ABSTRACT
To describe the clinical case of coronavirus disease-2019, in a patient with rheumatoid arthritis. The patient A., 54, woman, was admitted in a rheumatologic hospital on April 27, 2020 due to the exacerbation of RA. The patient has been observed with the diagnosis of RA since 2013. At the time of admission, the patient took selective NSAIDs only. RNA SARS-CoV-2 (April 24, 2020) was negative. Results of the hospital examination (April 28, 2020): body mass index 32.63 kg/m2. CRP 13 mg/l, rheumatoid factor 65.4 IU/ml, MCV antibodies 30.7 U/ml, beta-2-glycoprotein antibodies IgG > 100 U/ml, ESR 35 mm/hour. Hospital treatment was carried out: methylprednisolone in a total dose of 2 grams intravenously drop-by-drop (from April 30 to May 4, 2020), methylprednisolone in tablets 6 mg/day, leflunomide 20 mg/day. On May 5, 2020 the patient presented with fever up to 38.5°C, which lasted two days, weakness, headache, abundant sweating, SpO2 96%, CRP 45 mg/l. CT of chest (May 7, 2020) was performed: numerous seals of pulmonary tissue of the type of "matte glass" with a peribronchial and subpleural localization on both lungs (severe double pneumonia) (Fig. 1). RNA SARS-?oV-2 (May 7, 2020) was positive. The patient was transferred to the infectious clinic. The patient received therapy with Azithromycin, Levofloxacin, Ambroxol, Hydroxychloroquine, Paracetamol, Enoxaparin Sodium, and oxygen therapy. CT of chest (May 11, 2020): 70% reduction in lung damage. The patient was discharged in a satisfactory condition on May 15, 2 020. Currently, the dominant concept is that patients with rheumatic diseases have a higher risk of developing severe forms of COVID-19 than in the general population. The presented data demonstrate a case of undisturbed COVID-19 course in a patient with active rheumatoid arthritis and a risk factor (obesity), who did not have such typical signs as coughing and shortness of breath, as well as a short-term fever course. According to the authors, earlier therapy with glucocorticoids (intravenously and further per os) could facilitate the faster regress of COVID-19.