Introduction Loneliness is prevalent among patients with inflammatory rheumatic diseases (IRDs), however the COVID-19 pandemic may intensify loneliness among patients with IRDs, as they are at higher risk of severe illness. Early evidence suggests that this was indeed the case during the early stages; however, it remains largely unknown whether loneliness remains present and what factors are associated. The objective of the present study was to identify risk and protective factors associated with loneliness in individuals living with IRDs in the later stage of the COVID-19 pandemic.

Methods Data from an online cross-sectional survey study of individuals with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) between May 2022 and February 2023. Participants were recruited from a list of patients already enrolled in a multi-site longitudinal observation study. All participants provided informed consent. Loneliness was assessed with the University of California, Los Angeles Loneliness Scale (Version 3), Short Form 3-item (UCLA- LS3-SF3). The Impact of Event Scale-Revised (IES-R) assessed post-traumatic stress symptoms (PTSS) caused by the COVID-19 pandemic. The Patient Health Questionnaire-8 (PHQ-8) measured symptoms of depression. Resilience and concerns related to COVID-19 were also assessed. Descriptive statistics and linear regressions were conducted.

Results The study population was n = 160 (SLE = 102, RA = 58), mean age 60.1 years (±13) and 21.9% (n=35) were men. Almost one third (28.1%) reported moderate to severe loneliness. (UCLA-LS3-SF3 score ≥6), with statistically significant difference between both disease groups (SLE = 36.3%; RA= 13.8%). Among participants with SLE, gender (men), psychological burden from the COVID-19 pandemic, and higher depressive symptoms were independently associated with greater loneliness, accounting for 38% of the variance (table 1). Among individuals living with RA, identifying as female and greater psychological burden from the COVID-19 pandemic were independently associated with greater loneliness, accounting for 55% of the variance.

Discussion The results suggest that special attention to men with SLE and women with RA is needed when targeting loneliness in people with IRDs. More attention to strategies to decrease depressive symptoms and the psychological burden of the pandemic in patients living with IRDs are needed in future public health crises.