UK Diagnoses of Rheumatological Conditions Decreased During the Pandemic

A recent population-level study of hospital and primary care data in the United Kingdom, conducted to discover the impact of the COVID-19 pandemic on the delivery of care to individuals with inflammatory arthrititis, found a steep decline in new diagnoses of these conditions.

Researchers used an open-source data analytics platform for electronic health records (EHRs), OpenSAFELY, that was created to evaluate the impacts of the pandemic.

The goal of the study was to replicate, using OpenSAFELY, the key metrics from the National Early Inflammatory Arthritis Audit (NEIAA) to analyze how people with inflammatory arthritis experienced COVID-19 as it influenced the delivery of care in England. NEIAA metrics for hospitals include time from primary care referral to initial rheumatology assessment, and time to starting a disease-modifying antirheumatic drug (DMARD).

NEIAA audits are completed manually by hospitals, leading to missing data, and the audits were suspended during the pandemic.

In contrast to the manually collected data, “OpenSAFELY provides a secure software interface, enabling analyses of pseudonymised health records in near real-time within the EHR vendor’s highly secure data centre, avoiding the need for data transfer off-site.”

The OpenSAFELY data platform includes the data of 17.7 million adults, representing 40% of the UK population, and it was was used to contrast the same NEIAA metrics from before and after the pandemic began, from April 1, 2019, to March 31, 2022.

Adults in the data set were aged 18 to 110 years. Inflammatory arthritis included rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, or undifferentiated inflammatory arthritis.

During the study time period, 31,280 inflammatory arthritis diagnoses were recorded.

The mean (SD) age of patients was 55.4 (16.6) years; nearly 60% were female, 40.5% were male, and most were White.

For the year beginning April 2020, new inflammatory arthritis diagnoses fell by 20.3% compared with the prior year (5.1 vs 6.4 diagnoses per 10,000 adults).

Monthly diagnoses fell by 40% between March and April 2020.

Individuals seeking medical care for inflammatory arthritis for the first time during the pandemic experienced a shorter time to complete the first rheumatology assessment than before the pandemic (median [IQR], 18 [8–35] days), compared with the previous time period (21 [9-41] days).

In addition, the proportion of patients prescribed conventional synthetic DMARDs in primary care was similar in both time periods.

However, fewer patients were prescribed methotrexate or leflunomide during the pandemic, and more were prescribed sulfasalazine or hydroxychloroquine, possibly because clinicians were worried about perceived immunosuppressive qualities of certain medications.

Limitations of the study included potential diagnostic misclassification and diagnostic coding variations.

Besides the clinical findings, the authors said the study is also notable for showing how “it is feasible to use routinely captured clinical data on a national scale to benchmark care quality for a long-term condition.”

Reference

Russell MD, Galloway JB, Andrews CD, et al. Incidence and management of inflammatory arthritis in England before and during the COVID-19 pandemic: a population-level cohort study using OpenSAFELY. Lancet Rheumatol. 2022;4(12):e853-e863. doi:10.1016/S2665-9913(22)00305-8