Mediterr J Rheumatol 2020;31(Suppl 2):288-94
Nocebo-Prone Behaviour in Patients with Autoimmune Rheumatic Diseases during the COVID-19 Pandemic
Authors Information

1. First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, “Laiko” General Hospital, Athens, Greece

2. First Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

George E. Fragoulis,Gerasimos Evangelatos, Vasiliki-Kalliopi Bournia, Kalliopi Fragiadaki, Katerina Laskari
Stylianos Panopoulos, Dimos D. Mitsikostas, Maria G. Tektonidou

Background: 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. Methods: 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. Results: 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). Conclusion: 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.


This work is licensed under a Creative Commons Attribution 4.0 International License (CC-BY). 

©Fragoulis GE, Evangelatos G, Arida A, Bournia V-K, Fragiadaki K, Karamanakos A, Kravvariti E, Laskari K, Panopoulos S, Pappa M, Mitsikostas DD, Tektonidou MG, Sfikakis PP.

Article Submitted: 12 Jun 2020; Article Accepted: 30 Jun 2020; Available Online: 10 Sep 2020