ACR News in brief: Lockdown worsens depression in fibromyalgia; Geocoding to assist vulnerable rheumatology patients; ICU mortality in rheumatic disease is stable 

Thursday, 11 Nov 2021

COVID-19 lockdown worsens depression in fibromyalgia

Melbourne patients with fibromyalgia reported increased isolation, less exercise, worse sleep and increased medication use during the lengthy COVID-19 lockdown last year.

According to a poster presented at ACR Convergence, the rates of moderate-to-severe and severe depression also increased during lockdown.

“Six months after the conclusion of lockdown, surveyed patients’ self-reported depression had continued to worsen.”

“The percentage of patients with mod-severe depression had improved to 12 (34%) patients but this remains higher than previously published data (25%).”

The Monash study, by Drs Benjamin Worcester, Emma Guymer and Geoffrey Littlejohn, said most other clinical aspects of fibromyalgia had returned to normal after the end of lockdown.

Geocoding to assist vulnerable rheumatology patients

A new ACR study group on climate and health has heard that clinicians may be able to provide real time warnings around critical weather events to their patients with rheumatic disease.

A project at the Brigham and Women’s Hospital has geocoded 24,585 patients with rheumatic disease to their place of residence and linked each to social, heat and environmental quality indices.

The study found about 20% of patients live in areas of high social vulnerability, 11-12% in areas at high heat vulnerability and the majority of the population reside in areas of high environmental vulnerability.

Rheumatologist Dr Candace Feldman said being able to integrate patient vulnerabilities along with weather warnings into the EMR would allow clinicians to tailor advice during consultations or via mobile technology.

“We frequently give recommendations to our patients to walk, to take public transportation, to exercise and our ability to do that particularly in patients who live in areas of high heat vulnerability may certainly be limited.”

“Can we provide notification to advise people such as: ‘you are on medications including diuretics and are at increased risk of dehydration, and you are in an area with a substantial heat warning right now, please make sure you drink lots of water’.”

ACR Convergence 2021 session chair Associate Professor Paul Delarippa said the mechanisms by which heat triggered systemic inflammation were unclear but heat could certainly complicate existing rheumatic diseases.

ICU mortality in rheumatic disease is stable

Annual ICU admissions of patients with systemic rheumatic diseases has increased over time from 2004 to 2019 but mortality rates have largely remained stable.

According to data from the Australia New Zealand Intensive Care Society Adult Patient Database (ANZICS-APD), there were 1,478 ICU admission episodes during the 15 year study period.

The increase in admissions was consistent with growth in the size of the database over time, a poster presented at ACR Convergence said.

Median length of hospital stay over the study period did not demonstrate any temporal trend.

In-hospital mortality was highest in patients with scleroderma (20%), connective tissue disease (17%) and vasculitis (10%).

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