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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.
ABSTRACT
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: 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.
ABSTRACT
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).