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Challenges of Egyptian patients with systemic lupus erythematosus during the COVID-19 pandemic
 
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1
Rheumatology and Immunology Unit, Department of Internal Medicine, Mansoura University, Faculty of Medicine, Egypt
 
2
Department of Internal Medicine, Horus University, Faculty of Medicine, Egypt
 
3
Mansoura Nephrology and Dialysis Unit, Department of Internal Medicine, Mansoura University, Faculty of Medicine, Egypt
 
 
Online publication date: 2021-09-08
 
 
Reumatologia 2021;(Konferencja Pacjent post-COVID-owy. Co zostaje, a co się zmienia? 1):237-243
 
KEYWORDS
ABSTRACT
Introduction:
The coronavirus disease 2019 (COVID-19) pandemic in Egypt is part of the worldwide COVID-19 pandemic that has contributed to substantial deterioration of healthcare systems. The aim of this study was to assess the challenges faced by Egyptian systemic lupus erythematosus (SLE) patients during the COVID-19 pandemic.

Material and methods:
This questionnaire-based study was carried out on 200 patients with SLE from Egypt. The questionnaire provided covered socioeconomic status, lupus disease data, information about COVID-19 infection, and medical and family history of COVID-19 infection.

Results:
The mean age of the participants was 30.1 ±8.4 years. 140/200 (70%) of the participants reported difficulty in obtaining medications during the COVID-19 pandemic, particularly antimala­rials (60%). The lupus disease condition became worse because of the drug shortage in half of the participants. Wearing protective masks (74%) and using disinfectants of the hands several times per day (67%) were the most reported used measures. Forty patients (20%) had to stop or reduce taking nonsteroidal anti-inflammatory drugs while 10 patients (5%) had to start taking antimalarials as a prophylaxis against COVID-19 infection. Among those who needed hospitalization, the main cause was lupus activity, and most of them (71%) experienced difficulty in hospital admission. Thirty-two patients (16%) had confirmed COVID-19 infection. About half of them had lupus flare and had to change the medications used for treatment of lupus.

Conclusions:
The current COVID-19 pandemic has a negative impact on the healthcare provided to SLE patients in Egypt. Patients with SLE faced a shortage of their medications, especially antimala­rials, and difficulty in hospital admission.

 
REFERENCES (41)
1.
World Health Organization. WHO Coronavirus (COVID-19) Dashboard, https://covid19.who.int/ [access: 8.04.2021].
 
2.
Rathi M, Singh P, Bi HP, et al. Impact of the COVID-19 pandemic on patients with systemic lupus erythematosus: observations from an Indian inception cohort. Lupus 2021; 30: 158–164, DOI: 10.1177/0961203320962855.
 
3.
Gilbert M, Pullano G, Pinotti F, et al. Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study. Lancet 2020; 395: 871–877, DOI: 10.1016/S0140-6736(20)30411-6.
 
4.
Murtas R, Andreano A, Gervasi F, et al. Association between autoimmune diseases and COVID-19 as assessed in both a test-negative case-control and population case-control design. Auto Immun Highlights 2020; 11: 15, DOI: 10.1186/s13317-020-00141-1.
 
5.
Talarico R, Aguilera S, Alexander T, et al. The impact of COVID-19 on rare and complex connective tissue diseases: the experience of ERN ReCONNET. Nat Rev Rheumatol 2021; 17: 177–184, DOI: 10.1038/s41584-020-00565-z.
 
6.
Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis Rheumatol 2019; 71: 1400–1412, DOI: 10.1002/art.40930.
 
7.
Barber MRW, Clarke AE. Systemic lupus erythematosus and risk of infection. Expert Rev Clin Immunol 2020; 16: 527–538, DOI: 10.1080/1744666X.2020.1763793.
 
8.
Abualfadl E, Ismail F, Shereef RRE, et al. Impact of COVID-19 pandemic on rheumatoid arthritis from a Multi-Centre patient-reported questionnaire survey: influence of gender, rural–urban gap and north–south gradient. Rheumatol Int 2021; 41: 345–353, DOI: 10.1007/s00296-020-04736-9.
 
9.
Fatoye F, Gebrye T, Svenson LW. Real-world incidence and preva­lence of systemic lupus erythematosus in Alberta, Canada. Rheumatol Int 2018; 38: 1721–1726, DOI: 10.1007/s00296-018-4091-4.
 
10.
Shuman AG, Fox ER, Unguru Y. COVID-19 and drug shortages: a call to action. J Manag Care Spec Pharm 2020; 26: 945–947, DOI: 10.18553/jmcp.2020.26.8.945.
 
11.
Hassan F, Naffaa ME, Paz Z. Value of antimalarial drugs in the treatment of lupus. Systemic Lupus Erythematosus. 2nd ed. Elsevier, Amsterdam 2021: 591–595.
 
12.
Gomez A, Soukka S, Johansson P, et al. Use of antimalarial agents is associated with favourable physical functioning in patients with systemic lupus erythematosus. J Clin Med 2020; 9: 1813, DOI: 10.3390/jcm9061813.
 
13.
Fessler BJ, Alarcón GS, McGwin G Jr, et al. Systemic lupus ery­thematosus in three ethnic groups: XVI. Association of hydro­xychloroquine use with reduced risk of damage accrual. Arthritis Rheum 2005; 52: 1473–1480, DOI: 10.1002/art.21039.
 
14.
Schrezenmeier EV, Burmester GR, Eckardt KU, Dörner T. Role for antimalarials in the management of COVID-19. Curr Opin Rheumatol 2020; 32: 449–457, DOI: 10.1097/BOR. 0000000000000731.
 
15.
Peschken CA. Possible consequences of a shortage of hydro­xychloroquine for patients with systemic lupus erythematosus amid the COVID-19 pandemic. J Rheumatol 2020; 47: 787–790, DOI: 10.3899/jrheum.200395.
 
16.
Rosenberg ES, Dufort EM, Udo T, et al. Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York State. JAMA 2020; 323: 2493–2502, DOI: 10.1001/jama.2020.8630.
 
17.
Belayneh A. Off-label use of chloroquine and hydroxychloroquine for COVID-19 treatment in Africa against WHO recommendation. Res Rep Trop Med 2020; 11: 61–72, DOI: 10.2147/RRTM.S269936.
 
18.
Dejaco C, Alunno A, Bijlsma JW, et al. Influence of COVID-19 pandemic on decisions for the management of people with inflammatory rheumatic and musculoskeletal diseases: a survey among EULAR countries. Ann Rheum Dis 2020; annrheumdis-2020-218697, DOI: 10.1136/annrheumdis-2020-218697 [Online ahead of print].
 
19.
Mendel A, Bernatsky S, Askanase A, et al. Hydroxychloroquine shortages during the COVID-19 pandemic. Ann Rheum Dis 2020; 80: 1–2, DOI: 10.1136/annrheumdis-2020-218164.
 
20.
Jakhar D, Kaur I. Potential of chloroquine and hydroxychloroquine to treat COVID-19 causes fears of shortages among people with systemic lupus erythematosus. Nat Med 2020; 26: 632, DOI: 10.1038/s41591-020-0853-0.
 
21.
Aouhab Z, Hong H, Felicelli C, et al. Outcomes of systemic lupus erythematosus in patients who discontinue hydroxychloroquine. ACR Open Rheumatol 2019; 1: 593–599, DOI: 10.1002/acr2.11084.
 
22.
Husayn SS, Brown JD, Presley CL, et al. Hydroxychloroquine alternatives for chronic disease: response to a growing shortage amid the global COVID-19 pandemic. J Pharm Pract 2020; 897190020942658, DOI: 10.1177/0897190020942658 [Online.
 
23.
ahead of print].
 
24.
Plüß M, Chehab G, Korsten P. Concerns and needs of patients with systemic lupus erythematosus regarding hydroxychloroquine supplies during the COVID-19 pandemic: results from a patient-centred survey. Ann Rheum Dis 2020; annrheumdis-2020-217967, DOI: 10.1136/annrheumdis-2020-217967 [Online ahead of print].
 
25.
Sattui SE, Liew JW, Graef ER, et al. Swinging the pendulum: lessons learned from public discourse concerning hydroxychloroquine and COVID-19. Expert Rev Clin Immunol 2020; 16: 659–666, DOI: 10.1080/1744666X.2020.1792778.
 
26.
Hanaoka H, Iida H, Kiyokawa T, et al. Glucocorticoid, immunosuppressant, hydroxychloroquine monotherapy, or no therapy for maintenance treatment in systemic lupus erythematosus without major organ manifestations. Clin Rheumatol 2019; 38: 2785–2791, DOI: 10.1007/s10067-019-04633-y.
 
27.
Delis PC. Uncertainty and quality of life in systemic lupus erythematosus: a cross-sectional study. Rehabil Nurs 2019; 44: 2–10, DOI: 10.1097/rnj.0000000000000118.
 
28.
Ugarte-Gil MF, Acevedo-Vásquez E, Alarcón GS, et al. The number of flares patients experience impacts on damage accrual in systemic lupus erythematosus: data from a multiethnic Latin American cohort. Ann Rheum Dis 2015; 74: 1019–1023, DOI: 10.1136/annrheumdis-2013-204620.
 
29.
Hollander JE, Carr BG. Virtually perfect? Telemedicine for COVID-19. N Engl J Med 2020; 382: 1679–1681, DOI: 10.1056/NEJMp2003539.
 
30.
Schulze-Koops H, Specker C, Krueger K. Telemedicine holds many promises but needs to be developed to be accepted by patients as an alternative to a visit to the doctor. Response to: ‘Patient acceptance of using telemedicine for follow-up of lupus nephritis in the COVID-19 outbreak’ by So et al. Ann Rheum Dis 2020; annrheumdis-2020-218235: DOI: 10.1136/annrheumdis-2020-218235 [Online ahead of print].
 
31.
Bos WH, van Tubergen A, Vonkeman H. Telemedicine for patients with rheumatic and musculoskeletal diseases during the COVID-19 pandemic; a positive experience in the Netherlands. Rheumatol Int 2021; 41: 565–573, DOI: 10.1007/s00296-020-04771-6.
 
32.
Taylor PC. Adopting PROs in virtual and outpatient management of RA. Nat Rev Rheumatol 2020; 16: 477–478, DOI: 10.1038/s41584-020-0449-6.
 
33.
Maldonado D, Tu E, Mahmood SN, et al. Medication access difficulty and COVID-related distress are associated with disease flares in rheumatology patients during the COVID-19 pandemic. Arthritis Care Res (Hoboken) 2021; 73: 1162–1170, DOI: 10.1002/acr.24531.
 
34.
Masroor S. Collateral damage of COVID-19 pandemic: delayed medical care. J Card Surg 2020; 35: 1345–1357, DOI: 10.1111/jocs.14638.
 
35.
Chuah SL, Teh CL, Wan Mohd Akbar SA, et al. Impact of COVID-19 pandemic on hospitalisation of patients with systemic lupus erythematosus (SLE): report from a tertiary hospital during the peak of the pandemic. Ann Rheum Dis 2020; annrheumdis-2020-218475, DOI: 10.1136/annrheumdis-2020-218475 [Online ahead of print].
 
36.
Fazal F, Gupta N, Khot W, Ray Y. Collateral damage due to COVID-19. Trop Doct 2021; 51: 126–127, DOI: 10.1177/0049475520942387.
 
37.
Yuan Q, Xing X, Lu Z, Li X. Clinical characteristics and risk factors of infection in patients with systemic lupus erythematosus: a systematic review and meta-analysis of observational studies. Semin Arthritis Rheum 2020; 50: 1022–1039, DOI: 10.1016/j.semarthrit.2020.06.004.
 
38.
Gianfrancesco MA, Hyrich KL, Gossec L, et al. Rheumatic disease and COVID-19: initial data from the COVID-19 global rheumatology alliance provider registries. Lancet Rheumatol 2020; 2: e250–e253, DOI: 10.1016/S2665-9913(20)30095-3.
 
39.
Bozzalla Cassione E, Zanframundo G, Biglia A, et al. COVID-19 infection in a northern-Italian cohort of systemic lupus erythematosus assessed by telemedicine. Ann Rheum Dis 2020; 79: 1382–1383, DOI: 10.1136/annrheumdis-2020-217717.
 
40.
Favalli EG, Agape E, Caporali R. Are patients with systemic lupus erythematosus at increased risk of severe COVID-19? J Rheumatol 2020; 47: 1592, DOI: 10.3899/jrheum.200723.
 
41.
Favalli EG, Gerosa M, Murgo A, Caporali R. Are patients with systemic lupus erythematosus at increased risk for COVID-19? Ann Rheum Dis 2021; 80: e25, DOI: 10.1136/annrheumdis-2020-217787.
 
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