ABSTRACT
Background: Some factors associated with severe COVID-19 outcomes have been identifed in patients with psoriasis (PsO) and infammatory/autoimmune rheumatic diseases, namely older age, male sex, comorbidity burden, higher disease activity, and certain medications such as rituximab. However, information about specifcities of patients with PsO, psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), including disease modifying anti-rheumatic drugs (DMARDs) specifcally licensed for these conditions, such as IL-17 inhibitors (IL-17i), IL-23/IL-12 + 23 inhibitors (IL-23/IL-12 + 23i), and apremilast, is lacking. Objectives: To determine characteristics associated with severe COVID-19 outcomes in people with PsO, PsA and axSpA. Methods: This study was a pooled analysis of data from two physician-reported registries: the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), comprising patients with PsO/PsA, and the COVID-19 Global Rheumatology Alliance (GRA) registry, comprising patients with PsA/axSpA. Data from the beginning of the pandemic up to 25 October, 2021 were included. An ordinal severity outcome was defned as: 1) not hospitalised, 2) hospitalised without death, and 3) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics (age, sex, time period of infection), comorbidities (hypertension, other cardiovascular disease [CVD], chronic obstructive lung disease [COPD], asthma, other chronic lung disease, chronic kidney disease, cancer, smoking, obesity, diabetes mellitus [DM]), rheumatic/skin disease (PsO, PsA, axSpA), physician-reported disease activity, and medication exposure (methotrexate, lefunomide, sulfasalazine, TNFi, IL17i, IL-23/IL-12 + 23i, Janus kinase inhibitors (JAKi), apremilast, glucocorticoids [GC] and NSAIDs). Age-adjustment was performed employing four-knot restricted cubic splines. Country-adjustment was performed using random effects. Results: A total of 5008 individuals with PsO (n=921), PsA (n=2263) and axSpA (n=1824) were included. Mean age was 50 years (SD 13.5) and 51.8% were male. Hospitalisation (without death) was observed in 14.6% of cases and 1.8% died. In the multivariable model, the following variables were associated with severe COVID-19 outcomes: older age (Figure 1), male sex (OR 1.53, 95%CI 1.29-1.82), CVD (hypertension alone: 1.26, 1.02-1.56;other CVD alone: 1.89, 1.22-2.94;vs no hypertension and no other CVD), COPD or asthma (1.75, 1.32-2.32), other lung disease (2.56, 1.66-3.97), chronic kidney disease (2.32, 1.50-3.59), obesity and DM (obesity alone: 1.36, 1.07-1.71;DM alone: 1.85, 1.39-2.47;obesity and DM: 1.89, 1.34-2.67;vs no obesity and no DM), higher disease activity and GC intake (remission/low disease activity and GC intake: 1.96, 1.36-2.82;moderate/severe disease activity and no GC intake: 1.35, 1.05-1.72;moderate/severe disease activity and GC intake 2.30, 1.41-3.74;vs remission/low disease activity and no GC intake). Conversely, the following variables were associated with less severe COVID-19 outcomes: time period after 15 June 2020 (16 June 2020-31 December 2020: 0.42, 0.34-0.51;1 January 2021 onwards: 0.52, 0.41-0.67;vs time period until 15 June 2020), a diagnosis of PsO (without arthritis) (0.49, 0.37-0.65;vs PsA), and exposure to TNFi (0.58, 0.45-0.75;vs no DMARDs), IL17i (0.63, 0.45-0.88;vs no DMARDs), IL-23/IL-12 + 23i (0.68, 0.46-0.997;vs no DMARDs) and NSAIDs (0.77, 0.60-0.98;vs no NSAIDs). Conclusion: More severe COVID-19 outcomes in PsO, PsA and axSpA are largely driven by demographic factors (age, sex), comorbidities, and active disease. None of the DMARDs typically used in PsO, PsA and axSpA, were associated with severe COVID-19 outcomes, including IL-17i, IL-23/IL-12 + 23i, JAKi and apremilast.
ABSTRACT
Objectives: To evaluate changes in terms of disease activity, functionality and depressive symptoms in an ambulatory clinic-based cohort of Colombian Rheumatoid arthritis patients after the COVID-19 pandemic onset. Methods: We conducted a medical records review cohort study. Mean disease activity (DA) was calculated for a before pandemic period (Mar. 2019 -Mar. 2020) using the DAS28-ESR and up to 12 months after the pandemic onset (Sep. 2020 -Mar. 2021) through the RAPID-3 [1]. Both average scores were used to categorize our patients as having high-, moderate-, low-DA, or remission. Alongside, functionality and depressive symptoms were assessed through the HAQ and the PHQ9 which after the onset of the pandemic, were self-administered through a web-based tool. Differences on proportions (2 sample X2 test) were calculated and tested for statistical significance. Results: Our population was constituted by 584 patients of whom 78,6% were women and 58,4% presented with low DA or remission at baseline;mean age was 53,2 years (SD 13,12) and preserved functionality (HAQ score ≤ 0.375) was seen on 39,9% of cases. After the onset of the pandemic, over half of our patients were categorized as having moderate and high DA (Fig. 1) and when comparing before and after the pandemic onset, differences of proportions were statistically significant for patients reaching therapeutic goals (58,4% vs 34,2%: dif. of 24,1%;95%CI 18,4%-29,8%;p < 0,0001) and for patients with preserved functionality (39,9% vs 32,7%: dif. of 7,2%;95% CI 1,5% -12,9%;p 0,013). When focusing on the patients who presented at remission before the pandemic, 46,8% showed worsening, being categorized after the pandemic onset with high or moderate DA (Table 1). Interestingly, even when DA was worse, functionality was preserved for 50,2% (n = 119) of them;furthermore, according to the PHQ-9 score [2], results are somewhat counterintuitive showing what seems to be an improvement in depressive symptoms after the pandemic onset. Conclusions: This study contributes to our perception of the COVID-19 pandemic as an urgent challenge not only for RA patients but also for rheumatologists, when acknowledging the unmistakable worsening in terms of higher disease activity and a relatively decrease in functionality. Further research with a longer follow-up should be undertaken to investigate the role of distinct risk or protective variables, the potential explanations on adaptative coping mechanisms and mental health well-being.
ABSTRACT
Objectives: The aim of this study is twofold: 1) to describe the clinical, functional and depressive symptoms of RA patients during the COVID-19 pandemic, and 2) to determine the factors associated with achieving remission or low disease activity in RA patients based on RAPID-3 score assessed on a virtual setting. Methods: A medical records review cohort study was conducted. Patients were assessed remotely from September-2020 to March 2021. Self-administered questionnaires were completed by patients using an online platform evaluating disease activity, functionality and depressive symptoms in an outpatient clinic-based cohort. Disease activity was assessed using the RAPID-3 score. Functional status and depressive symptoms were assessed through the Health Assessment Questionnaire (HAQ) and the Patient Health Questionnaire (PHQ-9), which were self-administered by each patient through a web-based tool. A logistic regression analyses was done to identify determinants related to reaching remission or low disease activity in these RA patients. Results: In total 607 patients were included, 78%women (n = 474) with amean age of 51.8 (SD 13.4) years. Of them, 42.7% (n = 259) of all patients had completed the survey online, 33.4% had 2 registries, and 23.9% had more than 3 registries.Additionally, 54%(n = 327) of all patients assessed remotely were still working (employed). With regards to disease activity, the mean RAPID-3 score was 10.5 (SD 7.3), categorized in remission ≤3 (19.9%), low≤6 (13.7%), moderate 6-12 (26.2%) and high disease activity ≥12 (40.0%). Considering functional status, the mean HAQ score was 0.92 (0.7) and functionality (defined as HAQ score ≤ 0.375 and HAQ score ≤ 1.5) was observed in on 28.8% (n = 174) and 78.3% (n = 475), respectively. Finally, the mean PHQ-9 was 5.4 (SD 5.5), categorized as minimum ≤4 (54.7%), mild 5-9 (24.9%), moderate 10-14 (11.2%) and severe ≥15 (9.2). Predictive factor for achieving remission or low disease activity based on RAPID-3, were the functional status assessed by HAQ (p = ≤0.001) and depressive symptoms assessed by the PHQ-9 (p = ≤0.001). Conclusion: During the current pandemic there is a considerable frequency of disease activity and depressive symptoms in RA patients. Functional status (HAQ) and depressive symptoms (PHQ-9) were identified as determinants of achieving remission or low disease activity based on RAPID-3 score during this pandemic. The COVID-19 pandemic constitutes a critical challenge not only for RA patients but also for rheumatologists in terms of monitoring this condition.