Fragoulis George E, Evangelatos Gerasimos, Arida Aikaterini, Bournia Vasiliki-Kalliopi, Fragiadaki Kalliopi, Karamanakos Anastasios, Kravvariti Evrydiki, Laskari Katerina, Panopoulos Stylianos, Pappa Maria, Mitsikostas Dimos D, Tektonidou Maria G, Sfikakis Petros P
First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, "Laiko" General Hospital, Athens, Greece.
First Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Mediterr J Rheumatol. 2020 Sep 21;31(Suppl 2):288-294. doi: 10.31138/mjr.31.3.288. eCollection 2020 Sep.
The COVID-19 pandemic is associated with emotional distress and significant disruptions in health-care services. These are key players in the development of nocebo phenomena. We aimed to investigate nocebo-prone behaviour in patients with autoimmune rheumatic diseases (ARD) amid the COVID-19 pandemic-associated lockdown.
Consecutive patients were telephone-interviewed during the COVID-19 pandemic in Greece. Clinical and socioeconomic characteristics (eg, level of education) were recorded. For nocebo behaviour, a four-item validated questionnaire (Q-No, cut-off score>15), was used. Results were compared with pre-COVID-19 Q-No scores collected from patients followed-up in our department.
Nocebo behaviour was detected in 51/500 (10.2%) individuals. In patients with nocebo behaviour, use of anti-hypertensives was less common (17.6% vs 31.8%, p=0.04), but a higher level of education was more common (58.8% vs 35.9%, p=0.002), compared with patients with Q-No score ≤15; the latter retained statistical significance in multivariate regression analysis (p=0.009, OR [95%CI]: 2.29, [1.23-4.25]). Total Q-No scores were higher in the COVID-19-period compared to the pre-COVID-19 era [median (range); 12 (4-20) vs 11 (4-20), p=0.02]. Among 78 patients with available Q-No questionnaires in the pre-COVID-19 era, 11 (14.1%) displayed nocebo behaviour, which increased to 16 (20.5%) amid the COVID-19 pandemic. Interim development of nocebo behaviour was also associated with higher educational level (p=0.049, OR: 3.65, 95%CI: 1.005-13.268).
A considerable proportion of ARD patients manifested nocebo-prone behaviour during the COVID-19 pandemic, which was more common among those with high educational level.
新冠疫情与情绪困扰及医疗服务的重大中断有关。这些是反安慰剂现象发展的关键因素。我们旨在调查在新冠疫情相关封锁期间自身免疫性风湿病（ARD）患者中的反安慰剂倾向行为。
在希腊新冠疫情期间对连续的患者进行电话访谈。记录临床和社会经济特征（如教育水平）。对于反安慰剂行为，使用一份经过验证的四项问卷（Q-No，临界值>15）。将结果与我们科室随访的患者在新冠疫情前收集的Q-No评分进行比较。
在51/500（10.2%）的个体中检测到反安慰剂行为。与Q-No评分≤15的患者相比，有反安慰剂行为的患者中使用抗高血压药物的情况较少见（17.6%对31.8%，p=0.04），但较高的教育水平更为常见（58.8%对35.9%，p=0.002）；在多变量回归分析中，后者仍具有统计学意义（p=0.009，OR[95%CI]：2.29，[1.23 - 4.25]）。与新冠疫情前相比，新冠疫情期间Q-No总分更高[中位数（范围）；12（4 - 20）对11（4 - 20），p=0.02]。在新冠疫情前有可用Q-No问卷的78例患者中，11例（14.1%）表现出反安慰剂行为，在新冠疫情期间这一比例增加到16例（20.5%）。反安慰剂行为的临时发展也与较高的教育水平相关（p=0.049，OR：3.65，95%CI：1.005 - 13.268）。
相当一部分ARD患者在新冠疫情期间表现出反安慰剂倾向行为，这在高教育水平患者中更为常见。
