What question did this study set out to answer?

To quantify the impact of the COVID-19 pandemic on new diagnoses of rheumatic diseases in England.

April 30, 2026

P168 Quantifying the missing burden of rheumatic disease following the COVID-19 pandemic: a population-level cohort study of 18 million adults in England

Key Points

To quantify the impact of the COVID-19 pandemic on new diagnoses of rheumatic diseases in England.
Analyzed primary care and hospital admission data for 18.1 million adults using OpenSAFELY.
Evaluated trends in incidence rates from April 2016 to March 2025.
Used seasonal autoregressive integrated moving-average models to quantify differences between observed and expected diagnosis rates.
PsA diagnoses decreased by 15,036 (24.5%) since March 2020, remaining below pre-pandemic levels.
RA diagnoses decreased by 12,139 (8.5%).
AxSpA diagnoses increased by 2,410 (8.5%) compared to expected rates post-pandemic.
CTDs experienced a decrease of 5,530 (10.1%) in diagnoses, notably Sjogren's disease only returning to pre-pandemic levels in 2024.
Vasculitis diagnoses down by 6,589 (12.4%) due to a decline in GCA diagnoses.

Abstract

Abstract Background/Aims Previous data highlighted a sharp decrease in new diagnoses of rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) during the early COVID-19 pandemic. Little is known about whether these diagnoses have rebounded as the NHS recovers from the pandemic, or how deficits in inflammatory arthritis diagnoses compare with connective tissue diseases (CTD) and vasculitis. Using data for 18 million adults in England, we quantified differences between observed and expected rates of new diagnoses for 10 rheumatic diseases up to March 2025. Methods With NHS England approval, we analysed primary care and hospital admission data for 18.1 million adults in England using the OpenSAFELY platform. We evaluated temporal trends in incidence rates for RA, PsA, axSpA, undifferentiated inflammatory arthritis, Sjogren’s disease, systemic lupus erythematosus, systemic sclerosis, myositis, giant cell arteritis (GCA), and ANCA vasculitis between April 1, 2016, and March 31, 2025. Differences between observed and expected incidence rates after the onset of the pandemic (from March 2020 to March 2025) were quantified using seasonal autoregressive integrated moving-average models. Results The largest and most persistent deficit in new diagnoses since March 2020 was evident for PsA, with 15,036 (24.5%) fewer diagnoses than expected (95% CI: 13,176, 16,896). As of March 2025, diagnosis rates for PsA remained substantially below pre-pandemic levels. For RA, there were 12,139 (8.5%) fewer diagnoses than expected (95% CI: 8,081, 16,197). In contrast, axSpA diagnoses have increased above pre-pandemic trends, with 2,410 (8.5%) more diagnoses than expected since March 2020 (95% CI: 762, 4,057). For CTDs, there were 5,530 (10.1%) fewer diagnoses than expected (95% CI: 4,098, 6,962), driven by a marked decrease in new diagnoses of Sjogren’s disease, which only returned to pre-pandemic rates in 2024. For vasculitis, there were 6,589 (12.4%) fewer diagnoses than expected (95% CI: 5,422, 7,757), accounted for by declining GCA diagnosis rates since the pandemic, whereas ANCA vasculitis diagnoses have remained broadly stable. Conclusion There continues to be a marked and disproportionate impact of the pandemic on diagnosis rates for many rheumatic diseases in England. For inflammatory arthritis, this has been most evident for PsA, with 25% fewer diagnoses than expected since the pandemic; contrasting a post-pandemic increase in axSpA diagnoses. For CTDs and vasculitis, the pandemic has disproportionately impacted Sjogren’s disease and GCA. Importantly, we have shown that it is possible to monitor the epidemiology of rheumatic diseases in England in near real-time using data in OpenSAFELY. This could inform strategies to enhance case detection and reduce unwarranted variation in care. Disclosure M.D. Russell: Honoraria; AbbVie, Biogen, Galapagos, Johnson Sandoz UK. A. Schaffer: None. B. MacKenna: Other; Employed by NHS England working on medicines policy and clinical lead for primary care medicines data. A. Mahto: None. K. Bechman: Honoraria; Galapagos, UCB and Viforpharma. Grants/research support; NIHR. C. Wincup: None. A.I. Rutherford: None. P. Gordon: None. E. Nikiphorou: None. S. Steer: None. S. Patel: None. M. Dey: None. K. Biddle: None. S. Patel: None. M. Gibson: None. E. Alveyn: Other; Received support for attending meetings from UCB. V. Allen: None. S. Bacon: None. A. Mehrkar: Consultancies; Has consulted for health care vendors, the last time in 2022; the companies consulted in the last 3 years have no relationship to OpenSAFELY. Other; Represented the RCGP in the health informatics group and the Profession Advisory Group that advises on access to GDPPR; former employee and interim Chief Medical Officer of NHS Digital. B. Goldacre: Grants/research support; Bennett Foundation, Laura Previously a Non-Executive Director at NHS Digital; also receives personal income from speaking and writing for lay audiences on the misuse of science. S. Norton: None. A.P. Cope: None. E. Price: None. J.B. Galloway: Honoraria; Abbvie, Biovitrum, BMS, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi and UCB. Grants/research support; Sandoz UK.

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