ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) infection is linked to high levels of inflammatory cytokines and prolonged immobilization;furthermore, corticosteroid treatment leads to increased bone loss and resorption. We aimed to study the change in bone mineral density (BMD) after COVID-19 infection in osteoporotic and osteopenic patients. One hundred osteoporotic or osteopenic patients were selected in this single-center retrospective study;the patients were divided into two groups. Group 1 included 56 patients who got COVID-19 infection. Group 2 included 44 patients who did not get COVID-19 infection. BMD was assessed at baseline, after 9 months of COVID infection, and then after 1 year follow-up using dual energy x-ray absorptiometry (DXA) scan. Results: There was no significant difference between two groups regarding demographic data (p > 0.05);there was a significant decrease in BMD of the lumbar region and femur at 9 months as compared to baseline in group1 (p < 0.001), while there was a significant increase in the lumbar BMD of osteoporotic patients who did not get COVID infection after 21 months. Concerning activity of COVID infection, there was a significant difference between the three subgroups of COVID patients regarding percentage of change in BMD after 9 months, the severe group having the highest decrease in BMD (p < 0.001). Conclusions: COVID-19 may have deleterious effect on BMD in osteoporotic patients. It is recommended to assess BMD in osteoporotic/osteopenic patients who got COVID infection to detect if there is an increased risk of fracture which may necessitate post-COVID change in the therapeutic intervention plan. Supplementary Information: The online version contains supplementary material available at 10.1186/s43166-022-00165-7.
ABSTRACT
Background: Concerns of hydroxychloroquine (HCQ) shortage for patients with rheumatic diseases are growing during the era of COVID-19 pandemic as it was assigned in some treatment protocols. Its nonavailability may impact the disease management especially in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Objectives: To evaluate the shortage of HCQ in patients with RA and SLE and its impact on patients anxiety and disease activity. Methods: 219 RA patients (according to 2010 ACR/EULAR criteria) and 200 SLE patients (according to 2012 SLICC criteria) were recruited in the study. Demographic and clinical features of the patients together with the current disease activity parameters (CDAI and SELENA/SLEADI) were prospectively collected. previous disease activity measures were collected from the patients records before hydroxychloroquine shortage. Patient's anxiety was measured using Hamilton anxiety rating scale. Results: A total of 419 patients divided into two groups, Group (1);219 RA patients with mean age 45.6±9.6 years, disease duration 45.5±32.8 months with female predominance (63 %). Group (2): 200 SLE patients with mean age 33.8±7.9 years, disease duration 61.2±39.2 months with female predominance (84%). 168 (76.7%) of the RA patients and 128 (64%) of SLE patients reduced or stopped the dose of HCQ due to unavailability. Despite HCQ shortage, there was no signifcant change in disease activity in RA or SLE patients (P=0.063 and 0.064 respectively). All participants suffered from different levels of anxiety which was positively correlated with HCQ shortage (p= 0.001 and 0.005 for RA and SLE respectively). Conclusion: COVID 19 pandemic caused hydroxychloroquine shortage in the majority of patients with RA and SLE with no signifcant impact on their disease activity. Anxiety was found correlating to HCQ shortage in both diseases more signifcantly in SLE patients.
ABSTRACT
Background: During COVID-19 disease era, there is an accelerated demand for hydroxychloroquine since it was suggested by some centers as potential therapy for COVID-19 which has led to diminished supplies for patients with rheumatic disease and which carried unexpected risk for disease flare particularly in patients with systemic lupus erythematosus and rheumatoid arthritis. The purpose of the work is to detect the effect of HCQ shortage in patients with RA and SLE on anxiety and disease activity. Results: A total of 320 patients were divided into two groups: group 1-216RA patients with mean age 45.5 +/- 9.59 years, disease duration 43.4 +/- 25.6 months with female predominance (62.5%). Group 2-104 SLE patients with mean33.4 +/- 7.9 age years, disease duration 52.1 +/- 34.6 months with female predominance (85.6%). HCQ shortage occurred in 174 RA patients (80.5%) and 76 lupus patients (73.1%). Despite HCQ shortage, there were no significant change in disease activity of RA (using CDAI) and SLE (using SELENA) p = 0.063 and 0.064 respectively before and after HCQ shortage. Anxiety level was higher in patients who were exposed to HCQ shortage in both groups (SLE p 0.0058 and RA p 0.0044) when we compared them to those without HCQ shortage. Conclusion: In most patients with RA and SLE, the COVID-19 pandemic resulted in a HCQ scarcity, with no effect on disease activity. Anxiety was found to be associated with HCQ shortage in both diseases.
ABSTRACT
Background Thrombotic consequences have been reported in COVID-19-infected patients, especially those who are critically ill. Multiple studies have tested antiphospholipid antibodies (aPLs) among COVID-19 patients, but to date, the actual frequency of aPLs is still uncharted. In this cohort study, we analyzed the outcomes of 173 consecutive patients with confirmed COVID-19 infection. Anti-phospholipid antibodies, which include anti-cardiolipin antibodies [aCL (IgM), aCL (IgG)], and B2-glycoprotein I antibodies [a beta 2GPI (IgM), a beta 2GPI (IgG)] were detected by using immunoassays. In contrast, lupus anti-coagulant (LAC) antibodies are identified through a coagulation-based assay. Results The study demonstrated a high incidence of thrombotic consequences in severe COVID pneumonia cases and supported an increased risk of developing aPLs following COVID-19 infection. Pulmonary embolism had the most common prevalence of all thrombotic events. Among the various aPLs tested in thrombotic patients, lupus anti-coagulant (LAC) had the highest positivity (46.2%). Most patients with arterial thromboembolism (stroke, myocardial infarction, limb ischemia, bowel ischemia, and renal artery thrombosis) had triple positivity of anti-phospholipid antibodies. Testing aPLs antibodies after 12 weeks of recovery for survived patients only 2 out of 23 patients had aPLs positivity compared to 35 out of 65 tested during hospital admission. Furthermore, we found no significant changes in aPLs positivity between survived and non-survived patients with thrombotic event. Conclusions aPLs increased transiently as an inflammatory-mediated condition. Individuals with aPLs triple positivity (positive LAC, aCL, and aB2GPI) had a considerable risk of arterial thromboembolism (ATE).