ABSTRACT
Background: The new coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) is a source of concern for the management of patients suffering from rheumatic and musculoskeletal diseases (RMDs) treated with immunomodulatory therapies (1). Objectives: We aimed to analyze the prevalence of SARS-CoV-2 infection in patients with RMDs living in Italy. Methods: During the first wave (March-May 2020) and during the second wave (October-December 2020) of COVID-19, we conducted a survey to investigate the incidence of SARS-CoV-2 infection in patients with RMDs followed at the Rheumatology Unit of the University of Campania, Italy. The demographic data, medication use, the frequency of respiratory symptoms and the incidence of COVID-19 confirmed by nasopharyngeal swab were collected with questionnaires administered by phone. The prevalence of COVID-19 of our cohort was compared to that of the general population (2). Results: During the first wave, we collected data from 900 patients with RMDs (Table 1): 320 patients with rheumatoid arthritis (RA), 295 patients with spondyloarthropathies (SpA), 283 patients with systemic lupus erythematosus (SLE), 2 patients with vasculitis. 546 (60%) were treated with bDMARD/tsDMARDs. Overall, a total of 11/900 (1%) cases were tested for COVID-19 due to compatible symptoms. 2 (0.2%) adult patients treated with bDMARDs were registered as swab test positive by PCR for COVID-19. 2 patients without confirmed COVID-19 developed pneumonia that required admission to hospital. No deaths occurred among the patients with confirmed COVID-19. During the second wave, data were collected from 470 patients who accepted to take part of the study (Table 1). 49 presented with symptoms that were compatible with COVID-19. 139 patients were tested whereas 30 patients (6%) had a swab confirmation of SARS-CoV-2 infection. Among them, 16 (53%) were treated with bDMARDs and a patient was treated with tofacitinib. we found no increase in COVID-19 prevalence in patients treated with bDMARD/tsDMARDs (p≥0.05). A patient with SLE developed pneumonia that required admission to hospital and died. Lacking distinct prevalence data between first and second waves, we found no differences in total COVID-19 prevalence between general population living in Campania (215.752/5.802.000;3.7%) and patients with RMDs (32/900;3.5%). However, we had a significant increase in COVID-19 prevalence in our cohort during the second wave compared to the first. Nevertheless, no increase in mortality or hospitalization was recorded, confirming the safety of immunomodulatory therapies in patients with RMDs. Conclusion: In this cohort of patients with RMDs in a geographical region with a high prevalence of COVID-19, the risk of SARS-CoV-2 infection does not appear different from that observed in the general population.
ABSTRACT
This article aimed to investigate the incidence of COVID-19 in patients with SLE followed at the Rheumatology Unit of the University of Campania, Italy. Out of them, the majority were females (249), with a median age of 47 years. Approximately 72% of patients were treated with HCQ (5 mg/kg/day), 37% with conventional synthetic disease-modifying drugs (47 mycophenolate, 37 azathioprine, 12 methotrexate, 4 cyclosporine, 1 colchicine), 15 patients were receiving biological agents (13 belimumab, 1 rituximab, and 1 abatacept), and more than half of the cohort were also taking corticosteroids (median dose 5 mg daily). A further 50 patients reported respiratory symptoms consistent with a viral infection, but they did not have access to the swab. These patients had a mild clinical course with a rapid resolution of symptoms. Serological test was performed in 2 patients with respiratory symptoms and was negative. No patients were admitted to hospital care and none reported a viral pneumonia. Even HCQ seems to not have a prophylactic role in the prevention of COVID-19 infection, as it has recently been shown by a randomised controlled trial, such conclusion cannot be drawn from this study which identified no confirmed cases of COVID-19. In conclusion, although they cannot exclude asymptomatic infections, the likely low incidence of COVID-19 in our SLE cohort could encourage the maintenance of ongoing rheumatological therapy. However, these are preliminary results that can only be regarded as tentative to help clinicians until replicated in larger cohorts.