Purpose To measure the changes in follow-up activities in patients with SLE during the COVID-19 pandemic and evaluate its impact on health outcomes.
Methods We extracted data of all patients under treatment of a rheumatologist or internist in both 18 months before as during the COVID-19 pandemic (study period ranged from 01-09-2018 to 01-09-2021, March 2020 is considered the start of the COVID-19 pandemic) with a billing code ‘SLE’ and of whom ACR’97 criteria were manually checked. In these patients we described the absolute frequency of blood analyses and urinalyses as well as the relative amount of abnormal values. Furthermore, we described frequency of consultations (percentages of face-to-face consultations), hospital admissions, ER visits and intensification of medical therapy. Intensification of therapy was defined as the start or increase in dosage of corticosteroids or start of disease-modifying anti-rheumatic drugs, including azathioprine, mycophenolate mofetil, methotrexate, leflunomide, ciclosporin A, belimumab, rituximab and cyclophosphamide.
Results The frequency of follow-up activities in the selected 152 SLE patients is shown in table 1. During the pandemic the overall frequency of blood analyses decreased with a median of once every 105 days pre-COVID-19 (IQR 23–580) to once every 119 days during COVID-19 (IQR 24–580). However, this difference was not statistically significant. For urinalysis a similar non-significant decrease in frequency was visible, with a median of 122 days pre-COVID-19 (IQR 26–580) to 132 days during COVID-19 (IQR 21–580). In general, consultation frequency did not change significantly before and during COVID-19. However, there was a significant decrease in face-to-face consultations; replaced by consultations by telephone (with the possibility of video calling). Diminished face-to-face contact did not result in changes in patient outcomes, as the relative frequency of abnormal values for blood work and urine remained stable and the amount of escalations in medical therapy was correspondent between both periods, as shown in table 2.
Conclusions The fact that the amount of abnormal values and therapy escalations was similar before and during the COVID-19 pandemic, while diagnostic tests and face-to-face contacts decreased, suggests that physicians are quite capable of making choices when faced with relative scarcity.
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