Background: The challenge posed by the COVID-19 pandemic may represent an overwhelmingly stressful event for ankylosing spondylitis (SpA) patients and impact their treatment adherence. In response to the COVID-19 pandemic, Tunisia,have adopted community containment to manage the spread of the virus. However, COVID-19 restrictions can alter psychological wellbeing and limit access to treatment for SpA patients.

Objectives: This study aimed to evaluate the impact of COVID-19 pandemic on psychological health and treatment adherence on Tunisian SpA patients.

Methods: This is a cross sectional study including patients with SpA (ASAS criteria). A survey comprising questions about adherence to stay home warnings; the obligation to go outside for work; satisfaction with the medical support or information received for COVID-19; showing up to medical check-ups, proper use of the medications; medications that the patient stopped taking.

Anxious and depressive symptoms were assessed using the Arabic version of Hospital Anxiety and Depression Scale (HADS) questionnaire.

Results: We included thirty patients. the average age was: 39,7 years-old and the sex ratio was: 13,3. 75 % of patients were married. The SpA was axial in 25%, peripheral in 20%, and both in 55 %. Most patients had a moderate activity and the mean activity scores were: BASDAI = 2.60, ASDAScrp:2.65

38% of patients were on biologics, 36 % on sulfasalazine and NSAIDs and 26 % on NSAIDs only.

It seemed that significant number of patients strictly adhered to stay home warnings (> 89%) only 11% were obliged to go out for work during general lockdown while only 24 % adhered to it after general lockdown.

Most of the patient 78 % were not satisfied with the medical support or information about COVID 19. 88% of patients requested information from TV while 10 % requested it from social media and 2 % from relatives and friends working in health care field.

After the outbreak, 23% of the patients who had a scheduled chek-up visit attended the appointment as it was before.The remaining either ‘did not want to come’ (43%), wanted to come but could not contact anyone in the hospital (11%), was advised to postpone their visits (10%), or couldn’t find means of transport (13%).A significant number of patients decreased or skipped their dose (69%), while only 13% continued their medications and 16%stopped taking NSAIDs.

Biological DMARDs(anti-TNF agents) were the most frequent drugs which patients decreased their dose, skipped or stopped taking 33%. sulfasalazine and NSAIDs were least likely 17% to be skipped or stopped.

43% of patients Had a HADS anxiety level more than or equal to 11: 87 % women and 13 % men. The highest anxiety scores were found among patients aged less than 45 years old (87%) married with children .32% of patients had a HADS depression level more than or equal to 11: 54 % women and 44 % men. the highest depression scores were found among patients aged less than 45 years old married with children.

No significant relationship was found between anxiety and depression levels regarding biologic treatment.

Conclusion: Our results suggest that patients with SpA were less likely to comply strictly to ‘stay home’ restrictions, most probably due to the male predominance and relatively younger age. Additionally, we noticed that SpA patients treated with anti-TNF agents were the patients that regular drug use had been considerably disrupted.

COVID 19 pandemic has heightened the need to care for patients with SpA in an increasingly virtual environment.

Additionally, we found that being female, having a lower level of education, having a child, living in a crowded family is correlated to higher levels of anxiety and depression.

References: [1]Smarr KL, Keefer AL. Measures of depression and depressive symptoms: Beck Depression Inventory-II (BDI-II),Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9) Arthritis care.

Acknowledgements: I would like to express my special thanks of gratitude to Rheumatology department of Hedi Chaker Hospital Sfax.

Disclosure of Interests: None declared