclude that patients who participated to an online survey might represent a category of individuals more attuned to the recommendations. The main results of the survey are presented in table 1.
However, as observed by Hooijberg et al, 2 patients with RA were very compliant to confinement and isolation measures (table 1). This could be explained by the fact that almost all our patients were on biological or targeted DMARDs, known to increase infectious risk.1 3 4 Thus, despite this risk and the fear of COVID-19,4 5 patients were also very adherent to their RA medications, and therapeutic changes were mainly driven by RA activity, as observed in the Swiss Registry by Ciurea et al.1 This could be explained by the adaptive effort of the medical community that struggle to keep the link with their isolated patients, with an increased use of teleconsultation and only a few planned medical visit cancelled during this period.
These findings about drug adherence and the use of new numeric tools to keep the contact with physicians are reassuring in this period of second wave of COVID-19 pandemic leading to new confinement measures in several European countries.
Patient consent for publication
We would like to thank the French Society of Rheumatology the sponsor of this study. and Sanoia for the help in designing the online survey. We would also like to thank the ART scientific committee: Professor X Mariette, Professor JE Gottenberg, Professor B Combe, Professor M Dougados, Professor T Schaeverbeke, Professor RM Flipo, Professor A Constantin, Professor J Morel, Professor A Saraux, Professor M Soubrier, Professor O Vittecoq, Professor P Dieudé, Dr E Dernis, Professor H Marotte, Professor A Cantagrel and Professor Avouac. We thank all the investigators recruiting patients in ART Registry.
Correction notice This article has been corrected since it published Online First. The acknowledgement section has been updated.
Contributors AR-W and RS were responsible for the conception of the study, management of the study, data analysis, data interpretation and manuscript writing. They had access to all the data. M-ET, AB and MS were responsible for recruitment of patients from the e-cohort and gave the final aggreement for publication.
Funding The ART Registry is supported by the French Rheumatology Society. The French Rheumatology Society received grants for conducting the ART Registry from Abbvie, Pfizer, UCB, MSD, Biogen, Sandoz, Amgen, Mylan, Fresenius Kabi, Nordic Pharma. We thank Yacin Boudali, the study coordinator.
Competing interests AR-W reports grants and personal fees from Abbvie, grants and personal fees from Pfizer, personal fees from USB, personal fees from MSD, personal fees from Roche-Chugai, personal fees from Sanofi-Aventis, personal fees from Gilead, personal fees from Mylan, personal fees from Fresenius Kabi, personal fees from Sandoz, personal fees from Amgen, personal fees from Novartis, personal fees from Lilly, personal fees from BMS, outside the submitted work. M-ET reports personal fees from Pfizer, personal fees from Abbvie, personal fees from UCB, outside the submitted work; AB reports personal fees from UCB, personal fees from LILLY, personal fees from ABBVIE, personal fees from BMS, personal fees from JANSSEN, personal fees from MSD, personal fees from NOVARTIS, during the conduct of the study. RS reports non-financial support and other from amgen, other from fresenius kabi, other from pfizer, other from roche, other from lilly, non-financial support and other from gsk, other from bms, outside the submitted work.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; internally peer reviewed.