Long-term Behavioral Changes During the COVID-19 Pandemic and Impact of Vaccination in Patients With Inflammatory Rheumatic Diseases

Bente Glintborg; Dorte Vendelbo Jensen; Lene Terslev; Oliver Hendricks; Mikkel Østergaard; Simon Horskjær Rasmussen; Mogens Pfeiffer Jensen; Thomas Adelsten; Ada Colic; Kamilla Danebod; Malene Kildemand; Anne Gitte Loft; Heidi Lausten Munk; Jens Kristian Pedersen; René Drage Østgård; Christian Møller Sørensen; Niels Steen Krogh; Jette Nørgaard Agerbo; Connie Ziegler; Merete Lund Hetland

doi:10.3899/jrheum.211280

Long-term Behavioral Changes During the COVID-19 Pandemic and Impact of Vaccination in Patients With Inflammatory Rheumatic Diseases

J Rheumatol. 2022 Oct;49(10):1163-1172. doi: 10.3899/jrheum.211280. Epub 2022 Jun 15.

Authors

Bente Glintborg¹, Dorte Vendelbo Jensen², Lene Terslev³, Oliver Hendricks⁴, Mikkel Østergaard⁵, Simon Horskjær Rasmussen⁶, Mogens Pfeiffer Jensen³, Thomas Adelsten⁷, Ada Colic⁷, Kamilla Danebod⁸, Malene Kildemand⁹, Anne Gitte Loft¹⁰, Heidi Lausten Munk¹¹, Jens Kristian Pedersen¹², René Drage Østgård¹³, Christian Møller Sørensen¹⁴, Niels Steen Krogh¹⁵, Jette Nørgaard Agerbo¹⁶, Connie Ziegler¹⁶, Merete Lund Hetland⁵

Affiliations

¹ B. Glintborg, MD, PhD, DMSc, M. Østergaard, MD, PhD, DMSc, Professor, M.L. Hetland, MD, PhD, DMSc, Professor, DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen Rigshospitalet, Glostrup, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; glintborg@dadlnet.dk.
² D.V. Jensen, MD, DANBIO, Rigshospitalet, Glostrup, Copenhagen, and Department of Rheumatology, Center for Rheumatology and Spine Diseases Gentofte and Herlev Hospital, Gentofte.
³ L. Terslev, MD, PhD, Professor, M. Pfeiffer Jensen, MD, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Glostrup, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen.
⁴ O. Hendricks, MD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, and Department of Regional Health Research, University of Southern Denmark, Odense.
⁵ B. Glintborg, MD, PhD, DMSc, M. Østergaard, MD, PhD, DMSc, Professor, M.L. Hetland, MD, PhD, DMSc, Professor, DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen Rigshospitalet, Glostrup, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen.
⁶ S.H. Rasmussen, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen.
⁷ T. Adelsten, MD, A. Colic, MD, Department of Rheumatology, Zealand University Hospital, Køge.
⁸ K. Danebod, MD, Department of Rheumatology, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup.
⁹ M. Kildemand, RN, Department of Rheumatology, Odense University Hospital, Odense.
¹⁰ A. Gitte Loft, MD, DMSc, Department of Rheumatology, Aarhus University Hospital, and Department of Clinical Medicine, Health, Aarhus University, Aarhus.
¹¹ H.L. Munk, MD, PhD, Rheumatology Research Unit, Odense University Hospital and University of Southern Denmark, Odense.
¹² J.K. Pedersen, MD, PhD, Rheumatology Section, Department of Medicine, Odense University Hospital and Svendborg Hospital, Svendborg, and Department of Clinical Research, University of Southern Denmark, Odense.
¹³ R.D. Østgård, MD, PhD, Diagnostic Center, Silkeborg Regional Hospital, Silkeborg.
¹⁴ C.M. Sørensen, MD, Department of Medicine, Horsens Regional Hospital, Horsens.
¹⁵ N.S. Krogh, Zitelab, Copenhagen.
¹⁶ J.N. Agerbo, Patient Representative, C. Ziegler, Patient Representative, Gigtforeningen/Danish Rheumatism Association, Denmark.

PMID: 35705237
DOI: 10.3899/jrheum.211280

Abstract

Objective: To explore anxiety and self-isolation in patients with inflammatory rheumatic disease (IRD)15 months into the coronavirus disease 2019 (COVID-19) pandemic, including attitudes toward and effects of SARS-CoV-2 vaccination.

Methods: A nationwide online survey was conducted at 3 timepoints: May 2020, November 2020, and May 2021. Patients with IRD followed in the Danish Rheumatology Quality Registry (DANBIO) were asked about the effects of the pandemic, including SARS-CoV-2 infection and their behavior, anxiety, and concerns. The May 2021 survey included attitudes toward SARS-CoV-2 and influenza vaccination. Characteristics associated with self-isolation in May 2021 were explored with adjusted logistic regression analyses that included patient characteristics and SARS-CoV-2 vaccination status.

Results: Respondents to surveys 1, 2, and 3 included 12,789; 14,755; and 13,921 patients, respectively; 64% had rheumatoid arthritis and 63% were female. Anxiety and concerns were highest in May 2020 and decreased to stable levels in November 2020 and May 2021; 86%, 50%, and 52% of respondents reported self-isolation, respectively. In May 2021, 4% of respondents self-reported previous SARS-CoV-2 infection. The SARS-CoV-2 vaccine acceptance rate was 86%, and the proportion of patients vaccinated against influenza had increased from 50% in winter 2019-2020 to 64% in winter 2020-2021. The proportion of patients with anxiety appeared similar among those vaccinated and unvaccinated against SARS-CoV-2. In multivariable analyses, being unvaccinated, female gender, receiving biologic drugs, and poor quality of life were independently associated with self-isolation.

Conclusion: Levels of anxiety and self-isolation decreased after the initial lockdown period in patients with IRD. Half of the patients reported self-isolation in May 2021, a phase that included widespread reopening of society and large-scale vaccination. The lack of prepandemic data prevented a full understanding of the long-term effects of the pandemic on anxiety and self-isolation in patients with IRD.

Keywords: autoimmune diseases; disease outbreaks; registries; rheumatic diseases; vaccines.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Arthritis, Rheumatoid*
Biological Products*
COVID-19 Vaccines / therapeutic use
COVID-19* / prevention & control
Communicable Disease Control
Female
Humans
Influenza, Human* / epidemiology
Influenza, Human* / prevention & control
Male
Pandemics / prevention & control
Quality of Life
Rheumatic Diseases*
SARS-CoV-2
Vaccination

Substances

COVID-19 Vaccines
Biological Products