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Aims: Rheumatological disease flares may occur after many infections. However, our knowledge of the post-Coronavirus disease-2019 (COVID-19) axial spondyloarthritis (SpA) flares and related factors is limited. Methods: We retrospectively assessed the axial SpA patients who had COVID-19. Demographic and clinical data were collected from the medical records. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was applied via telephone for pre- and post-COVID-19 SpA symptoms. An increase of 2 points in the BASDAI score or any new extra-articular manifestations were defined as SpA flares and SpA patients were grouped as flares and no-flare. Factors predicting SpA flare were also analyzed. Results: A total of 48 axial SpA patients were included in the study [age, mean+or-standard deviation (SD): 42.3+or-8.6 years;male: 65%]. Post-COVID-19 SpA flare was identified in 19 patients (40%), and new extra-articular manifestations were recorded in 6 patients (13%). Although the diagnosis of inflammatory bowel disease was more common in the flare group, the difference was not significant compared with that of the no-flare group. Other features of SpA and COVID-19 disease severity were similar between the flare and no-flare groups. In the flare group, the frequency of back pain (84% vs. 62%, p=0.091) and diarrhea (53% vs. 28%, p=0.080), and headache (84% vs. 52%, p=0.021) were higher than the no-flare group. No risk factor for a post-COVID-19 SpA flare could be identified. Conclusions: Post-COVID-19 flare was common in the axial SpA, and even new extra-articular manifestations could be reported. Although some clinical manifestations of COVID-19 were more common in patients with a flare, any predictive factor could not be identified among the study variables.
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Background: Pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), has become a major global health issue since December 2019. Patients affected by systemic rheumatic disorders represent a high-risk group for severe COVID-19. During the COVID-19 pandemic, vaccination has become one of the cornerstones of the fght against this disease. The EULAR and the ACR recommend vaccination in all patients with rheumatological diseases. There is a paucity of data regarding the safety of COVID-19 vaccines in patients with rheumatic and musculoskeletal diseases such as BehÇet's disease (BD). Objectives: In this study, we evaluated the safety and tolerance of COVID-19 vaccines, post-vaccine BD exacerbation and discontinuation of BD therapy in BD patients by retrospectively examining our BD cohort, from the patients' perspective. Methods: We retrospectively evaluated 450 BD patients followed in our clinic using hospital records and formed a retrospective cohort of patients who met the International Study Group (ISG) criteria. COVID-19 vaccination status, vaccine type (inactivated or mRNA), post-vaccine side effects and exacerbations, drug compliance, change in treatment after exacerbation, and post-vaccine COVID-19 occurrence were evaluated by interviewing patients over the phone or face to face. Patient demographics, comorbid diseases, and active BD treatments were collected from our hospital records. Disease activity was measured using the BSAS and the BDCAF form. Results: Our cohort consisted of a total of 450 BD patients. Two hundred and eighty seven patients had at least 1 dose of the COVID-19 vaccine. Of the total number of COVID-19 vaccines (n= 639), 379 (59%) were Pfzer-BionTech vaccines and 257 (41%) were Sinovac vaccines. The side-effects after frst, second, third and fourth vaccine dose were 151 (52.6%), 135 (47%), 29 (10.1%) and 3 (1%), respectively. BehÇet fare after frst, second, third and fourth vaccine dose were 151 (52.6%), 135 (47%), 16 (22.9%) and 3 (33.3%), respectively. The most common side effects were arm pain, joint pains or arthritis, malaise, while the most common BD exacerbations were arthralgia or arthritis, oral aphthae, pap-ulopustular eruption Pfzer-BionTech and Sinovac vaccines were compared in terms of side effects, there was a signifcant difference after the 1st (p<0.001) and 2nd doses (p<0.001), but no signifcant difference was found at the 3rd dose (p= 0.353) (Table 1). When Pfzer-BionTech and Sinovac vaccines were compared in terms of BD exacerbations, no signifcant difference was found after the 1st (p= 0.417), 2nd (p= 0.465) and 3rd doses (p= 0.565). Only 4 patients (1.3%) developed exacerbation with organ involvement after COVID-19 vaccine. Anterior uveitis developed in 2 patients, panuveitis in 1 patient, panuveitis and deep vein thrombosis in one patient. Conclusion: In conclusion, our study shows that the COVID-19 vaccine is well tolerated in BD patients, and that post-vaccine BehÇet's exacerbation predominantly includes mucocutaneous and articuler fndings, and exacerbations with organ involvement are rare. According to the COVID-19 vaccines, although the side effects were more in the Pfzer-BioNTech group compared to the Sinovac group, there was no difference between BehÇet's fare compared to the COVID-19 vaccines.
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Background: To prevent COVID-19 disease SARS-CoV 2 vaccines put into use worldwide with emergency use authorizations despite ongoing safety concerns. Since pyrin mediated infammasome response is dysregulated in FMF, exposure to SARS-CoV 2 proteins via vaccination may potentially trigger infammation, leading to attacks and/or increased rate of adverse events (AE). Objectives: Aim of this study to investigate frequency of adverse events and attacks related to vaccination in recipients of CoronaVac and BNT162b2 comparatively in our FMF patients. Methods: Data regarding, number of vaccine doses, types of vaccines (Coro-naVac or BNT162b2), presence of AEs and/or FMF attacks after any vaccine dose within a month, history of COVID-19 infection before or after vaccination, adherence to FMF treatment during vaccination were collected from hospital database or via telephone. Results: A total of 161 vaccinated FMF patients were included. Mean ± SD age was 40.5 ± 11.7 years. 57.1% was female. 10.6% of the patients had chronic kidney disease and 9.3% had amyloidosis. Most common MEFV mutations were M694V heterozygous (27%) and M694V homozygous (21.6%). 93.2% of the patients were under colchicine, 21.8% under anti-interleukin 1 agents, 2.5% under TNF-a inhibitors. 96.3% of the patients adhered to FMF treatment during vaccination. Vaccination properties and data regarding adverse events are presented in Table 1. 57.8% of patients reported to suffer from an AE/attack after a vaccine dose. Number of patients with AE after BNT162b2 was signifcantly higher (p<0.001). None of the patients had severe AEs. 39 patients had COVID-19 infection prior to primary vaccination. 61.5% of these suffered from an adverse reaction/attack after vaccination, in comparison to 56.6% of the patients without prior COVID-19 infection (p=0.584). When patients with and without AEs/attacks were compared, no signifcant differences were observed regarding age, gender, body mass index, comorbidities, FMF treatments and total vaccine doses. Conclusion: We observed considerable number of FMF patients suffered from vaccine related AEs/attacks, particularly with BNT162b2. However, no serious AE was detected. Demographics, clinical characteristics and prior history of vaccination did not signifcantly affect AE/attack occurrence.
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Background: Rheumatological disease fares may be seen after many infections. However, our knowledge for the post-COVID axial spondyloarthritis (SpA) fares and its related factors is limited. Objectives: We aimed to evaluate disease activity and factors that may be associated with disease activity in axial SpA patients in post-COVID period. Methods: We retrospectively assessed the axial SpA patients who have had COVID-19 disease confrmed by a positive SARS-CoV-2 polymerized chain reaction (PCR) test result. Demographics, comorbid diseases, active medical treatments for SpA and information regarding COVID-19 clinical courses were collected from medical records. PCR positive patients were reached via telephone and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scored for pre-and post-COVID SpA symptoms. An increase of ≥2 points in the BASDAI score was defned as fare, and SpA groups with and without fare were compared. Factors predicting SpA fare were also analyzed by the logistic regression analysis. Results: A total of 48 axial SpA patients were included in our study, 65% of them male and the mean±SD age was 42.3±8.6 years. Post-COVID SpA fare was seen in 38% patients. Demographic, clinical, medical features of the SpA patients and COVID-19 disease severity were similar between Flare and No fare groups. In comparison of the COVID-19 symptoms, although most of the COVID-19 related symptoms were similar between two groups, the frequency of the back pain and diarrhea were higher in the Flare group than No fare group. But in multivariate analysis, only history of the infammatory bowel disease had an increased risk for post-COVID SpA fare (Table 1). Conclusion: The presence of infammatory bowel disease statistically signifcant related post-COVID SpA fares. In addition, diarrhea and back pain symptoms in COVID-19 disease may be stimulating factors for SpA fares but we found no effect of rheumatological therapies.
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Background: Compared to biologic-agents, little is known about effects of sul-fasalazine used for axial spondyloarthritis(AxSpA) on COVID-19 outcomes. Objectives: So, we aimed to understand the impact of sulfasalazine on COVID-19 in AxSpA patients. Methods: This was a retrospective study from a single center which included 2344 AxSpA patients. We analyzed 219 of 406 confrmed COVID-19 patients from March 2020 to July 2021. The primary outcome was COVID-19 severity in terms of COVID-19 pneumonia, hospitalization rate and length of hospitalization. Analyses were stratifed according to use of sulfasalazine and/or biologic-agents. Results: Most of the patients were male(59%) with a mean age of 45.0 years. Peripheral arthritis was present in 35% and uveitis in 15%. In total, sulfasalazine was used in 42% and biologic-agent in 42%. COVID-19 pneumonia detected in 16%, hospitalization required in 14% and median(IQR) duration of hospitalization was 10(8) days. Two patients died due to COVID-19. The sulfasalazine users had higher age, more frequent COVID-19 pneumonia, hospitalization and longer hospitalization. After biologic-agent users were excluded, the sulfasalazine group had again longer hospitalization. When patients regrouped as sulfasalazine mon-otherapy, sulfasalazine+biologic and biologic monotherapy, in pairwise comparisons, sulfasalazine monotherapy group had a higher frequency of COVID-19 pneumonia than biologic monotherapy group(p=0.008). Conclusion: Although sulfasalazine seemed to be related with increased rates of COVID-19 pneumonia and hospitalization, this impact diminished after exclusion of biologic-agent users. Sulfasalazine monotherapy and sulfasalazine+bio-logic therapy might be associated with development of COVID-19 pneumonia, compared to biologic monotherapy. Our results imply sulfasalazine may be related with worse disease course AxSpA patients with COVID-19.
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Background: Anti-phospholipid syndrome (APS) is an autoimmune disorder characterized by presence of anti-phospholipid antibodies (aPL) comprising lupus anticoagulant, anti-β2-glycoprotein I and/or anti-cardiolipin antibodies together with recurrent thrombosis and/or obstetric morbidity. In the course of COVID-19, thromboembolism may ocur due to endothelial dysfunction directly related to the viral factor and systemic infammatory response. Concerns about COVID-19 vaccines began to arise after unexpected thromboembolic events were launched with the launch of vaccine campaigns around the world to prevent the disease. Objectives: The purpose of the study is to contribute to the literature on this subject by evaluating the development of any side effects or activation of the disease after the COVID-19 vaccine in our APS patients. Methods: This study was designed as a cross-sectional, retrospective cohort study. The patients who meet the Sapporo Criteria for APS which are followed up in Ankara City Hospital Rheumatology Clinic, 18 years and over and vaccinated with any of the COVID-19 vaccines, were included into the study. The files of the patients were examined in order to evaluate the side effects and APS disease activation (thrombosis, embolism or pregnancy complications) in the 3-month period after the last dose of the COVID-19 vaccines (CoronaVac and BNT162b2). Also, information of the patients was collected via telephone or reviewed at regular follow-up visits. Results: A total of 35 patients were included into the study (Table 1). In our patients, we did not observe any new thrombotic events or pregnancy complications during the 3-months observation period after COVID-19 vaccinations. The most common side effects after vaccinations were as follows;myalgia (30%), weakness (16.7%) and fever (10%) (Table 2). No patient became pregnant or gave birth during the follow-up. Conclusion: According to our results, no thrombotic events or pregnancy complications were observed after CoronaVac and BNT162b2 vaccines in APS patients. Apart from this, minor side effects related to COVID-19 vaccines were clinically acceptable level.
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Aim: To investigate clinical implications of antineutrophil cytoplasmic antibody (ANCA) positivity detected in COVID-19 patients during follow up. Materials & methods: A retrospective survey in a hospital database was carried out to detect COVID-19 patients in which ANCAs had been tested. Clinical, laboratory and imaging data were collected from this hospital database and compared between ANCA-negative and-positive patients. Results: ANCAs were tested in 87 COVID-19 patients. Eight had positivity in at least one ANCA test. COVID-19 symptoms on admission and rate of pulmonary involvement were similar. Acute phase reactant levels were higher in ANCA-positive patients. Rate of mortality was higher in the ANCA-positive group without statistical significance. Conclusion: ANCA positivity detected during COVID-19 in patients without a prior diagnosis of any rheumatic condition may be related with worse outcomes.
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BACKGROUND: Aim of this study is to investigate COVID-19 outcomes in patients with antiphospholipid syndrome (APS). METHODS: A retrospective cohort was formed from APS patients. Patients were screened for a record of positive SARS-CoV 2 PCR. In PCRpositive patients, clinical data and information regarding COVID-19 outcomes were collected from medical records. RESULTS: A positive PCR test was detected in 9/53 APS patients, while 66.7 %, 33.3 % and 11.1 % of APS patients with COVID-19 were under hydroxychloroquine, LMWH or warfarin, and acetylsalicylic acid, respectively. There were 3/9 patients found to be hospitalized and one died. No new thrombotic event was reported in any of the patients during COVID-19 infection. CONCLUSION: Baseline use of hydroxychloroquine, antiaggregants and anticoagulants may be associated with an absence of new thrombotic event (Tab. 2, Ref. 33).
Subject(s)
Antiphospholipid Syndrome , COVID-19 , Antibodies, Antiphospholipid , Anticoagulants/therapeutic use , Antiphospholipid Syndrome/complications , Heparin, Low-Molecular-Weight , Humans , Retrospective Studies , SARS-CoV-2ABSTRACT
Coronavirus disease 2019 (COVID-19) is a global pandemic caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The SARS-CoV-2 virus primarily targets the respiratory system, but extrapulmonary involvements can be frequently seen. We presented a COVID-19 case with anti-neutrophil cytoplasmic antibody-positive IgA nephropathy, alveolar hemorrhage, and rapidly progressive kidney disease. The patient received pulse corticosteroids, plasma exchange, and intravenous immunoglobulin as treatment. Azathioprine was added as an immunosuppressive therapy. To the best of our knowledge, this is the first reported case of IgA nephropathy coexisting with COVID-19 infection.