Self-protection strategies and health behaviour in patients with inflammatory rheumatic diseases during the COVID-19 pandemic: results and predictors in more than 12 000 patients with inflammatory rheumatic diseases followed in the Danish DANBIO registry

RMD Open. 2021 Jan;7(1):e001505. doi: 10.1136/rmdopen-2020-001505.


Aims: In Danish patients with inflammatory rheumatic diseases to explore self-protection strategies and health behaviour including adherence to disease-modifying antirheumatic treatment (DMARD) during the initial phase of the COVID-19 pandemic and again after the reopening of the society started. Furthermore, to identify characteristics of patients with high levels of anxiety and self-isolation.

Methods: Patients in routine care followed prospectively in the nationwide DANBIO registry were invited to answer an online questionnaire regarding disease activity and COVID-19 infection, behaviour in March and June 2020. Responses were linked to patient data in DANBIO. Characteristics potentially associated with anxiety, self-isolation and medication adherence (gender/age/diagnosis/education/work status/comorbidity/DMARD/smoking/EQ-5D/disease activity) were explored with multivariable logistic regression analyses.

Results: We included 12 789 patients (8168 rheumatoid arthritis/2068 psoriatic arthritis/1758 axial spondyloarthritis/795 other) of whom 65% were women and 36% treated with biological DMARD. Self-reported COVID-19 prevalence was 0.3%. Patients reported that they were worried to get COVID-19 infection (March/June: 70%/45%) and self-isolated more than others of the same age (48%/38%). The fraction of patients who changed medication due to fear of COVID-19 were 4.1%/0.6%. Female gender, comorbidities, not working, lower education, biological treatment and poor European Quality of life, 5 dimensions were associated with both anxiety and self-isolation.

Conclusion: In >12 000 patients with inflammatory arthritis, we found widespread anxiety and self-isolation, but high medication adherence, in the initial phase of the COVID-19 pandemic. This persisted during the gradual opening of society during the following months. Attention to patients' anxiety and self-isolation is important during this and potential future epidemics.

Keywords: arthritis; epidemiology; health care; outcome assessment; patient reported outcome measures; rheumatoid.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antirheumatic Agents / therapeutic use
  • Anxiety / epidemiology
  • Arthritis, Psoriatic / drug therapy
  • Arthritis, Psoriatic / epidemiology
  • Arthritis, Psoriatic / psychology
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / epidemiology
  • Arthritis, Rheumatoid / psychology
  • COVID-19 / epidemiology*
  • COVID-19 / prevention & control
  • COVID-19 / psychology
  • Denmark / epidemiology
  • Female
  • Health Behavior*
  • Health Surveys / statistics & numerical data
  • Humans
  • Male
  • Medication Adherence / statistics & numerical data
  • Middle Aged
  • Pandemics*
  • Quarantine / statistics & numerical data
  • Registries / statistics & numerical data
  • Rheumatic Diseases / drug therapy
  • Rheumatic Diseases / epidemiology
  • Rheumatic Diseases / psychology*
  • SARS-CoV-2*
  • Spondylarthropathies / drug therapy
  • Spondylarthropathies / epidemiology
  • Spondylarthropathies / psychology


  • Antirheumatic Agents