Treatment of chronic inflammatory joint disease in Zanzibar: Impact of the Covid-19 pandemic

Background: The Covid-19 pandemic has had a major impact on economies and health globally. It has also affected the availability of drugs such as hydroxychloroquine, commonly used in rheumatic disorders. Objective: The aim of this study was to describe the impact of the Covid-19 pandemic among patients with chronic inflammatory joint disease. Methods: A study on chronic inflammatory joint disease in Zanzibar was undertaken in July 2019 and is ongoing. So far, 38 participants have been recruited and were included in the present study. These participants were contacted for phone interview regarding information on self-reported disease activity, joint pain and swelling. Patients were also asked about adherence to medication, Covid-19 symptoms, household expenditure and quality of life during the pandemic. Results: At baseline, 38 patients, mostly females (92%), had been enrolled. The mean age was 45 years and mean disease duration was 3.5 years. Majority had moderate and severe disease activity (58%). For this study, 33 patients were reached for interview. The majority reported joint pain (91%) and swelling (52%). Twenty four (73%) noted their disease activity to be better than before joining the ongoing study. Only 13 (39%) reported symptoms of Covid-19. Adherence was generally lower during the pandemic (52%) compared to baseline (58%) although this was not statistically significant. About a third of participants were unable to quantify their expenditure. Of the remainder, 13 (39%) participants reported a decrease. Conclusion: The pandemic had a negative impact on patients due to lack of funds to purchase drugs and unavailability of drugs such as hydroxychloroquine which is cheaper compared to alternatives. We believe that the overall improvement in disease activity may be attributed to management that had been commenced prior to the pandemic