COVID-19 Crisis and Rheumatology Care in the Arab World

The coronavirus pandemic 2019 (COVID-19) is the most significant public health concern in current times. In addition to its massive morbidity and mortality toll, the pandemic significantly impacted social interactions and global economies. As a group, the Arab countries ranked 12th in the list of most affected countries in terms of the total number of cases (31,304 cases/1,000,000 population) and ninth in the list of deaths worldwide (383 deaths per 1,000,000 population as of March 2023). Many disparities in epidemiology, infection rate, and clinical outcomes were observed within the Arab countries, which may be attributed to differences in the population’s age, ethnicity, vaccination rates, and healthcare systems. Patients with chronic rheumatic and musculoskeletal diseases (RMDs) were particularly affected, as many of them are generally immunocompromised and vulnerable to infection. Data from the Arab League of Associations for Rheumatology (ArLAR) highlighted the deleterious consequences of the COVID-19 pandemic on the continuity of rheumatology care, the persistence of chronic medication (particularly hydroxychloroquine), the patient’s mental health, and the overall income, which are all key predictors of disease prognosis. Studies also highlighted the negative impact on rheumatologists, with a significant reduction in outpatient and inpatient activities and an important effect on physicians’ mental health. In addition to the risk of infection, the main challenges in managing patients with RMDs during the pandemic included the difficulty of access to rheumatology care, lack of proper access to telehealth, shortage of essential anti-rheumatic drugs, and a negative impact on mental health and economic levels. All these factors were associated with a low persistence of chronic anti-rheumatic drugs and poor disease control. These challenges were addressed through a series of strategies, including the development and dissemination of the best practice guidelines for the use of telehealth in rheumatology by the ArLAR, the conduct of studies investigating the acceptability of the COVID-19 vaccination in patients with RMDs and healthcare providers, and the promotion of awareness campaigns targeting patients with RMDs and the general population. Rheumatologists were compelled to leave their comfort zone, adopt new technologies, promote public health, and fulfill their duties as role models to patients. These are crucial practice lessons that will remain in the future.