Medication access difficulty and COVID-related distress are associated with disease flares in rheumatology patients during the COVID-19 pandemic.

Objective Due to concerns of infection and medication disruptions during the COVID-19 pandemic, rheumatology patients at the pandemic epicenter were at risk of distress and poor health outcomes. We sought to investigate medication disruptions and COVID-related distress shortly after the peak of the pandemic in the Bronx, NY, and determine whether factors related to the pandemic were associated with flares, disease activity, and overall health. Methods We surveyed adult patients and parents of pediatric patients from rheumatology clinics in the Bronx, in the month following the epidemic peak regarding medication access, medication interruptions, COVID-19 infection, COVID-19 hospitalization, and COVID-related distress. We examined which factors associated with patient-reported flares, disease activity, and overall health scores in regression models accounting for socio-demographics and rheumatologic disease type. Results Of 1,692 patients and parents contacted, 361 (21%) responded; 16% reported medication access difficulty, 14% medication interruptions, and 41% flare. In a multivariable logistic regression model, medication access difficulty was associated with increased odds of flare (OR 4.0, 95% CI 1.5-10.4, p=0.005), as was high COVID-related distress (OR 2.4, 95% CI 1.2-4.6, p=0.01). In multivariable linear regression models, medication access difficulty and high distress were associated with worse disease activity scores and high distress was associated with worse health scores. Conclusion Medication access difficulties and flares were common among rheumatology patients from the Bronx, NY in the month following the epidemic peak. Medication access difficulty and COVID-related distress were highly associated with flare and disease activity. COVID-related distress was associated with overall health scores.