Factors Associated with Self-medication with Glucocorticoids during the COVID-19 Pandemic and Their Clinical Consequences in Rheumatoid Arthritis Patients: A Before-and-after Study.

OBJECTIVE

The objective of this study was to evaluate factors associated with glucocorticoid (GC) self-medication during the COVID-19 pandemic and to describe its clinical consequences.

METHODS

Self-medication practices and disease activity were assessed in rheumatoid arthritis patients before and after the hospital closure due to the COVID-19 pandemic through telephone survey and clinical record review. GC toxicity was evaluated using a modified Glucocorticoid Toxicity Index (GTI). Comparisons were performed using statistical tests as appropriate.

FINDINGS: Following the hospital's reopening, 51% of patients had modified their GC dose ("changers"), while 49% maintained the same dose ("nonchangers"). Lower adherence to methotrexate (MTX) was significantly associated with self-medication (P < 0.001). Self-medication correlated with increased C-reactive protein levels and pain perception but did not alter clinical activity score. The GTI revealed more infections and neurological effects in the changer group.

CONCLUSION

MTX nonadherence was the primary determinant of GC self-medication during the hospital closure. Although transient, this behavior was associated with increased inflammatory markers, pain perception, and adverse events.