The impact of COVID-19 and national COVID-19 policies on people with rheumatic diseases; the CORE (COVID-19 in rheumatic diseases) project


The aims of the CORE (COVID-19 in rheumatic diseases) project are to determine the impact of the pandemic on health care utilization for the most frequent RMDs (incl. rheumatoid arthritis (RA), spondyloarthritis (SpA), and osteoarthritis (OA). It will also assess the impact of different national COVID-19 lockdown policies on RMD patients’ healthcare utilisation in comparison with the reference population.

Facts and Figures

Project Lead
M Englund
Lund University
FOREUM research grant: € 100.000

Meet the Team

Project Lead

M Englund
Lund University
K Magnusson
Norwegian Institute of Public Health (NIPH)
S Bierma-Zeinstra
Erasmus MC Netherlands

Final Results

In this project, we examined the impact of the COVID 19 pandemic on patients which rheumatic diseases, using population-wide data from Norway, Sweden, and the Netherlands. Our studies have found that both diagnosis and treatment of osteoarthritis (OA) were severely reduced due to the pandemic. However, important care for severe OA (for instance hip and knee replacement surgeries) were offered at rates close to normal towards later stages of the pandemic, implying that crucial treatment for severe OA can be provided during a pandemic when suitable measures are taken. We also found that strict lockdown in Norway was associated with reduced risk of hospitalization and (to a lesser extent) death due to COVID-19 among patients with rheumatic diseases, compared to neighbouring Sweden where no lockdown was enforced.

Lay Summary

We aimed to understand the impact of the COVID-19 pandemic on people with rheumatic diseases. Using healthcare data from the Netherlands, Sweden and Norway, we found that the first wave of the pandemic was associated with greatly reduced in-person healthcare consultations, although remote consultations increased somewhat. In Sweden, we found that hip and knee replacement surgeries were greatly reduced in the first wave of the pandemic. However, in the second wave of the pandemic, the rates of these surgeries were nearly back to normal, offering hope that care for severe disease can be provided during a pandemic alongside suitable measures to contain the spread of infection. We also studied the risks faced by people with rheumatic diseases when exposed to COVID-19 infection, as well as the impact of country-specific policies on this vulnerable patient population’s health outcomes. Comparing Norway, which implemented strict lockdowns, with neighbouring Sweden, which implemented only recommendations for social distancing, we found that hospitalizations due to COVID-19 were largely reduced in Norway among patients with rheumatic diseases, compared to Sweden. This confirms the effect of strict lockdown on healthcare outcomes, in particular among older persons with rheumatic diseases, who are at higher risk of COVID-19 complications.


  • Ali Kiadaliri, Karin Magnusson, Aleksandra Turkiewicz, Andrea Dell’Isola, Jos Runhaar, Sita Bierma-Zeinstra, Martin Englund, Impact of the first wave of the COVID-19 pandemic on healthcare use in osteoarthritis: A population register-based study in Sweden, Osteoarthritis and Cartilage Open, Volume 4, Issue 2, 2022, 100252, ISSN 2665-9131,

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  • Dell'Isola A, Kiadaliri A, Turkiewicz A, Hughes V, Magnusson K, Runhaar J, Bierma-Zeinstra S, Englund M. The impact of first and second wave of COVID-19 on knee and hip surgeries in Sweden. J Exp Orthop. 2021 Aug 13;8(1):60. doi: 10.1186/s40634-021-00382-7. PMID: 34389919; PMCID: PMC8363236.

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