The effect of COVID19 public health restrictions on the health of people with musculoskeletal conditions and symptoms: the CONTAIN study

Gary J Macfarlane* (Corresponding Author), Rosemary J Hollick, Eva-Maria Bachmair, R Stuart Anderson, Karen Forrest Keenan, Peter Murchie, Kevin Stelfox, Gareth T Jones, Lakrista Morton, Marcus Beasley, Maureen Heddle, Daniel Whibley

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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OBJECTIVE: To quantify the change in quality of life, disease-specific indicators, health, and lifestyle before and during the COVID19 pandemic amongst people with musculoskeletal diagnoses and symptoms.

METHODS: We undertook an additional follow-up of two existing UK registers involving people with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA) and participants in a trial in the UK who had regional pain and were identified at high risk of developing chronic widespread pain. Participants completed the study questionnaire between July and December 2020, throughout which time there were public health restrictions in place.

RESULTS: 1054 people took part in the study (596 axSpA, 162 PsA, 296 regional pain). In comparison to their previous (pre-pandemic) assessment, there was an age-adjusted significant, small, decrease in quality of life measured by EQ-5D (-0.020 95% CI (-0.030, -0.009)) overall and across all population groups examined. This was primarily related to poorer mental health and pain. There was a small increase in fibromyalgia symptoms, but a small decrease in sleep problems. There was a small deterioration in axSpA disease activity, and disease-specific quality of life and anxiety in PsA participants. Predictors of poor quality of life were similar pre- and during the pandemic. The effect of lockdown on activity differed according to age, gender, and deprivation.

CONCLUSION: Important lessons include focussing on addressing anxiety and providing enhanced support for self-management in the absence of normal health care being available, and awareness that all population groups are likely to be affected.

Original languageEnglish
Pages (from-to)SI13-SI24
Number of pages12
Issue numberSI
Early online date21 Apr 2021
Publication statusPublished - Oct 2021

Bibliographical note

This work was supported by Versus Arthritis [Grant Number: 20748] and the British Society for Rheumatology. The funding for the original studies included were from Versus Arthritis (MAmMOTH) and the British Society for Rheumatology (BSRBR-AS and BSR-PsA). Daniel Whibley is supported by a Versus Arthritis Foundation Fellowship [Grant Number 21742]

We are grateful to help from staff at the National Ankylosing Spondylitis Society and specifically to patient partners Lynne Laidlaw (for help with designing questionnaire) and Susan Davis (for commenting on the manuscript). The authors do not report any conflicts of interest. GJM conceived the idea for the study and all authors were involved in the detailed planning. MH, KK, EM-B and MB were responsible for obtaining ethics and research governance approvals. MB undertook the analysis which was independently verified by GTJ. GJM, with input from MB, drafted the manuscript, and all authors contributed important intellectual content via written comments. We thank Linda Dean for comments on the manuscript.

Data Availability Statement
The data within the article which relate to the collection of BSR register data are owned by the BSR – access to these data are subject to application being made to the BSR: Registers ( . For other data in the article, application can be made for access to the data by contacting the corresponding author.


  • COVID19
  • axial spondyloarthritis
  • psoriatic arthritis
  • pain
  • quality of life


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