ABSTRACT
In rheumatology, the problem of infectious pathology is quite acute. This is primarily due to the participation of various infectious agents in the development of immuno-inflammatory rheumatic diseases (IIRD), in which microorganisms play a trigger role, triggering the immunopathological mechanisms of inflammation. Vivid examples of such diseases are acute rheumatic fever and reactive arthritis. The infectious etiology of Lyme disease has been proven. An equally difficult task is the fight against comorbid infection (CI), which often complicates the course of many IIRD due to a violation of the immune status caused by both the background disease and the use of immunosuppressive drugs. The predominance of respiratory tract lesions in the structure of CI in patients with IIRD makes it necessary to use influenza and pneumococcal vaccines in them, since the risk of deaths from these infections among these patients is quite high. During the development of the COVID-19 pandemic, which has become a challenge to all mankind, a large number of new fundamental and medical problems have been revealed concerning the relationship between viral infection and many widespread chronic non-communicable diseases, among which IIRDs occupy an important position. As one of the methods of combating the current COVID-19 pandemic, great hopes are pinned on the widespread use of vaccination. The possibility of using monoclonal antibodies for pre-exposure prophylaxis of COVID-19, including in patients with IIRD, is discussed.Copyright © 2023 Ima-Press Publishing House. All rights reserved.
ABSTRACT
Background. Patients with autoimmune and inflammatory rheumatic diseases (AIRDs) are at high risk of developing COVID-19. Vaccination is an effective method of preventing this disease, which may be unsafe for patients with AIRDs. The aim of the study is to assess the safety of Gam-COVID-Vac in patients with IVRD in real clinical practice. Material and methods. A cross-sectional study was carried out. The main group consisted of patients with AIRDs, the control group consisted of individuals without AIRDs. All participants were interviewed by the research physician using a unified questionnaire, additional information was obtained from medical records. Results. The study included 222 patients with AIRDs (119 with rheumatoid arthritis, 36 with ankylosing spondylitis, 17 with psoriatic arthritis, 17 with Sjogren's disease, 10 with undifferentiated spondyloarthritis, 8 with systemic lupus erythematosus, 4 with metabolic arthritis, 3 with systemic scleroderma, 3 with systemic vasculitis, 2 with polymyalgia rheumatica, 2 with undifferentiated systemic connective tissue disease, 1 with adult Still's disease) and 111 patients without AIRDs. The number of patients with AIRDs who had a combination of local and systemic adverse events (AE) on the introduction of the first component of the vaccine was significantly less than in the control group (22.1 and 44.1%, respectively, P<0.001). Similar differences were also noted after the introduction of the second component (14.0 and 29.7%, respectively, P<0.001). AEs such as pain at the injection site without restriction of movement, weakness, fever, arthralgia/myalgia, headache, and chills were significantly more common in the control group after the introduction of the first component of the vaccine. After complete immunization, AEs were absent in 35.6% of patients with AIRDs and in 21.6% of control group patients (P=0.01). Exacerbations of AIRDs and new autoimmune phenomena were not registered in any cases. Conclusions. According to preliminary data, immunization of patients with AIRDs with the Gam-COVID-Vac combined vector vaccine appears to be quite safe.Copyright © Team of Authors, 2022.
ABSTRACT
The review analyzes data on the course and outcomes of axial spondyloarthritis (axSpA) accumulated over the previous 2.5 years of the COVID-19 pandemic. The issues of clinical and immunological efficacy of vaccination against COVID-19 in this disease are considered. It was noted that the presence of axSpA, as well as treatment with tumor necrosis factor-α inhibitors and non-steroidal anti-inflammatory drugs, did not significantly increase the risk of COVID-19 infection and did not worsen its outcomes, apart from an increase in the incidence of venous thromboembolism. At the same time, it is assumed that anticytokine therapy for SpA may protect against severe COVID-19 course. The data presented suggest that the benefits of vaccination in SpA far outweigh the potential harms associated with the development of adverse events. It has been shown that in patients with SpA, vaccination does not affect the activity of the inflammatory process, and biologic disease modifying antirheumatic drugs have almost no significant effect on the post-vaccination response. © 2023, Ima-Press Publishing House. All rights reserved.
ABSTRACT
The review analyzes data on the course and outcomes of axial spondyloarthritis (axSpA) accumulated over the previous 2.5 years of the COVID-19 pandemic. The issues of clinical and immunological efficacy of vaccination against COVID-19 in this disease are considered. It was noted that the presence of axSpA, as well as treatment with tumor necrosis factor-α inhibitors and non-steroidal anti-inflammatory drugs, did not significantly increase the risk of COVID-19 infection and did not worsen its outcomes, apart from an increase in the incidence of venous thromboembolism. At the same time, it is assumed that anticytokine therapy for SpA may protect against severe COVID-19 course. The data presented suggest that the benefits of vaccination in SpA far outweigh the potential harms associated with the development of adverse events. It has been shown that in patients with SpA, vaccination does not affect the activity of the inflammatory process, and biologic disease modifying antirheumatic drugs have almost no significant effect on the post-vaccination response. © 2023, Ima-Press Publishing House. All rights reserved.
ABSTRACT
The problem of coronavirus disease 2019 (COVID-19) still remains relevant even now, after two years. As one of the methods of combating the current COVID-19 pandemic, most experts suggest the widespread use of vaccination. The use of anticovid vaccines in patients with rheumatic diseases raises a number of questions related to efficacy, immunogenicity (especially in patients receiving immunosuppressive therapy), as well as safety of immunization. With that in mind, it is very important to analyze the data on the above-mentioned aspects in real time. This review presents the results of studies on COVID-19 vaccination immunogenicity in rheumatology conducted over the past two years. The ability of a number of antirheumatic drugs to have a negative effect (to varying degrees) on the post-vaccination response has been demonstrated. Interpretation and comparison of the results of vaccine immunogenicity studies are complicated by a number of factors usually associated with the design of works. Within the framework of the problem under consideration, there are still a sufficient number of questions, the answers to which should be found in further research.Copyright © Team of Authors, 2022.
ABSTRACT
The problem of coronavirus disease 2019 (COVID-19) still remains relevant even now, after two years. As one of the methods of combating the current COVID-19 pandemic, most experts suggest the widespread use of vaccination. The use of anticovid vaccines in patients with rheumatic diseases raises a number of questions related to efficacy, immunogenicity (especially in patients receiving immunosuppressive therapy), as well as safety of immunization. With that in mind, it is very important to analyze the data on the above-mentioned aspects in real time. This review presents the results of studies on COVID-19 vaccination immunogenicity in rheumatology conducted over the past two years. The ability of a number of antirheumatic drugs to have a negative effect (to varying degrees) on the post-vaccination response has been demonstrated. Interpretation and comparison of the results of vaccine immunogenicity studies are complicated by a number of factors usually associated with the design of works. Within the framework of the problem under consideration, there are still a sufficient number of questions, the answers to which should be found in further research.Copyright © Team of Authors, 2022.
ABSTRACT
The problem of coronavirus disease 2019 (COVID-19) still remains relevant even now, after two years. As one of the methods of combating the current COVID-19 pandemic, most experts suggest the widespread use of vaccination. The use of anticovid vaccines in patients with rheumatic diseases raises a number of questions related to efficacy, immunogenicity (especially in patients receiving immunosuppressive therapy), as well as safety of immunization. With that in mind, it is very important to analyze the data on the above-mentioned aspects in real time. This review presents the results of studies on COVID-19 vaccination immunogenicity in rheumatology conducted over the past two years. The ability of a number of antirheumatic drugs to have a negative effect (to varying degrees) on the post-vaccination response has been demonstrated. Interpretation and comparison of the results of vaccine immunogenicity studies are complicated by a number of factors usually associated with the design of works. Within the framework of the problem under consideration, there are still a sufficient number of questions, the answers to which should be found in further research.Copyright © Team of Authors, 2022.
ABSTRACT
Background. Patients with autoimmune and inflammatory rheumatic diseases (AIRDs) are at high risk of developing COVID-19. Vaccination is an effective method of preventing this disease, which may be unsafe for patients with AIRDs. The aim of the study is to assess the safety of Gam-COVID-Vac in patients with IVRD in real clinical practice. Material and methods. A cross-sectional study was carried out. The main group consisted of patients with AIRDs, the control group consisted of individuals without AIRDs. All participants were interviewed by the research physician using a unified questionnaire, additional information was obtained from medical records. Results. The study included 222 patients with AIRDs (119 with rheumatoid arthritis, 36 with ankylosing spondylitis, 17 with psoriatic arthritis, 17 with Sjögren's disease, 10 with undifferentiated spondyloarthritis, 8 with systemic lupus erythematosus, 4 with metabolic arthritis, 3 with systemic scleroderma, 3 with systemic vasculitis, 2 with polymyalgia rheumatica, 2 with undifferentiated systemic connective tissue disease, 1 with adult Still's disease) and 111 patients without AIRDs. The number of patients with AIRDs who had a combination of local and systemic adverse events (AE) on the introduction of the first component of the vaccine was significantly less than in the control group (22.1 and 44.1%, respectively, P<0.001). Similar differences were also noted after the introduction of the second component (14.0 and 29.7%, respectively, P<0.001). AEs such as pain at the injection site without restriction of movement, weakness, fever, arthralgia/myalgia, headache, and chills were significantly more common in the control group after the introduction of the first component of the vaccine. After complete immunization, AEs were absent in 35.6% of patients with AIRDs and in 21.6% of control group patients (P=0.01). Exacerbations of AIRDs and new autoimmune phenomena were not registered in any cases. Conclusions. According to preliminary data, immunization of patients with AIRDs with the Gam-COVID-Vac combined vector vaccine appears to be quite safe.
ABSTRACT
The problem of coronavirus disease 2019 (COVID-19) still remains relevant even now, after two years. As one of the methods of combating the current COVID-19 pandemic, most experts suggest the widespread use of vaccination. The use of anticovid vaccines in patients with rheumatic diseases raises a number of questions related to efficacy, immunogenicity (especially in patients receiving immunosuppressive therapy), as well as safety of immunization. With that in mind, it is very important to analyze the data on the above-mentioned aspects in real time. This review presents the results of studies on COVID-19 vaccination immunogenicity in rheumatology conducted over the past two years. The ability of a number of antirheumatic drugs to have a negative effect (to varying degrees) on the post-vaccination response has been demonstrated. Interpretation and comparison of the results of vaccine immunogenicity studies are complicated by a number of factors usually associated with the design of works. Within the framework of the problem under consideration, there are still a sufficient number of questions, the answers to which should be found in further research.
ABSTRACT
Objective: To compare the incidence of complications and the need for hospitalization for COVID-19 in groups of patients older than and younger than 60 years of age with rheumatic diseases (RD). Material(s) and Method(s): The study involved 89 patients with RD who underwent COVID-19, verified by RT-PCR for SARS-CoV- 2 RNA, for the period from 05/15/2020 to 12/01/2021. Participants in the study, after talking with the research physician, filled out questionnaires on past COVID-19 and post-COVID syndrome. The information was supplemented with data from discharge records after inpatient treatment for COVID-19. Statistica program (version 12) was used for statistical processing. Result(s): The data obtained were differentiated depending on the age of the participants: < 60 years (group 1), N = 69 and > = 60 years (group 2), N = 20. Both groups were dominated by women (82.6% and 85%). The average age in group 1 was 41.9 +/- 11.6 years, in group 2 -68.5 +/- 5.1 years. 19 patients (48.7%) in group 1 and 13 patients (65%) in group 2 were hospitalized. Of these, oxygen support was statistically more frequent (P < 0.05) in group 2 patients: 9 (69.2%) vs 5 (26.3%). Complications were registered in group 1 in 9 cases (13%): venous thrombosis in 1 patient, acute respiratory failure in 4 patients and the development of concomitant infections in 4 patients. In group 2, complications were noted significantly more often (P < 0.05) -in 8 cases (40%): venous thrombosis in 2, acute respiratory failure in 1, acute heart failure in 1, acute cerebrovascular accident in 1 and the development of concomitant infections in 3 patients. 7 patients (10.1%) in group 1 had COVID-19 again on average 11.5 +/- 2.2 months after the first case. Of these, 1 patient required hospitalization. There were no recurrences of COVID-19 in group 2. Conclusion(s): Elderly patients with RD with COVID-19 are more likely to need oxygen support. Also in this group, COVID-19 is more likely to cause serious complications, including cardiovascular and respiratory failure and thrombotic complications.
ABSTRACT
Purpose: To compare the frequency of occurrence of various symptoms of post-covid syndrome (PCS) in groups of patients with rheumatic diseases (RD) of the elderly to young. Material(s) and Method(s): The study involved 89 patients with RD who underwent COVID-19, verified by RT-PCR for SARS-CoV- 2 RNA, for the period from 05/15/2020 to 12/01/2021. Participants in the study, after talking with the research physician, completed questionnaires on past COVID-19 and post-COVID syndrome (PCS). The information was supplemented with data from discharge records after inpatient treatment for COVID-19. Result(s): The data obtained were differentiated depending on the age of the participants: <60 years (group 1), N = 69 and >=60 years (group 2), N = 20. Both groups were dominated by women (82.6% and 85%). The average age in group 1 was 41.9 +/- 11.6 years, in group 2 -68.5 +/- 5.1 years. 33 (47.8%) patients in group 1 and 10 (50%) in group 2 noted the development of PCS. In group 1, the following symptoms of PCS prevailed: memory impairment -in 17 (51.5%) patients, fatigue, weakness -in 14 (42.4%), problems with concentration -in 14 (42.4%), arthralgia -in 12 (36.4%) %, shortness of breath during physical exertion -in 11 (33.3%), drowsiness -in 10 (30.3%), irritability -in 9 (27.3%). In group 2, the most common memory impairment -in 8 (80%) patients, weakness, fatigue -in 7 (70%), arthralgia -in 7 (70%), problems with concentration -in 6 (60%), weight loss -in 5 (50%), irritability -in 5 (50%), sleep disturbance -in 5 (50%). The frequency of occurrence of different manifestations of PCS did not differ significantly between the groups. On average (median), each patient in group 1 noted 4 [2;8], group 2 -10 [8.25;12.5] symptoms of PCS at the same time, but the differences did not reach statistical significance. Conclusion(s): The frequency of occurrence of various clinical manifestations of PCS did not have statistically significant differences between the study groups. In a comparative assessment, the group of elderly patients noted a greater number of symptoms of PCS at the same time.
ABSTRACT
Objective: to compare the features of COVID-19 in groups of patients older and younger than 60 years of age with rheumatic diseases (RD). Material(s) and Method(s): The study involved 89 patients with RD who underwent COVID-19, verified by RT-PCR for SARS-CoV- 2 RNA. Participants in the study, after talking with the research physician, completed questionnaires on the past COVID-19. The information was supplemented with data from discharge records after inpatient treatment for COVID-19. Result(s): The data obtained were differentiated depending on the age of the participants: <60 years (group 1), N = 69 and >=60 years (group 2), N = 20. In both groups, RDs were predominantly represented by rheumatoid arthritis (53.6% and 75%, respectively). Both groups were dominated by women (82.6% and 85%). The average age in group 1 was 41.9 +/- 11.6 years, in group 2 -68.5 +/- 5.1 years. At the time of the development of COVID-19, the severity of symptoms of RD according to VAS did not have significant differences in both groups and amounted to 4.3 +/- 2.8 in group 1 and 4.8 +/- 2.7 in group 2. Among the clinical manifestations of COVID-19 in both groups, weakness, fatigue -in 65 (94.2%) and 18 (90%) patients, respectively, fever -in 56 (81.1%) and 15 (75%), anosmia -in 43 (62.3%) and 14 (70%) patients, arthralgia -in 37 (53.6%) and 13 (65%) patients, myalgia -in 32 (46.4%) and 16 (80%) patients. In group 2, myalgia occurred significantly more often than in group 1 (P < 0.05). During the COVID-19 period, CT scan was performed in group 1 -39 patients, in group 2 -14. Changes corresponding to CT-0 were detected in groups 1 and 2 in 10 (25.5%) and 0 patients, respectively, CT-1 -in 19 (48.7%) and 4 (28.6%), CT-2 -in 9 (23.2%) and 5 (35.7%), CT-3 -in 1 (2.6%) and 4 (28.6%), CT-4 -in 0 and 1 (7.1%). Statistically, severe lung damage (CT-3.4) was significantly more common in group 2, and patients in group 1 more often had the disease without lung damage (CT-0), P < 0.05. Conclusion(s): Weakness, fever, arthralgia, myalgia and anosmia were the most common manifestations of COVID-19 in the study groups. Myalgia was significantly more common in patients over 60 years of age. When assessing pulmonary changes, the severe course of COVID-19 was significantly more common in the group of elderly patients.
ABSTRACT
Epstein-Barr virus (EBV) belongs to the family of herpesviruses (herpes type 4) and is one of the most common and highly contagious. During the pandemic of a new coronavirus disease, it was found that in patients previously infected with EBV, COVID-19 can cause its reactivation, which is often manifested by the clinic of acute hepatitis. The article presents a clinical case of the development of acute hepatitis in a patient with mixed infection with EBV and SARS-CoV-2 in combination with allergic toxic reaction while taking sulfasalazine prescribed for spondyloarthritis. A feature of this case was the development of severe hepatitis of mixed genesis with a favorable outcome. The importance of adherence to drug monitoring rules for newly prescribed drugs for COVID-19 was emphasized. In severe cases of the disease, the possibility of mixed infection should be taken into account. © 2022, Ima-Press Publishing House. All rights reserved.
ABSTRACT
Background: It is assumed that patients with immuno-infammatory rheumatic diseases (IIRDs) in old age are susceptible to a more severe course of COVID-19 both due immunological disorders (autoimmune disease and its activity, immuno-suppressive therapy, immunosenescence leading to systemic subclinical chronic infammation with increased secretion of IL-6, IL-1, IL-18, TNF-α) and due to the presence of comorbid pathology. There are no Russian data on the course of COVID-19 in elderly patients with IIRDs. Objectives: To study the features of the course of COVID-19 in elderly patients with IIRDs. Methods: The study included 93 patients with IIRDs: 72 women, 21 men, average age 67.5±6.1 years. Of them, 62 patients suffered from rheumatoid arthritis, 9-systemic sclerosis, 5-ankylosing spondylitis, 4-Sjogren's disease, 4-systemic vasculitis, 3-psoriatic arthritis, 2-osteoarthritis, 1 systemic lupus erythematosus, 1-polymyositis, 1-rheumatic polymyal-gia, 1-gout. At the moment of COVID-19, 10 patients had high activity of IIRDs, 26-moderate, 40-low, 17-remission. 69 patients were treated with disease-modifying antirheumatic drugs-DMARDs (40-methotrexate, 12-lefunomide, 8-sulfasalazine, 7-hydroxychloroquine), 45-glucocorticoids (34-low doses, 11-medium or high doses). 36 patients received biologic or target DMARDs: 24-rituximab (the interval from the last administration to the development of COVID-19 symptoms averaged 7 months), 4-TNF-α inhibitors, 3-abatacept, 2-secukinumab, 1-tofacitinib, 1-baricitinib, 1 ustekinumab. Comorbidities included hypertension (n=74), coronary artery disease (n=27), obesity (n=17), diabetes mellitus (n=8), bronchial asthma (n=5), chronic obstructive pulmonary disease (n=4), chronic kidney disease (n=3). The patients were interviewed by a research doctor, additional information was obtained from medical documentation. Results: The most common symptoms of COVID-19 were fever-67.7%, weakness/drowsiness-53.7%, cough-48.4%, as well as anosmia and dyspnea-35.5% each, headache-20.4%, body aches-16.1%, congestion nose-8.6%, chest pain-7.5%, dysgeusia-5.4%, diarrhea/vomiting-3.2%. According to CT chest scan, 8 patients had 0% of lung damage, 31-25%, 32-50%, 12-75%, in other cases the study was not carried out (n=9) or data are not available (n=1). In 2 patients the course of COVID-19 was complicated by bacterial pneumonia, in 1-bacterial-fungal. An asymptomatic course was noted only in 2 patients (PCR+/IgM +, CT 0, close contact with a confrmed case of COVID-19). Recovery was noted in 90 patients, fatal outcome-in 3. Exacerbation of IIRDs after COVID-19 was noted in 48.4% of patients, which required intensifying antirheu-matic therapy. Conclusion: Preliminary data indicate that COVID-19 is characterized by moderate and severe course in elderly patients with IIRDs. Further studies are required to identify risk factors for severe course and complications in order to provide timely qualifed care.
ABSTRACT
Background: Patients with spondyloarthritis (SpA) probably have a high incidence of COVID-19. Vaccination remains one of the most effective methods of preventing infectious diseases. However, data on the safety of vaccines against COVID-19 in patients with SpA are few and relate to foreign vaccines that are not licensed in Russia. Objectives: To study the safety of COVID-19 vaccines in patients with SpA in real clinical practice. Methods: The study included 47 SpA patients (25-ankylosing spondylitis, 13-psoriatic arthritis, 9-undifferentiated SpA, 19 women, 28 men, age 42.3±11.6 years, duration of the disease 11.8±9.2 years)-the main group and 97 people without any immuno-infammatory rheumatic diseases (67 women, 30 men, age 43.7±13.1 years)-the control group. 20 patients received disease-modifying antirheumatic drugs (12-methotrexate, 8-sulfasalazine), 10-biological drugs (8-TNF-α inhibitors, 2-IL-17 inhibitors), 6-glucocorticoids, 1-tofacitinib, 12-only nonsteroidal anti-infammatory drugs, 8-did not receive therapy. In the main group, 40 patients were vaccinated with Gam-COVID-Vac (Sputnik V), 3-Covi-Vac and Sputnik Light, 1-EpiVacCorona (both components of the vaccine were received by 44 patients). In the control group 69 were vaccinated with Sputnik V, 15-CoviVac, 5-Sputnik Light and BNT162b2, 2-EpiVacCorona, 1-mRNA-1273. (91 participants received both components of the vaccine). All participants were interviewed by a research doctor with a unifed questionnaire, additional information was obtained from medical documentation. Results: The data obtained are refilected in the Table 1. Local adverse events (AEs) occurred relatively less frequently in patients with SpA than in the control group. After the introduction of the first component of the vaccine, there was a significant increase in the frequency of pain without restriction of movement and edema/hyperemia in the control group (p<0.001 and p=0.049, respectively), while after the introduction of the second component, a significant difference was registered only for the first indicated symptom (p<0.001). The most frequent systemic AEs were weakness, fever, arthralgia or myalgia, headache, and chills, which were significantly less common (p=0.008) in the main group after immunization with the first component. The proportion of SpA patients without any reactions was significantly higher after the introduction of the first component of the vaccine (59.6% and 29.9%, p<0.001), while after immunity with the second component there were no differences (59.1% and 44.0%, p>0.05). After complete immunization, the percentage of patients without any AEs was significantly higher in the main group than in the control (50.0% and 17.6%, p<0.001). There was no exacerbation of SpA or development of new autoimmune phenomena in the main group after full vaccination. Conclusion: According to preliminary data, the tolerability of vaccines against COVID-19 in patients with SpA is satisfactory. Further studies with an increased sample are needed to study the safety, immunogenicity and clinical efficacy of immunization against COVID-19 in patients of this cohort.
ABSTRACT
Background: Almost two years after the start of the pandemic, it has become clear that the severity of COVID-19 is not limited to the manifestations of the acute phase of SARS-CoV-2 infection. The so-called post-covid syndrome (PCS) can occur even in patients who have experienced mild or moderate COVID-19 and includes long-term symptoms that may be associated with residual infammation, organ damage, non-specifc effects of hospitalization or prolonged ventilation, social isolation, or comorbid diseases. In October 2021, the WHO defned PCS as a condition that occurs in individuals with a history of probable or confrmed infection with the SARS-CoV-2 virus, usually within 3 months of the onset of COVID-19, and is characterized by the presence of symptoms for at least 2 months, as well as the impossibility of explaining them with an alternative diagnosis. Objectives: To conduct a comparative assessment of clinical and demographic indicators in groups of patients with rheumatoid arthritis who underwent COVID-19, with and without PCS. Methods: The material of the questionnaires flled in by patients of the V.A. Nasonova Research Institute of Rheumatology, who underwent COVID-19, ver-ifed by RT-PCR for SARS-CoV-2 RNA. The information was supplemented with data from discharge records after inpatient treatment for COVID-19. Statistica program (version 12) was used for statistical processing. The results of correlation analysis were considered signifcant at p<0.05. Results: The study included 23 adult patients (over 18 years of age) with a reliable diagnosis of rheumatoid arthritis (ACR/EULAR). Of these, 11 (47.8%) patients noted the development of PCS (Group 1), and 12 patients underwent COVID-19 without consequences (Group 2). Both groups were represented predominantly by women (90.9% and 91.7%, respectively). The average age in both groups did not differ sig-nifcantly and amounted to 56.73±14.79 years in group 1, and 48.17±19.59 years in group 2. The median number of comorbid diseases was 2 [1;4] in group 1 and 0.5 [0;2.5] in group 2. PCS was presented by the following symptoms: weakness, increased fatigue-in 6 patients, problems with attention, concentration-in 7, memory impairment-in 6, sleep disturbances-in 7, increased pain in the joints-in 7, shortness of breath during exercise-in 6, fuctuations in blood pressure-in 5, tachycardia-in 4. On average (median), each patient noted 10 [6.5;12] symptoms of PCS at a time. When assessing the number of symptoms in the infectious phase, in group 1, patients reported 20 [16;23], and in group 2, 10 [7;12] symptoms of COVID-19. At the time of development of COVID-19, the severity of RA symptoms, assessed by VAS, was 5.64±3.26 in group 1 and 4.75±2.99 in group 2. In group 1, 5 (45.5%) patients needed hospitalization, 3 of them needed oxygen support. In group 2, 4 (33.3%) patients were hospitalized, two of them needed oxygen support. 3 patients in group 1 suffered COVID-19 again on average 9.33±2.52 months after the frst illness. One of them has been vaccinated. All patients in this group were treated as outpatients, while the frst case of COVID-19 required one hospitalization and oxygen support. Statistical assessment of signifcant differences (p<0.05) between groups in terms of sex, age, number of comorbid diseases, number of COVID-19 symptoms in the infectious phase, severity of RA symptoms, and hospitalization rate was not revealed. Conclusion: Even though when assessing the socio-demographic characteristics, no statistically significant differences were found between the study groups, the average age, the number of comorbid diseases, and the severity of RA symptoms at the time of COVID-19 were higher in the group of patients with RA and PCS. Patients with PCS reported higher rates of hospitalizations and more severe COVID-19. There were also repeated cases of COVID-19 in this group. It is necessary to continue the study on a larger cohort.
ABSTRACT
Background: COVID-19 remains a serious problem almost two years later, despite the ongoing active search for effective tools to control it. To date, it is known that COVID-19 not only proceeds as an acute respiratory illness, but also leads to a systemic infammatory response and hypercoagulability through activation of both the innate and adaptive immune systems. Patients with rheumatic and musculoskeletal diseases appear to be more vulnerable to the development of severe forms of COVID-19 due to the impaired immune response associated with RMD. In addition, immunosuppressants prescribed to control RMD increase the risk of infections. And fnally, RMD is often combined with comorbid conditions from the group of risk factors for severe forms of COVID-19 such as arterial hypertension, diabetes mellitus and obesity. Objectives: to characterize the features of the course of COVID-19 in patients with rheumatoid arthritis. Methods: We studied the material of questionnaires flled out by patients of the hospital of the V.A. Nasonova Research Institute of Rheumatology who underwent COVID-19, verifed by RT-PCR to SARS-CoV-2 RNA, for the period from 05/15/2020 to 12/15/2021. The information was supplemented with data from discharge reports after inpatient treatment of COVID-19. Statistica software (version 12) was used for statistical processing. The results of the correlation analysis were considered reliable at p≤0.05. Results: The study included 32 adult (over 18 years old) patients (29 women, 90%) with a reliable diagnosis of rheumatoid arthritis (ACR/EULAR). The average age of patients is 50.75 ± 16.48 years. In the study group, 29 (90.6%) patients never smoked, 2 smoked in the past and 1 was an active smoker. The duration of the course of RA (median) was 8 [4;14.5] years. The most common comorbidities were diseases of the cardiovascular system (in 20 patients), diseases of the gastrointestinal tract (in patients), diabetes (in 4 patients) and obesity (in 5 patients). The median number of comorbid diseases was 1 [0;3]. At the time of the development of COVID-19, the severity of RA symptoms, assessed by the VAS, was 4.78 ± 3.06. As antirheu-matic therapy, 10 (31.25%) patients took glucocorticoids at an average dose of 5 ± 3.9 mg/day. (prednisolone equivalent), 22 (68.75%)-DMARDs. 19 patients received bDMARDs, incl. 12-rituximab (37.5%, of which 7 received the last infusion within 6 months or less before the frst symptoms of COVID-19 appeared). Among the clinical manifestations of COVID-19, weakness was most often noted, fatigue-in 29 (90.6%), fever-in 23 (71.9%), anosmia-in 20 (62.5%), dysgeusia-in 19 (59.4%), increased arthralgia-in 17 (53.1%), shortness of breath during exercise-in 16 (50%), cough-in 15 (46.9%). There was a signifcant positive correlation between increased arthralgia during COVID-19 and RA activity. On average (median), each patient reported 13.5 [9.75;19.25] symptoms associated with COVID-19. There was no signifcant correlation between the number of COVID-19 symptoms and RA activity. During COVID-19, CT scan was performed in 19 patients: CT-0-in 1 patient (5.3%), CT-1-in 9 (47.4%), CT-2-in 5 (26.3%), CT-3-in 3 (15.7%), CT-4-in 1 (5.3%). There was no correlation between the CT stage and RA activity. 12 patients (37.5%) were hospitalized, of which needed oxygen support. Rituximab treatment was not associated with hospitaliza-tion rates. Complications were reported in 4 cases (12.5%): venous thrombosis in 2 patients and acute respiratory failure in 2 more patients. Conclusion: 37.5% of COVID-19 patients in the study group required inpatient treatment. In 12.5%-COVID-19 proceeded with complications. The number of symptoms associated with COVID-19 did not correlate with RA activity. However, patients with higher RA activity more often noted increased arthralgia.
ABSTRACT
Background: Patients with rheumatoid arthritis (RA) are at high risk of developing COVID-19. Vaccination should be an effective method of preventing this disease. However, vaccination may be unsafe in RA patients. At present, data on the safety of vaccines against COVID-19 in RA patients are few and relate to foreign vaccines that are not licensed in Russia. Objectives: To study the safety of COVID-19 vaccines in patients with RA in real clinical practice. Methods: The study included 131 RA patients (120 women, 11 men, age 53.8±13.9 years, duration of disease 11.5±9.2 years)-the main group and 121 people without any immuno-infammatory rheumatic diseases (87 women, 34 men, age 39.8±14.2 years)-the control group. 103 patients received disease-modifying antirheumatic drugs (54-methotrexate, 30-lefunomide, 10-hydroxychloroquine, 8-sulfasalazine, 1-mofetil mycophenolate), 68-biological drugs (58-rituximab, 5-TNF-α inhibitors, 4-abatacept, 1-tocilizumab), 64-glucocorticoids, 10-did not receive therapy. In the main group, 92 patients were vaccinated with Gam-COVID-Vac (Sputnik V), 21 with Sputnik Light, 16 with CoviVac, 2 with EpiVacCorona (110 patients received two components of the vaccine). In the control group, 91 were vaccinated with Sputnik V, 16 with Covi-Vac, 6 with BNT162b2, 5 with Sputnik Light, 2 with EpiVacCorona, 1 with mRNA-1273 (114 participants received two components of the vaccine). All participants were interviewed by a research doctor with a unifed questionnaire, additional information was obtained from medical documentation. Results: Local and systemic adverse events (AEs) were observed both in the main group and in the control group. After the introduction of the frst component of the vaccine, local AEs (pain/hyperemia/edema) were noted in 12.2% of RA patients and in 10.7% of the control group, after the introduction of the second component of the vaccine-in 9.1% and 11.4% of respondents, respectively (in both groups p>0.05). There was a signifcant difference between the main group and the control group in the frequency of pain at the injection site without restriction of movements both after the frst (24.4% and 40.5%, p=0.007) and after the second component (18.2% and 31.6%, p=0.021). The most frequent systemic AEs were weakness, fever, muscle or joint pain, headache, chills, which were observed in both groups after administration of both the frst and second components of the vaccine. There was a signifcant difference between the main group and the control group in the frequency of fever (16.8% and 39.7%, p<0.001), weakness (26.0% and 38.8%, p=0.029), muscle and joint pain (9.2% and 25.6%, p<0.001) after administration of the frst (but not the second) component of the vaccine. A signifcant difference was revealed between the main group and the control group in the number of patients with local and systemic AEs both after the introduction of the frst component of the vaccine (19.1% and 43%, p<0.001) and after the second (15.5% and 30.7%, p=0.007). After administration of the two components of the vaccine, a higher number of patients without any AEs were detected in the main group compared to the control group (32.7% and 18.4%, p=0.014). Exacerbation of RA and the emergence of new autoimmune phenomena in main group are not marked. Conclusion: According to preliminary data, the tolerance of vaccines against COVID-19 in RA patients is satisfactory. Further studies are needed to study the safety, immunogenicity and clinical efficacy of immunization against COVID-19 in patients of this cohort.