Good Uptake of the COVID-19 Vaccine Among Patients with Rheumatic Diseases in the United Arab Emirates (UAE)

Background: Many patients with rheumatic diseases are immunosuppressed and take forms of immunomodulator medication. Hence, these patients might be at a heightened risk of Covid-19 and have special concerns in regard to vaccines, such as safety and efficacy. Vaccines have been available for the population of UAE as of January 2021, these being Pfizer (the United States and Europe), Sinopharm (China), and AstraZeneca (United Kingdom). The aim of our paper was to examine the rate of vaccine uptake among our patients with rheumatic conditions in the United Arab Emirates. Methods: A questionnaire was distributed among patients with rheumatic diseases attending a rheumatology specialised clinic in the United Arab Emirates. We collected data on 149 consecutive patients who were seen during a one-month period from 10/06/2021 to 10/07/2021 in Dubai. Results: The mean age of the patients was 45.9 +/- 41.3. The majority of the patients had underlying rheumatic diseases (86.9%), the rest having conditions such as soft tissue pain or to rule out rheumatic conditions. 48.5% were taking immunomodulators. 41.7% of respondents had other chronic diseases. It was also found that 18.9% had Covid-19 previously, all of whom recovered, with the average duration of the illness being 11 days. 99.1% of individuals reported that receiving the Covid-19 vaccine was extremely important, and 95.0% had already received the vaccination. Their reasoning for receiving the vaccination varied from medical advice (17.5%), general worry about infection/ reinfection of Covid-19 (65.3%), in order to travel (8.4%), employee requirement (5.6%), and other reasons (3.2%). Specifically, 48.3% chose the Pfizer vaccine, 39.8% had Sinopharm, and 11.9% had AstraZeneca. These decisions on which vaccine to choose were influenced by the availability of the vaccine (35.1%), medical advice (16.9%), effectiveness (15.5%), safety and side effect profile (18.2%), age restrictions (2.7%), experience/ advice from friends and family (8.1%) and other reasons (3.4%). Conclusion: Overall, an overwhelming majority of our patients (95.0%) with rheumatic diseases in the specialised muscular-skeletal clinic in the UAE have received the Covid-19 vaccine. This reflects good public health service messaging and concentrated efforts from the medical community, UAE government, and the patient’s rheumatologists.

Representation of Skin of Color in Rheumatology Educational Resources

Objective To investigate the availability of images representing black, indigenous, and people of color in rheumatology educational resources. Methods Colorized images were collected from 5 major educational resources and cataloged by educational resources they came from, underlying rheumatic conditions, and skin type. Fitzpatrick skin type (FST) was used to categorize images into "light", "dark", or "indeterminate". The images were initially scored by a fellow in the Division of Rheumatology and subsequently validated by a faculty member from the Department of Dermatology. Results Of the thousands of images reviewed, 1604 images met study criteria. Fitzpatrick skin type validation from Dermatology resulted in the re-coding of 111 images. The final scoring revealed 86% of the images to be light skin, 9% of images to be dark skin, and 5% of images to be indeterminate. Conclusion The paucity of dark skin images in rheumatology resources is incongruent with current diversity estimates in the United States. Significant efforts should be made to incorporate images of black, indigenous, and people of color into educational resources.

Factors associated with patient activation in inflammatory arthritis: a multisite cross-sectional study

Objectives Patient activation covers the skills, abilities and behaviour that impact how able and willing someone is to take an active role in self-managing their health. This study explored clinical and psychosocial factors associated with patient activation in rheumatology patients. Methods This was a cross-sectional study using postal survey methods. Participants with inflammatory rheumatic conditions were from six rheumatology centres in England. Patient activation was captured using the Patient Activation Measure (PAM). Twenty-nine explanatory factors were tested for potential association with patient activation in univariable and multivariable analyses. In preliminary multivariable analyses, factors found to have an association with patient activation at a P < 0.1 level were entered into the final multivariable model. Those that remained significant at a P < 0.05 level were considered associated with patient activation. Results The sample comprised 251 participants (74% female) with a mean age of 59.31 years (s.d. 12.69), disease duration of 14.48 years (s.d. 12.52) and a PAM score of 58.3 (s.d. 11.46). Of the 29 candidate factors, 25 were entered into a preliminary multivariable analysis. In the final multivariable analysis, four factors (self-efficacy, the illness belief that treatment will control participants’ condition and two dimensions of health literacy) were significantly associated with patient activation. This final model accounted for 40.4% of the variance in PAM scores [F(4, 246) = 41.66, P < 0.001]. Conclusions Patient activation is important in managing rheumatic conditions. Our data confirm that self-efficacy and health literacy are particular targets for patient activation interventions.

Attitudes of patients with a rheumatic disease on drug use in the COVID-19 pandemic

Background Anti-rheumatic drugs can increase the predisposition to infection, and patients may be unaware of continuing their treatment during the COVID-19 pandemic. Objective This study aimed to assess whether patients maintain their treatment for rheumatic conditions during the pandemic period and determine the factors responsible for discontinuation. Methods Patients were randomly selected from the prospectively collected database of our tertiary referral center. The patients were interviewed by telephone through a standardized closed-ended questionnaire, which is targeting the continuity of the treatment plan and the considerations related to the individual choice. The patients were asked whether they hesitated to visit the hospital for follow-up or intravenous drug administration. Results A total of 278 patients completed the questionnaire. While 62 of the patients (22.3%) had reduced or interrupted the treatment, only 11 patients (3.9%) stopped the treatment completely. A significant difference was observed between the duration of illness and the discontinuation of treatment. (p = 0.023) There was a significant difference in disease activity between the group that stopped treatment and continued treatment. (p = 0.001) There was no statistically significant difference in other demographic characteristics. One hundred thirty-five patients (48.6%) made the treatment decision by themselves, and 80% continued the treatment. Reasons for stopping the treatment were anxiety (48.4%), not being able to go to the hospital for intravenous treatment (45.1%), and not being able to find the drug (6.5%). Conclusion Since patients with long-term illnesses were found to be significantly more likely to stop their treatment, this group of patients should be monitored.

Rheumatologic manifestations in a cohort of patients with Vogt–Koyanagi–Harada disease

ABSTRACT Objectives Vogt–Koyanagi–Harada Disease (VKHD) is a systemic autoimmune disorder characterized by granulomatous panuveitis. Inflammatory rheumatic diseases (IRDs) are among the differential diagnosis of VKHD. However, current knowledge on the rheumatological aspects of VKHD is still limited. We aimed to investigate the prevalence of rheumatic conditions in VKHD patients. Methods VKHD patients were included in the study and they were reviewed in terms of the presence of any rheumatological manifestations. Results There were 18 patients with a female preponderance (83.3%, female). Inflammatory type of peripheral joint pain (11%) and sicca symptoms (33%) were the most common rheumatological findings. The frequency of spondyloarthritis-related features such as inflammatory back pain and HLA-B27 rate was not increased. None of the patients had radiographic sacroiliitis. Anti-nuclear antibody was positive in high titres nearly in 30% of the patients and three patients had antibodies against extractable nuclear antigens. Nailfold capillaroscopy was abnormal in about one-third of the patients. Pathergy test was negative in all cohorts. While angiotensin-converting enzyme was elevated in nearly 20% of the patients, there were no abnormalities on chest X-rays. Conclusion VKHD shares some features with IRDs. The common features were mostly suggestive of connective tissue disease rather than SpA or rheumatoid arthritis.

Workplace Barriers Among People With Arthritis: Results From the Work Experience Survey for Rheumatic Conditions

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Introduce OTs to the Work Experience Survey for Rheumatic Condition, and discuss the major reported barriers people with arthritis and rheumatological conditions Primary Author and Speaker: Rawan Alheresh Contributing Authors: Julie Keysor

Home and Community Barriers to Work Participation Among People With Arthritis: Results From the Work Experience Survey for Rheumatic Conditions

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Introduce OTs to the Work Experience Survey for Rheumatic Condition, and discuss the major barriers in the home and community context reported by people with arthritis and rheumatological conditions. Primary Author and Speaker: Rawan Alheresh Contributing Authors: Julie Keysor

Reducing fatigue in pediatric rheumatic conditions: a systematic review

Background Although fatigue is a prevalent distressing symptom in children and adolescents with Pediatric Rheumatic Conditions (PRCs), intervention studies designed for reducing fatigue in PRCs are limited. Aim To systematically review evidence regarding the efficacy of interventions intended to reduce fatigue in patients with PRCs. Methods Comprehensive electronic searches were performed in PubMed/ MEDLINE, Embase, Web of Science and Cinahl. The risk of bias was assessed using the ‘Revised Cochrane risk-of-bias tool for randomized trials’ and ‘Quality Assessment Tool for Before-After Studies With No Control Group’ for respectively studies with and without a control group. Results Ten out of 418 studies were included with a total of 240 participants (age range 5–23 years). Interventions included land-based and aquatic-based exercise therapy, prednisolone, vitamin-D and creatine supplementation, psychological therapy and a transition program into an adult rheumatology program. Fatigue was assessed with self-reported questionnaires in all included studies. Land-based exercise therapy was effective in one pre-post intervention study, whereas not effective in two randomized controlled trials. Aquatic-based exercise therapy was found more effective than land-based exercise therapy. Two placebo-controlled studies showed a significant positive effect in reducing subjective fatigue with prednisolone and vitamin-D. Creatine was not found effective. Cognitive therapy was effective in one pre-post intervention study, while one RCT did not show an effect in reducing fatigue. A transition program based on health education showed a small reducing effect, however, it was not clear if this was a significant effect. Six studies showed a high risk of bias, three studies a moderate risk, and one study had a low risk of bias. Conclusions Insufficient evidence is provided to substantiate the efficacy of current interventions to reduce fatigue in PRCs. The low number of studies, non-comparable interventions, risk of bias, and inconclusive outcomes of the included studies denote future research should focus on intervention studies aimed at the treatment of fatigue in children and adolescents with PRCs. Identification of possible underlying biological and psychosocial mechanisms as possible treatment targets to reduce complaints of fatigue in children and adolescents with PRCs is warranted.