The COVID-19 pandemic has led to a paradigm shift in the way primary care operates and patients with non-COVID related symptoms are managed. Almost all patients are managed remotely. Routes to refer patients routinely for specialist care have been paused. This study aims to use primary care electronic healthcare records to explore changing trends in the prevalence and incidence of consultations for rheumatic musculoskeletal disorders (RMDs), prescribing of analgesia, and the incidence and time to diagnosis of rheumatoid arthritis (RA) and juvenile idiopathic arthropathy (JIA) in the pre- peri- and post- pandemic periods.
Project LeadV Welsh
Consultations for musculoskeletal conditions fell sharply during March 2020 and returned to pre-pandemic levels by October 2021. However, the proportion of consultations in which analgesia was prescribed rose steeply in March 2020 and then returned to pre-pandemic trajectory by December 2021.
The incidence of rheumatoid arthritis and juvenile idiopathic arthritis reduced from March 2020 and then rose again, though not to pre-pandemic rates. Referral rates to specialist services for patients with suspected inflammatory arthritides reduced between February 2020 and May 2020 before recovering by October 2021. Time to diagnosis of RA from first consultation was longer in the early pandemic and late pandemic periods. Time between referral and diagnosis of RA was longest for those who received a diagnosis in the late pandemic period in the pre-pandemic period. Residents of the most deprived areas experienced the longest time between first consultation and RA diagnosis.
COVID-19 pandemic changed healthcare access and delivery. Patients had healthcare consultations remotely. Doctors could only refer patients to specialists for urgent problems.
We assessed the impact of these restrictions on the care of patients living with musculoskeletal symptoms (for example, pain). We measured: 1) consultations for musculoskeletal conditions, 2) prescriptions of pain-relieving medicines, and 3) referral patterns to specialist healthcare services for diagnosis and treatment of inflammatory arthritis, including rheumatoid and juvenile idiopathic arthritis.
We looked at anonymized health records of 6 million people who had consulted their primary care team with a musculoskeletal condition. We compared three time periods: pre-pandemic (April 2017-February 2020), early pandemic (March 2020–August 2020), and later pandemic (September 2020–October 2021).
Fewer consultations for musculoskeletal conditions occurred in the early pandemic period, but this returned to pre-pandemic levels by October 2021. More pain-relieving medicines were prescribed to patients who consulted during the early-pandemic period compared to pre-pandemic , but prescribing patterns returned to pre-pandemic levels by October 2021. Referrals to specialists continued at the same rate across all time periods. It took longer for patients to be diagnosed with rheumatoid arthritis in the early and later pandemic periods, particularly for residents in more deprived areas.
Healthcare services to support diagnosis and management of musculoskeletal conditions must remain open and accessible during healthcare crises. This would help to avoid high levels of pain-relieving medicine and their associated side effects and ensure early diagnosis of rheumatoid arthritis which requires rapid treatment to prevent worsening symptoms.