Don’t overlook risks for OA patients in COVID-19 pandemic: rheumatologists

While much attention has been paid to the COVID-19 risks faced by people with immune-related rheumatic disorders, those with osteoarthritis also face a ‘perfect storm’ of risks due to the pandemic, according to a group of international rheumatologists.

People with osteoarthritis form a large group of patients whose condition may be worsened by enforced inactivity, reduced access to healthcare and inappropriate self-treatment with analgesics, an article in Annals of Rheumatic Diseases warns.

Lead author Dr Francis Berenbaum, of the department of rheumatology, Sorbonne Universite, Paris, notes that some studies have shown patients with OA have double the odds of  poor outcomes from COVID-19 (hospitalisation and ICU admission) compared to the general population .

This increased risk was seen even after adjusting for the COVID-19 risk factors common in people with OA such as older age and obesity, the article notes.

But of equal concern are the changes to lifestyle and OA management during the pandemic that may explain why studies of patients with OA have shown an increase in pain, worsening of physical function and a decrease in physical activity compared to the pre-pandemic lockdown period.

Dr Berenbaum and co-authors say high rates of physical inactivity and obesity were already a problem for people with OA prior to the pandemic, and are likely to have been worsened by lockdown policies that promote social isolation and discourage visits to hospitals and face-to-face consultations with healthcare professionals.

“Coincidentally, increased age, higher BMI, reduced physical activity and cardiovascular diseases, which are more prevalent in the OA patient, have been associated with a worse prognosis among patients with COVID-19,” they write.

“We may then envision that prolonged periods of virtually complete physical inactivity will most likely worsen sarcopenia and frailty as well as cardiovascular risk in patients with OA.

The authors recommend that home-based exercise programs should be promoted for people with OA, but caution that uptake has been poor to date.

They also warn that an increase in OA pain and stiffness resulting from physical inactivity – or deferred procedures – may lead to increased use of inappropriate analgesia such as self-medication with NSAIDs or use of prescription opioids and other non-recommended painkillers.

Because of the cardiovascular risks of NSAIDs, the article suggests that rheumatologists advise patients to use paracetamol for self medication, despite this not being recommended in guidelines. And with patients having limited access to healthcare during the pandemic, they also propose the use of intra-articular injections of hyaluronic acid or steroids, which may provide long term relief of pain for up to three months

Rheumatologists should also consider the psychological wellbeing of their OA patients who may be suffering more pain in isolation, the authors suggest.

“Healthcare professionals should try to establish more frequent, even short, online visits as well as encourage social ‘online gatherings’ with family and friends,” they write.

And being housebound also increases the risks of  poor diet and weight gain which may further exacerbate the of OA, suggesting the need for nutritional counselling.

“Being proactive, [rheumatologists] might improve our patient’s opportunities to tackle this pandemic [but] a worsening of symptoms in OA patients after this confinement period might be anticipated,” they conclude.

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