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.