COVID-19 HAD DISPROPORTIONATE IMPACTS ON RA SYMPTOMS AND FUNCTION BY SEX AND AGE: RESULTS FROM THE CANADIAN EARLY ARTHRITIS COHORT (CATCH)

BackgroundDuring the COVID-19 pandemic, Canadians with RA faced considerable uncertainty due to greater risk of infection, hospitalization, changing access to RA medications, and very limited access to in-person RA care. Further, to reduce transmission of the virus and COVID-related hospitalizations, stringent mitigation measures were implemented across the country to greatly reduce social contacts including curfews, limits on private gatherings and business closures. Little is known about the impact of the COVID-19 pandemic and associated mitigation efforts in RA. We hypothesized that women and younger adults with RA would report greater impairments in HRQL.ObjectivesTo compare changes in HRQL prior-to and during the COVID-19 pandemic by sex and age groups in real-world RA patients seen in routine practice settings.MethodsData were from patients in the Canadian Early Arthritis Cohort (CATCH) who completed a study visit in the year prior to the COVID-19 pandemic (Mar 2019 through Feb 2020) and a repeat assessment during the pandemic period (Mar 2020 – Jan 2022). RA disease activity was assessed using the RA Flare Questionnaire, a validated patient-reported measure of current RA disease symptoms (pain, stiffness, fatigue) and function (physical, participation). An RA-FQ score ≥ 20 was used to classify RA symptoms consistent with an RA inflammatory flare. HRQL was assessed using PROMIS-29 Adult Profiles. We compared changes in mean Physical (PHS) and Mental Health (MHS) scores, and the proportion of patients with impairments in each domain (i.e., scores ≥ 55 for pain interference, fatigue, anxiety, depression, and sleep and ≤45 for physical function and participation) before and during the COVID-19 pandemic across sex and age groups (<40, 40-64, ≥65 years).ResultsThe 938 CATCH participants in the analytic sample with data available at both time periods had a mean (SD) age of 60 (13) and RA symptom duration of 5.8 (3.7) years; 72% were women, 88% were white, and 64% reported >high school education. Most (80%) were in CDAI REM/LDA at the most recent visit prior to start of pandemic. The proportion of patients with RA-FQ ≥20 were similar at both time periods. While physical and emotional RA symptom impacts remained stable in men prior to and during the COVID-19 pandemic, women reported significant increases in anxiety and depression during the pandemic period. Younger RA patients <40 reported increases in depression, and older RA patients (65+) reported increases in anxiety and greater impacts on participation.ConclusionOur results illustrate that while the proportions of patients with high inflammatory disease activity were similar prior to and during the COVID-19 pandemic, we observed disproportionate impacts on HRQL by sex and age with a higher proportion of women, adults <40, and those ≥65 years of age experiencing greater impairments in several HRQL domains.Table 1.DomainWomen (N = 673)Men (N=265)Age <40 (N=84)Age 45-64 (N=492)Age 65+ (N= 362)BeforeDuringBeforeDuringBeforeDuringBeforeDuringBeforeDuringRA Flare >20%17%21%19%18%13%7%18%21%18%21%Anxiety34%*42%*23%23%42%55%32%35%28%*35%*Depression28%*34%*22%20%25%*42%*28%28%24%30%Fatigue36%38%24%23%43%43%36%33%26%32%Pain47%52%48%45%39%48%46%49%49%54%Physical function54%57%46%46%40%40%49%50%59%62%Participation42%47%34%36%37%38%40%41%40%*49%*Sleep30%34%18%22%26%29%29%33%23%28%*p <0.05AcknowledgementsCATCH is supported through unrestricted research grants from: Amgen and Pfizer Canada since 2007; AbbVie since 2011; Medexus since 2013; Sandoz Canada since 2019; Fresenius Kabi Canada since 2021 and; Organon Canada since 2021. Previous funding from Janssen Canada (2011-16); UCB Canada and Bristol-Myers Squibb Canada (2011-18); Hoffman La Roche (2011-21); Sanofi Genzyme (2016-17); Eli Lilly Canada (2016-20); Merck Canada (2017-21) and Gilead Sciences Canada (2020-21)Disclosure of InterestsNone declared