ABSTRACT
Background: The management of patients with immuno-rheumatological diseases has profoundly changed during the COVID 19 pandemic and telemedicine has played an important role in the disease follow-up. In addition to monitoring disease activity and any adverse events, especially infectious events, assessing the psychological situation of the patient can be fundamental in particular considering that COVID-19 has also a serious impact on mental health and it has been demonstrated a signifcantly higher incidence of anxiety disorders and depressive symptoms especially in younger people Objectives: The aim of this study is to evaluate the incidence of depressive disorders, anxiety and fbromyalgia in our patients with rheumatoid arthritis and psoriatic arthritis during the lockdown period due to the COVID 19 pandemic and validate the use of telemedicine in the clinical management of these patients. Methods: Patients affected by rheumatoid and psoriatic arthritis treated with biological disease-modifying drugs were contacted to evaluate the state of health and the presence of any adverse events and a nurse administered the clinimetric questionnaires assessment to evaluate the disease activity, the impact of rheumatic disease on the health status and the presence of anxiety, depression and fbromy-algia. In particular the following scales have been used: The Rheumatoid Arthritis Impact of Disease (RAID), the Psoriatic arthritis impact of disease (PsAID), Beck Depression Inventory BDI-II, State-Trait Anxiety Inventory (STAI) and The Fibromy-algia Rapid Screening Tool questionnaire (FIRST), The VAS scale for the assessment of pain. Patients who reported disease fare-up or adverse events underwent an outpatient visit and during visit Disease Activity Score (DAS 28) and Disease Activity Index for Psoriatic Arthritis (DAPSA) were used. Results: 171 patients with rheumatoid arthritis (RA) and 129 patients with psoriatic arthritis were enrolled. The incidence of fbromyalgia was increased in the two groups during the lockdown compared to the previous evaluations and in particular in patients with psoriatic arthritis (AR p =0.013, AP p= 0.001).Our analysis did not report signifcant differences between the two groups for the presence of fbromyal-gia and anxiety-related disorders during lockdown, but a prevalence of depressive disorders in patients with rheumatoid arthritis was observed.During lockdown in RA patients, (n=50), no correlation was found between DAS28 and RAID score (r=0.112, p=0.438) and in PsA patients (n=34), no correlation was found between DAPSA and PSAID score (r=0.131, p=0.459) while median value of RAID was higher in STAI I and II positive and median value of PSAID was higher in STAI I and II positive. Patients positive at BDI had higher RAID score (median 6.28 vs 1.14) and PSAID (median 4.95 vs 2.85) score (Mann Whitney p<0.001 and p=0.003) Conclusion: In conclusion, mental and physical stress during COVID-19 pandemic can greatly worsen FM symptoms and intensify the patients' suffering without a clinical fare of the infammatory disease for patients affected by rheumatoid arthritis. Telemedicine has allowed us to identify patients who needed a face-to-face approach for therapeutic reevaluation even if not related to a fare of the disease.
ABSTRACT
Background and aims: Herein authors present a systematic review and metanalysis on the incidence of thrombotic events in pediatric and adolescent Sars-Cov-2 infection and the use of anticoagulant therapy in this age group. Methods: N 244 titles were screened using the elected MESH words, n 188 s and n 120 full text were read, n 12 articles were included, and among these last, four were included for metanalysis. Results: Over 1128 COVID-19 positive patients, nearly half of them developed inflammatory sequelae, and 7.35% developed thrombotic events. Less than half patients who developed inflammatory disease were under anticoagulant prophylactic treatment, and dosages of therapeutic anticoagulant protocols vary from different centres. Thrombotic events solved after the onset of unfractioned heprin (UFH) therapy in the majority of cases, even if 1.06% died. Two of these deaths had peripheral severe gangrene. No difference in the incidence of thrombotic events between patients under prophylactic low molecular weight heparin (LMWH) and without was found in metanalysis. Conclusions: Little is known on the incidence and management of hypercoagulopathy in pediatric COVID-19 infection;prophylactic doses of LMWH seem to be inefficient in preventing thrombotic events. Therapeutic dosed of UFH seem more efficient. Protocols on dosages have to be discussed. (Figure Presented).