ABSTRACT
Background/Aims Coronavirus-2 (SARS-CoV-2) has become a disastrous pandemic since its first outbreak in December 2019. Until 8th of October, 2021, more than 239 million people were infected by COVID-19 leading to over 4.8 million deaths. While vaccines and drugs are two arms in controlling the pandemic, safe and effective vaccines are one of the most reliable interventions to suppress viral transmission. Patients with specific immunological deficits, such as patients with autoimmune diseases or those receiving immunosuppressive need special attention. Besides, vaccination in these patients is problematic due to the probable suppression or over-activation of the immune system. However, there still remain questions about the efficacy and safety of vaccination in immunocompromised patients. Studies are ongoing into the safety and immunogenicity of approved of SARS-CoV-2 vaccines, with regards to immuno-deficient individuals. The aim of this audit was to check the uptake and side effects of the BNT162b2 and ChAdOx1 vaccines. Methods We collected data on 352 patients from routine clinics which included diagnosis, type of vaccine, number of doses, side effects of the vaccines and flare up of arthritis or underlying autoimmune condition. Descriptive statistics were used to analyse the data. Results Of the 352,174 (49%) were Males and 178 (51%) Females. Most common diagnosis was Rheumatoid Arthritis 181 (51%), Axial spondyloarthropathy, 80(23%), Psoriatic Arthritis 65 (18%), GCA 10 (3%), Non-Radiographic Axial Spondyloarthropathy 5 (1.4%), JIA 3 (0.9%), Sarcoidosis 1 (0.3%), and overlap 6 (2%). Medications: 227(65%) patients were on Biosimilars, 26 (7%) on Biologics, 28 (8%) Certolizumab pegol, 21 (6%) Secukinumab, 2 (0.6%) Baricitinib, 3 (0.8%) Abatacept, 29 (8%) Tocilizumab and 16 (4.5%) on Tofacitinib. Vaccination uptake: 329 patients received double dose and 8 received single dose. 15 (4.3%) patients didn't take vaccine. Reasons for not taking vaccine were severe reactions to Arthritis medication and biologics, concerned they may have severe reaction with the vaccine. Some were worried that vaccine may trigger flares, COVID-19 vaccine potentially has tracking chips, didn't trust the vaccine as not gone through enough clinical trialling, lack of any statistics on side effects of the vaccines in immunocompromised patients. Side effects: 146 patients experienced mild side effects based on CTAE5 criteria. Only 3 (2.1%) had severe side effects Grade 3 or above, this included Pulmonary embolism, Stroke, and symptomatic pleural effusion. 15(10%) reported Arthritis flare. Most common side effects were Headache 50(34%), Fatigue 32(22%, Myalgia 32(22%), Fever 30(21%), Chills 30(21%), Injection site pain 28(19%), Rhinorrhoea 11(7.5%), Lethargy 11(7.5%) and maculopapular rash 5(3.4%). Conclusion This audit highlights both the ChAdOx1 and BNT162b2 are safe for use in immune-deficient patients. Immunocompromised patients should be encouraged to take vaccines as benefits of the COVID-19 vaccination outweigh the risks and might reduce the risk of developing severe complications due to COVID-19.
ABSTRACT
Case report-IntroductionCOVID-19 is an infectious disease caused by a newly discovered β-coronavirus, named Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), resulted in a recent pandemic of COVID-19.As a novel pathogen, the nature and degree of risk of COVID-19 to individuals with rheumatic diseases were unknown, as was its ability to induce musculoskeletal and autoimmune disease. Concerns were related to the chronic autoimmune or inflammatory disease and immune suppressive medications to treat it. The consequences of this infection are currently not fully understood, including the autoimmune sequelae. Here we present two cases of inflammatory arthritis with a temporal link to COVID-19. Case report-Case description: Case 1A 37-year-old Caucasian male was referred to Rheumatology with severe joint pains. He developed flu-like symptoms in early April 2020, with myalgia, fever, sore throat, anosmia, and fatigue. SARS-CoV-2 PCR swab was positive. He recovered from these initial symptoms, however 4 weeks later, he developed pain and swelling in his hands, feet, ankles, and knee joints with early morning stiffness.On examination, there was marked synovitis of hands, wrists, knees, and ankle joints. Systemic examination was otherwise normal.Case 2A 70-year-old lady developed sore throat and cough started in late March 2020. 3 weeks later, she became generally unwell with lethargy and fatigue. Her cough gradually improved, but she continued to experience breathlessness on minimal exertion. In early May 2020, she developed excruciating pain in her hands, wrists, and right knee joints with morning stiffness. On examination she had synovitis in the wrists, small joints of the hands and right knee. Systemic examination otherwise was unremarkable.Given the severe inflammatory arthritis, both patients were commenced on oral prednisolone with remarkable improvement 4 weeks later.Case report-DiscussionWe present 2 cases of acute inflammatory arthritis, which were suspected to have been triggered by COVID-19 viral infection without any musculoskeletal complications with good prognosis. COVID-19 is a new disease and our understanding of it is continuing to grow.The initial concern was that COVID-19-19 infection may lead to severe illness in immunocompromised patients, including those and with rheumatic conditions. However, this was not seen in large numbers. To our knowledge, COVID-19-related inflammatory arthritis has not previously been reported in the literature.Our current understanding of the COVID-19 pathogenic mechanisms is limited. However, it is likely that the disease may evolve in overlapping phases.Case report-Key learning pointsIn both cases, it was suggested that COVID-19 19 may be a triggering factor for inflammatory arthritis with good prognosis and settled with steroid therapy. It was suggested that arthritis may occur in patients with COVID-19, in previously fit and well patients without any underlying co-morbidities and autoimmune rheumatic disease and warrants urgent Rheumatology review. However, all COVID-19 suspected cases should be investigated on an individual basis to exclude other diagnosis to avoid missing other common reversible illnesses.
ABSTRACT
Background/AimsShielding measures were implemented within the United Kingdom inan attempt to slow the rate of COVID-19 infections, with shieldingletters being sent to extremely vulnerable patients. This includedrheumatology patients on immunosuppressive therapies sufficient toincrease their risk of infection. MethodsThis was a retrospective audit assessing the number of rheumatologypatients within the Mid and South Essex NHS Foundation Trust (MSETrust) and Barking, Havering and Redbridge University Trust (BHRTrust) who were sent shielding letters. We audited how effective thesemeasures were in preventing COVID-19 infection during the shieldingperiod (up to 1st July 2020). Risk criteria from NHS Digital and theBritish Society for Rheumatology (BSR) were used by individualdepartments within these Trusts to identify the relevant patients. Weaudited from case records demographic details, rheumatologicaldiagnoses, therapies and associated co-morbidities in these patients.ResultsA total of 5, 876 high risk patients within these Trusts were identifiedand sent shielding letters: 4, 914 within the MSE Trust and 962 patientswithin the BHR Trust. As seen in Table 1, of these 5, 876 patients, 28(0.48%) were hospitalised with positive tests for COVID-19: 23 of the4, 914 (0.47%) in MSE Trust and 5 of the 962 (0.52%) in BHR Trust.Of the 28 COVID-19 admissions, 10 died (36%). The number ofrheumatology patients that developed COVID-19 as a proportion of allpatients admitted across these two Trusts was 0.76% (28 out of3, 695).ConclusionThis audit supports the idea that shielding is an effective tool inprotecting these vulnerable patients. Most of our patients admittedwere elderly, had multiple co-morbidities and generally conformedwith the known risk factors for severe COVID-19 illness. This supportsGovernment guidelines and BSR risk scoring and is particularlyimportant as it is becoming increasingly apparent that COVID-19 willbe prevalent for a long time to come. In line with the recent EULARCOVID-19 registry report, only one of the hospitalised patients fromthese Trusts was on anti-TNF therapy, suggesting that these therapieswere in fact protective. It raises the open question: whetherimmunosuppression may have a protective effect in someRheumatology patients.