Perceived COVID-19 Risk and Shielding Behaviors Among Patients With Rheumatoid Arthritis During the Pandemic

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At a median follow-up of 36 months, patients with acute thrombotic thrombocytopenic purpura displayed impaired quality of life compared with the general population.
Researchers assessed perceived COVID-19 risk for infections and outcomes, as well as shielding practices, among patients with rheumatoid arthritis (RA) during the pandemic.

Survey data show the variability in perceptions of COVID-19 risk among patients with rheumatoid arthritis (RA). These findings were published in ACR Open Rheumatology. Greater perceived risk for COVID-19 was associated with increased adherence to shielding behaviors, including wearing masks, social distancing, and remaining in quarantine.

This cross-sectional study included a survey of patients with RA who received care at Massachusetts General Brigham in Boston. The survey was sent out between July 16 and November 8, 2020, which patients could complete by mail, by phone, or electronically. The survey included questions about COVID-19 risk perception (how strongly the patients believed that RA increased their risk for infection or severe disease outcomes). Patients were also asked to report if they had ever been diagnosed with COVID-19. Shielding behaviors of interest included social distancing, quarantine, and/or glove and mask use. An optional free-text response section was also provided. Logistic regression models were used to identify correlates of COVID-19 risk perception and shielding behaviors.

Survey data from 494 patients were included in the analyses. The majority of respondents were women (84.6%) and White (90.5%); mean age was 62.6±13.8 years. The majority of patients received treatment with disease-modifying antirheumatic drugs (DMARDs) in the 6 months preceding the pandemic. A history of COVID-19 infection was reported by 21 (4%) patients, though testing confirmed infection in 5 (1%). A total of 25 (5%) participants indicated that they were unsure whether they had been infected. Overall, 195 (40%) patients “strongly agreed” that their RA or associated treatments increased their risk for COVID-19 or severe outcomes; 169 (34%) participants “agreed” and 130 (26%) were either unsure or “disagreed.”

In adjusted analyses, younger age (odds ratio [OR], 0.98; 95% CI, 0.96-0.99), any comorbidity (OR, 1.60; 95% CI, 1.09-2.36), and recent use of biologic/targeted synthetic DMARDs (OR, 1.75; 95% CI, 1.14-2.68) were associated with increased perceived risk.

The majority of patients endorsed using at least 1 shielding practice, including quarantine (74%), masks and/or gloves (96%), or social distancing (98%). The majority of patients (71%) reported using all 3 measures. Compared with patients who were uncertain or disagreed that they were at higher risk for COVID-19, patients who strongly agreed were 4-fold as likely to use all shielding practices (OR, 4.15; 95% CI, 2.37-7.27). Patients who agreed were also more likely to use all shielding practices, though the difference was less pronounced (OR, 1.97; 95% CI, 1.17-3.32). Use of all shielding measures was also more common among those who used biologic/targeted synthetic DMARDs (OR, 1.99; 95% CI, 1.23-3.23) compared with those who did not. Patients receiving treatment with glucocorticoids were more likely to practice shielding measures than those who did not (OR, 1.81; 95% CI, 1.06-3.08).

In the free-text response section, the majority of respondents (53%) referred to mental health concerns, such as anxiety, stress, and depression. Greater perceived risk was associated with reporting mental health in the free-text section (P =.001). Other common themes including difficulties seeking/receiving health care, barriers to accessing medication, and employment concerns.

These survey data provided insights into the pandemic experience of patients with RA. Because RA and its treatment course may increase risk for infection and severe outcomes, data regarding shielding behaviors may be useful to practitioners developing educational materials.

Study limitations included the fact that the questionnaire was administered in the middle of 2020, after the first COVID-19 surge in the United States. Further, risk perceptions and behaviors may have changed over time, particularly after the introduction of the vaccine. In addition, the homogenous cohort limited data generalizability; all patients were English speakers and had access to health care, and a majority were White. Further studies with larger sample sizes are necessary to confirm these study findings.

“In this study of participants with RA in the greater Boston area during the COVID-19 pandemic, we observed strong associations between several patient and disease-specific features with COVID-19 risk perception,” the researchers wrote. “Additional studies are needed to clarify factors driving risk perception and shielding practices and the impact of these risks and practices on mental health.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for the full list of affiliations. 


Cook C, Cox H, Fu X, et al. Perceived risk and associated shielding behaviors in patients with rheumatoid arthritis during the coronavirus 2019 pandemic. ACR Open Rheumatol. Published online September 8, 2021. doi:10.1002/acr2.11340