Impact of COVID-19 on early inflammatory arthritis care in the UK

In 2020, the COVID-19 pandemic brought unprecedented changes to UK rheumatology practice. There has been a significant change in the working pattern of the Rheumatology team, with many staff redeployed to other areas of clinical need. This, along with the enormous pressure in primary care, has had a significant impact on the usual care of patients referred to rheumatology with suspected inflammatory arthritis.of Lancet rheumatology, Mark Russell and colleagues1Russell MD Galloway JB Andrew CD and others.Incidence and management of inflammatory arthritis in England before and during the COVID-19 pandemic: a population-level cohort study using OpenSAFELY. Explore new diagnostic codes for inflammatory arthritis in 2019-22 and the impact of the COVID-19 pandemic using the OpenSAFELY database. OpenSAFELY is an open source software platform developed for the analysis of electronic medical record data for the National Health Service (NHS). Access records from his two largest providers of electronic medical records software for UK general practitioners and analyze primary care records of 58 million patients with links to other routine medical data I can do it.Many of the authors of this study also participated in the National Early Inflammatory Arthritis Audit (NEIAA).2British College of RheumatologyNational Early Inflammatory Arthritis Audit (NEIAA): First Annual Report., 3British College of RheumatologyNational Early Inflammatory Arthritis Audit (NEIAA): Fourth Annual Annual Report. NEIAA collects data on referrals and initial care of patients with inflammatory arthritis across the UK, but data collection was suspended at the peak of the COVID-19 pandemic due to enormous pressure on clinical staff . With OpenSAFELY, therefore, the potential to gain insight into the impact of COVID-19 using routinely collected data that must be consistent in quality before, during, and after the pandemic period. is provided.The study first found a 20% decrease in new inflammatory arthritis diagnoses in the year starting April 2020. This decline is consistent with rheumatology data from other countries and other states in the UK.Fourhealth foundationUse of primary care during the COVID-19 pandemic., FiveBritish Medical AssociationThe hidden impact of COVID-19 on patient care in the UK NHS., 6Lee J. Ringold S Curtis JR and others.Impact of the SARS-CoV-2 global pandemic on rheumatology outpatient care delivery and telemedicine use in the United States: analysis of data from the RISE registry., 7George MD Daniela MI Watrous D and others.Disruption of rheumatism care and the rise of telemedicine as a response to the COVID-19 pandemic in community practice-based networks., 8Bower H Frisell T Giuseppe D. and others.Impact of the COVID-19 pandemic on patients with inflammatory joint disease in Sweden: from severity of infection to impact on care delivery. Relatively few were reviewed for rheumatism issues in secondary care during the peak of the pandemic. There is a possibility.Given the redeployment of clinical staff, further delays between referrals and rheumatology reviews were expected. However, this study found the opposite, with shorter referral times seen during the pandemic (median 18 days) compared to pre-pandemic referral times. versus 21 days ). Clinical insights make this finding seem sensible. Many routine new and follow-up appointments were canceled during that period, but urgent new appointments prioritizing inflammatory arthritis and vasculitis were maintained and some hospitals were operating in rheumatology departments. It was the only in-person clinic. Interestingly, Russell and colleagues report that 25% of first rheumatology appointments in the year starting April 2020 were made using telemedicine. (compared to 0.3% prior to April 2020). Diagnosis should usually be confirmed before initiation of conventional synthetic disease-modifying antirheumatic drugs (DMARDs).A similar number of prescriptions for conventional synthetic DMARDs were issued to patients diagnosed with inflammatory arthritis before and during the pandemic, whereas fewer prescriptions for methotrexate and leflunomide were issued during the pandemic. and the choice of DMARD seems to have been influenced. This may be related to guidance from the British College of Rheumatology shared early in the pandemic, stating that "sulfasalazine and hydroxychloroquine are more immunomodulatory than immunosuppressive and may be more appropriate. I have".9British College of RheumatologyCOVID-19 Guidance. This guidance has since been superseded. Hydroxychloroquine also has the potential advantage of not requiring regular blood monitoring. This was a problem in 2020 as many communities struggled to safely provide shared care, exacerbated by a nationwide shortage of NHS blood tubes for months. .The study's most worrying finding is the lack of an increase in referral rebound in the months following 2020. From the NEIAA data, it is possible to understand whether the 2021 and her 2022 onset patients have longer duration of symptoms and whether there are differences in disease activity, work productivity, and functioning at onset. It is important. These patients may represent a mildly ill subgroup who were delayed in seeking help. However, it is also possible that there are subgroups of patients who present with more severe disease as a result of delayed diagnosis. This increase in severity is associated with more rapid escalation to expensive medications and could cost the NHS even more.On the positive side, this study demonstrates the potential of routine data sources such as OpenSAFELY to audit care in the NHS beyond the COVID-19 pandemic. The authors highlight a good correlation with the NEIAA results, but without the need for manual data collection and without a high level of missing data. Although the OpenSAFELY dataset currently limits analysis to medical resource utilization and diagnostic coding, if considered prospectively, patient-reported results may be collected in parallel with such studies. One thing is clear.LCC has received grants or research support from AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, and UCB. He has worked as a paid consultant for AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Moonlake, Novartis, Pfizer, and UCB. Paid speaker for AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Medak, Novartis, Pfizer and UCB. EM declares no competing interests. Sources 1/ https://Google.com/ 2/ https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(22)00331-9/fulltext The mention sources can contact us to remove/changing this article

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Impact of COVID-19 on early inflammatory arthritis care in the UK

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Impact of COVID-19 on early inflammatory arthritis care in the UK

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