ABSTRACT
Background: COVID-19 has become a common disease in patients with rheumatic immune-mediated diseases (R-IMID). A risk stratifcation of the patients at COVID-19 onset is important to predict possible unfavorable results. Objectives: To identify predictive severity factors in patients with COVID-19 with R-IMID. Methods: Cross-sectional study in a single University Hospital. We included all consecutive patients with a R-IMID and COVID-19 up to November 6th, 2020. Confrmed infection was defned if the patient had a positive nasopharyngeal swab for SARS-CoV-2. COVID-19 case severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) COVID-19 guidelines (1). We performed a multivariable analysis and calculated de odds ratio of critical COVID in patients with R-IMID, adjusting by age, sex and comorbidities. Results: We included 274 patients with R-IMID complicated with COVID-19. At COVID-19 onset, the main comorbidities, analytical values, underlying R-IMID and treatments received are shown in Table 1. According to COVID-19 severity, patients were mild (n=209;76.3%), moderate (n=35;12.8%), severe (n=9;3.3%) and critical (n=21;7.7%). The predictive variables at COVID-19 onset related statistically to critical COVID were older patients, hypertension, dyslipidemia, previous cardiovascular disease, cancer, chronic kidney disease, and chronic liver disease. The only underlying R-IMID and treatment was polymyalgia rheumatica and Rituximab, respectively. Regarding analytical values were higher values of C-reactive protein, LDH, platelets and lymphopenia (Figure 1). Conclusion: We identifed various factors associated with a worse prognosis of COVID-19 in patients with R-IMID. This can help to identify which patients can present a worse course of the disease at the moment of the diagnosis.
ABSTRACT
Background: COVID19 may present different degrees of severity. It is generally thought that viral infections in patients with rheumatic infammatory diseases (R-IMID) or receiving immunosuppressive treatment tend to present more severe disease. However, data comparing the severity of the disease between R-IMID and the general population are scarce. Objectives: To assess the predisposing factors, clinical-analytical features and severity of COVID-19 infection in R-IMID compare to patients without R-IMID. Methods: Case-control study in a single University Hospital. We included all consecutive patients with a diagnosis of a R-IMID and a positive test for COVID-19 up to March 31st, 2021. A total of 274 controls were selected for each case, and matched by sex, age (± 5 years), and without previous diagnosis of R-IMID or use of immunosuppresive therapy. Confrmed infection was defned if the patient had a positive nasopharyngeal swab for SARS-CoV-2. COVID-19 case severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) COVID-19 guidelines (1). Mild/moderate COVID19 was compared with critical. Results: We included 274 patients (185 women/89 men), mean age 59.1 18 years. More frequent R-IMID were: Rheumatoid arthritis (RA) (n=87, 31.8%), Axial spondylarthritis/Psoriatic arthritis (SpA/PsA) (n=90, 32.8%), Polymyalgia Rheumatica (PMR) (n=22, 8%) and Systemic Lupus Erythematosus (SLE) (n=22, 8%) We also included 274 age and matched controls. Main characteristics of patients with R-IMID and controls are shown in Table 1. Concerning comorbidities, hypertension and dyslipidemia were more frequent in patients with R-IMID (p< 0.05). COVID-19 symptoms' distribution is shown in Figure 1. Cough and dyspnoea were more frequent and headache, odynophagia and diarrhea were less frequent in the R-IMID group. The only analytical difference was D-Dimer that was signifcantly higher in patients with R-IMID. Although most of the cases were mild, critical cases and deaths were more frequent in R-IMID (p <0.05). Conclusion: Most of the patients present a mild COVID-19. However, a more severe syndrome was observed in R-IMID.
ABSTRACT
Background: Immune-mediated inflammatory diseases (IMID) have an increased risk of infections due to the disease itself, and/or immunosuppressive therapy. Risk of COVID-19 infection in the different rheumatic IMID (R-IMID) remains controversial. Objectives: To assess the epidemiology and comorbidities of COVID-19 in R-IMID from a Single-University hospital. Methods: Cross-sectional study in a Single-University hospital. We included all consecutive patients with a diagnosis of a R-IMID and a positive test for COVID-19 up to November 6th, 2020. Medical records of 11,199 patients that suffered COVID-19 in our region, and 6891 with R-IMID from our hospital were reviewed. Incidence data in the different underlying R-IMID were calculated for patients with follow-up in our hospital. Confirmed infection was defined if the patient had a positive nasopharyngeal swab for SARS-CoV-2. Results: We included 147 patients from our region (96 women/51 men), mean age 60±18 years. Underlying R-IMID were: Rheumatoid arthritis (RA) (n=36, 24.5%), Axial spondyloarthritis/Psoriatic arthritis (SpA/PsA) (n=54, 36.7%), Polymyalgia Rheumatica (PMR) (n=16, 10.9%), systemic lupus erythematosus (SLE) (n=10, 6.8%), sarcoidosis (n=5, 3.4%), Sjögren's syndrome (SS) (n=4, 2.7%), giant cell arteritis (GCA) (n=3, 2%), Behet's disease (n=3. 2%), ANCA-vasculitis (n=2, 1.4%) and systemic sclerosis (SSc) (n=1, 0.7%). Main comorbidities were hypertension (n=65, 44.2%), dyslipidemia (n=64, 43.5%), age higher than 65 years old (n=55, 37.4%), obesity (n=35, 23.8%), coronary vascular disease (n=27, 18.4%), diabetes mellitus (n=22, 15%), chronic obstructive pulmonary disease (n=15, 10.2%) and chronic kidney disease (n=15, 10.2%). Total cumulative COVID-19 incidence in all patients from our region was 1.9% (11,199 /582,905). From 147 patients with COVID-19 from our region, 115 (76 women/39 men;mean age, 59±18 years) were followed in our hospital. In the latter, the global cumulative incidence in R-IMID was 1.7% (115/6891), ranging from 1.3% in Systemic Scleroderma (SSc) and Giant Cell Arteritis (GCA) up to 5.3% in Behcet's disease (Table 1 and Figure 1). In addition, Relative Risk (RR) in different R-IMID compared to the general population was calculated (Table 1). Although RR did not reach statistical significance in any R-IMID, most R-IMID showed a tendency to a higher risk, with the exception of RA, GCA and SSc. Conclusion: In our series, the total cumulative incidence of COVID-19 in R-IMID was similar to the general population. Higher RR, without statistical significance, was observed in Behet's disease, ANCA-vasculitis and Polymyalgia Rheumatica. GCA: Giant cell arteritis, PsA: Psoriatic arthritis, RA: Rheumatoid arthritis, SLE: Systemic lupus erythematosus, SpA: Axial spondyloarthritis, SSc: Systemic scleroderma.
ABSTRACT
Background: Immune-mediated inflammatory diseases (IMID) may have a global increased risk of infections due to the disease itself, and/or immunosuppressive therapy. The severity and characteristics of COVID-19 in patients with rheumatic IMID (R-IMID) remain unknown. Objectives: To analyze the severity of COVID-19 infection in R-IMID. Methods: Cross-sectional study in a single University Hospital. We included all consecutive patients with a diagnosis of a R-IMID and a positive test for COVID-19 up to November 6th, 2020. Confirmed infection was defined if the patient had a positive nasopharyngeal swab for SARS-CoV-2. Medical records of 11,199 patients with COVID-19 in our region, and 6891 with R-IMID from our hospital were reviewed. COVID-19 case severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) COVID-19 guidelines (1). Mild/moderate COVID19 was compared with critical. Results: We included 147 patients (96 women/51 men), mean age 60±18 years. Most cases were mild to moderate (n=123, 83.7%), 30 of them (20.4%) were asymptomatic. The remaining patients presented severe (n=5, 3.4%) or critical (n=19, 12.9%) disease (Table 1). Fatal outcome occurred in 12 patients (8.2%). More frequent underlying R-IMID were Rheumatoid Arthritis (n=36;24.5%), Psoriatic Arthritis (n=30;20.4%), axial spondyloarthritis (n=24;16.3%), conectivopathies (n=19;12.9%), polymyalgia rheumatica (n=16;10.9%) and vasculitis (n=9;6.1%) (Figure 1). Main comorbidities were hypertension (n=65, 44.2%), dyslipidemia (n=64, 43.5%), age higher than 65 years old (n=55, 37.4%), obesity (n=35, 23.8%), coronary vascular disease (CVD) (n=27, 18.4%) and diabetes mellitus (n=22, 15%). Comorbidities and R-IMID associated with critical disease (p<0.05) were hypertension, age higher than 65 years,CVD and Polymyalgia Rheumatica. Critical compared with mild/moderate disease showed significantly higher levels of creatinine and D-dimer, and lower level of lymphocytes and platelets (Table 1) and received more frequently systemic glucocorticoids. Tocilizumab and Anakinra were used only in critical patients, 2 cases each. Conclusion: Although most cases are mild, COVID-19 can be a severe life threatening disease in patients with R-IMID. Hypertension, older age, CVD and polymyalgia rheumatica were associated with critical disease.