Assessment of the need for hospitalization and the frequency of complications of COVID-19 in patients with rheumatic diseases

Objective: To compare the incidence of complications and the need for hospitalization for COVID-19 in groups of patients older than and younger than 60 years of age with rheumatic diseases (RD). Material(s) and Method(s): The study involved 89 patients with RD who underwent COVID-19, verified by RT-PCR for SARS-CoV- 2 RNA, for the period from 05/15/2020 to 12/01/2021. Participants in the study, after talking with the research physician, filled out questionnaires on past COVID-19 and post-COVID syndrome. The information was supplemented with data from discharge records after inpatient treatment for COVID-19. Statistica program (version 12) was used for statistical processing. Result(s): The data obtained were differentiated depending on the age of the participants: < 60 years (group 1), N = 69 and > = 60 years (group 2), N = 20. Both groups were dominated by women (82.6% and 85%). The average age in group 1 was 41.9 +/- 11.6 years, in group 2 -68.5 +/- 5.1 years. 19 patients (48.7%) in group 1 and 13 patients (65%) in group 2 were hospitalized. Of these, oxygen support was statistically more frequent (P < 0.05) in group 2 patients: 9 (69.2%) vs 5 (26.3%). Complications were registered in group 1 in 9 cases (13%): venous thrombosis in 1 patient, acute respiratory failure in 4 patients and the development of concomitant infections in 4 patients. In group 2, complications were noted significantly more often (P < 0.05) -in 8 cases (40%): venous thrombosis in 2, acute respiratory failure in 1, acute heart failure in 1, acute cerebrovascular accident in 1 and the development of concomitant infections in 3 patients. 7 patients (10.1%) in group 1 had COVID-19 again on average 11.5 +/- 2.2 months after the first case. Of these, 1 patient required hospitalization. There were no recurrences of COVID-19 in group 2. Conclusion(s): Elderly patients with RD with COVID-19 are more likely to need oxygen support. Also in this group, COVID-19 is more likely to cause serious complications, including cardiovascular and respiratory failure and thrombotic complications.

Characteristics of post-covid syndrome in elderly patients with rheumatic diseases

Purpose: To compare the frequency of occurrence of various symptoms of post-covid syndrome (PCS) in groups of patients with rheumatic diseases (RD) of the elderly to young. Material(s) and Method(s): The study involved 89 patients with RD who underwent COVID-19, verified by RT-PCR for SARS-CoV- 2 RNA, for the period from 05/15/2020 to 12/01/2021. Participants in the study, after talking with the research physician, completed questionnaires on past COVID-19 and post-COVID syndrome (PCS). The information was supplemented with data from discharge records after inpatient treatment for COVID-19. Result(s): The data obtained were differentiated depending on the age of the participants: <60 years (group 1), N = 69 and >=60 years (group 2), N = 20. Both groups were dominated by women (82.6% and 85%). The average age in group 1 was 41.9 +/- 11.6 years, in group 2 -68.5 +/- 5.1 years. 33 (47.8%) patients in group 1 and 10 (50%) in group 2 noted the development of PCS. In group 1, the following symptoms of PCS prevailed: memory impairment -in 17 (51.5%) patients, fatigue, weakness -in 14 (42.4%), problems with concentration -in 14 (42.4%), arthralgia -in 12 (36.4%) %, shortness of breath during physical exertion -in 11 (33.3%), drowsiness -in 10 (30.3%), irritability -in 9 (27.3%). In group 2, the most common memory impairment -in 8 (80%) patients, weakness, fatigue -in 7 (70%), arthralgia -in 7 (70%), problems with concentration -in 6 (60%), weight loss -in 5 (50%), irritability -in 5 (50%), sleep disturbance -in 5 (50%). The frequency of occurrence of different manifestations of PCS did not differ significantly between the groups. On average (median), each patient in group 1 noted 4 [2;8], group 2 -10 [8.25;12.5] symptoms of PCS at the same time, but the differences did not reach statistical significance. Conclusion(s): The frequency of occurrence of various clinical manifestations of PCS did not have statistically significant differences between the study groups. In a comparative assessment, the group of elderly patients noted a greater number of symptoms of PCS at the same time.

Features of COVID-19 in elderly patients with rheumatic diseases

Objective: to compare the features of COVID-19 in groups of patients older and younger than 60 years of age with rheumatic diseases (RD). Material(s) and Method(s): The study involved 89 patients with RD who underwent COVID-19, verified by RT-PCR for SARS-CoV- 2 RNA. Participants in the study, after talking with the research physician, completed questionnaires on the past COVID-19. The information was supplemented with data from discharge records after inpatient treatment for COVID-19. Result(s): The data obtained were differentiated depending on the age of the participants: <60 years (group 1), N = 69 and >=60 years (group 2), N = 20. In both groups, RDs were predominantly represented by rheumatoid arthritis (53.6% and 75%, respectively). Both groups were dominated by women (82.6% and 85%). The average age in group 1 was 41.9 +/- 11.6 years, in group 2 -68.5 +/- 5.1 years. At the time of the development of COVID-19, the severity of symptoms of RD according to VAS did not have significant differences in both groups and amounted to 4.3 +/- 2.8 in group 1 and 4.8 +/- 2.7 in group 2. Among the clinical manifestations of COVID-19 in both groups, weakness, fatigue -in 65 (94.2%) and 18 (90%) patients, respectively, fever -in 56 (81.1%) and 15 (75%), anosmia -in 43 (62.3%) and 14 (70%) patients, arthralgia -in 37 (53.6%) and 13 (65%) patients, myalgia -in 32 (46.4%) and 16 (80%) patients. In group 2, myalgia occurred significantly more often than in group 1 (P < 0.05). During the COVID-19 period, CT scan was performed in group 1 -39 patients, in group 2 -14. Changes corresponding to CT-0 were detected in groups 1 and 2 in 10 (25.5%) and 0 patients, respectively, CT-1 -in 19 (48.7%) and 4 (28.6%), CT-2 -in 9 (23.2%) and 5 (35.7%), CT-3 -in 1 (2.6%) and 4 (28.6%), CT-4 -in 0 and 1 (7.1%). Statistically, severe lung damage (CT-3.4) was significantly more common in group 2, and patients in group 1 more often had the disease without lung damage (CT-0), P < 0.05. Conclusion(s): Weakness, fever, arthralgia, myalgia and anosmia were the most common manifestations of COVID-19 in the study groups. Myalgia was significantly more common in patients over 60 years of age. When assessing pulmonary changes, the severe course of COVID-19 was significantly more common in the group of elderly patients.

Characteristics of elderly patients with rheumatoid arthritis who have not responded to methotrexate therapy within 24 weeks

Objective: To describe the clinical, laboratory and pharmacokinetic features of elderly patients with rheumatoid arthritis (RA), with insufficient response to methotrexate (MTX) therapy for 24 weeks compared with patients with a good response. Material(s) and Method(s): The study included 32 patients with RA, according to the older age category according to WHO criteria, 65 (82%) women and 14 (18%) men, BMI was 27 +/- 4 kg/m2, DAS28 was 5.9 +/- 1. In each case, MTX was administered parenterally, at the rate of 10-15 mg/m2 of body surface. therapeutic drug monitoring was carried out, it was the determination of the concentrations of MTX monoglutamate (initial form) and MTX compounds: polyglutamates and 7-hydroxymethotrexate (7-OH- MT) in erythrocytes (ER) and mononuclear cells (MO) after 4, 12 and 24 weeks. We used high performance liquid chromatography with mass spectrometric detection. The MTX metabolite index was calculated (the ratio of the metabolite concentration to the initial concentration of unchanged MT). Achievement of therapy targets (good response to therapy) was established in accordance with the EULAR criteria. The lack of achievement of therapy goals corresponded to an insufficient response to therapy. Result(s): By week 24, 12 patients (36%, group 1) achieved therapy targets, 17 patients (53%, group 2) did not reach treatment targets, and in 3 more, MTX was discontinued due to Adverse reactions (ARs) and/or the development of COVID-19. A comparison was made of clinical and laboratory parameters before the start of MTX treatment and during MTX therapy. At all stages of the study the groups did not differ in terms of: sex, age, BMI, disease duration, VAS (pain), DAS28 index, creatinine, taking glucocorticoids, statins, the presence and frequency of comorbid pathology (arterial hypertension, diabetes mellitus, chronic autoimmune thyroiditis). The 7-OH- MTX( ER) metabolic index after 12 weeks of treatment was higher in group 1 (1.35 [0.8;2.1] versus 0.35 [0.19;0.73] in group 2). Metabolic indices of other MTX metabolites did not differ. ARs were less common in group 1 (in 1 (18%) versus 6 (35%) in group 2), P = 0.09. Conclusion(s): Clinical and laboratory characteristics of patients of the older age group did not differ in groups with different responses to methotrexate therapy. The 7-OH- MT( ER) metabolism index after 12 weeks of treatment was higher in the group of patients with a good response to therapy, which most likely indicates a more rapid catabolism of MTX in this group of patients.

DISEASES OF THE ORAL MUCOSA IN PATIENTS IN THE POST-COVID PERIOD.

The impact of SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus-2) on the entire human body causes irreversible changes in all organs and systems. Complications in the form of chronic diseases require the treatment of clinicians in various fields of medicine. Dentists are faced with diseases of the oral mucosa in apparently healthy patients who are not predisposed to them but have undergone COVID-19. Purpose of the study - to assess the impact of the coronavirus infection (COVID-19) on the course of diseases of the oral mucosa. We examined 51 patients aged 20 to 75 who had undergone COVID-19 with various diseases of the oral mucosa. The study used clinical and laboratory methods. The features of the clinical course of certain diseases of the oral mucosa were revealed, the dynamics of the local immune defense of the oral cavity in the post-covid period was determined.

[Experience of anticipatory therapy with IL-6 receptor inhibitors and perspectives for its use in the evolution of COVID-19].

The Advisory Board chaired by the chief specialist in infectious diseases of the Ministry of Health of Russian Federation, Professor V.P. Chulanov was held on June 18, 2022 in Saint Petersburg. Aim. The main purpose of the Board was following discussion: the analysis of the real-world data of levilimab as an anticipatory therapy for COVID-19 in hospitalized patients; the review of the experience and perspectives of levilimab as an anticipatory anti-inflammatory option for outpatient patients who meet defined clinical and laboratory criteria. Results. The analyzed data on clinical efficacy and safety formed the basis of recommendations proposed by experts for the use of levilimab in the inpatient and outpatient medical care for COVID-19.

Features of the autoimmune profile of patients with immuno-inflammatory rheumatic diseases after COVID-19

Purpose of the Study: To assess the autoimmune profile of patients with IIRD recovered from COVID-19. Materials and Methods: The study included 33 patients (17 women, 16 men, mean age 47.4 ± 19 years) with the following diagnoses: psoriatic arthritis (PSA) -9 (27%), osteoarthritis (OA) -9 (27%), spondyloarthritis (SpA) 15 (46%). 21% of patients denied a history of COVID-19 symptoms. 79% reported any signs of COVID-19 3.095 ± 1.45 months before this research (Median 3 [2;4] months). All patients underwent a SARSCoV-2 IgG/IgM chromatographic rapid test (Xiamen Biotime Biotechnology, China) for antibodies to SARS-CoV-2, and IgG antibodies were detected. All patients underwent analyzes for ANFHep2 and Anti-ds-DNA (hardware method), antibodies to beta 2 glycoprotein IgM, IgG, Antibodies to citrullinated cytoplasmatic peptide (ACCP), Rheumatoid factor, Anti-Sm, Anti-centr, Anti-SCL, C3-and C4 complement components, AT to -Jo-1 by ELISA. The autoimmune profile of patients with IIRD can be described as follows. ACCP were found in 3 (9%) patients: SpA-2, PSA-1;ANF-Hep2, (hardware method) were found in 7 (20%) patients: SpA-4, PSA-3, with 1 case in a low titer (1/160), 2 -on average (1/320), 4-high (1/640). All patients did not have: Anti-ds-DNA (hardware method), Rheumatoid factor, Anti-Sm, Anti-center, Anti-SCL, AT to -Jo-1, Antibodies to beta 2 glycoprotein IgM. Antibodies to beta 2 glycoprotein IgG were detected in 1 (3%) patient with SpA. C3c below 0.9 were found in 4 (11%) patients: SpA-1, PSA-1, OA-2;C4c below 0.1 were found in 1 (3%) patient with SpA. Conclusions: The data obtained suggest the possibility of the development of autoimmune reactions leading to the emergence of new autoantibodies in the study group. A decrease in the C3c component of complement in 11% of patients may be the result of a SARS-CoV2 infection. Further prospective study is needed to study the clinical and immunological characteristics of patients with IIRD who had recovered from COVID-19.

Features of COVID-19 in patients with immunoinflammatory rheumatological diseases (register data)

Aim: To characterize the clinical and demographic indicators of patients with immunoinflammatory rheumatic diseases (IIRD) who underwent COVID-19, to assess the severity of the course and outcomes of infection in the study group, to identify patterns characteristic of patients with IIRD. Material and Methods: We studied the material of the Russian database (RIR/ARR-COVID-19), formed on the basis of reports from practicing rheumatologists, which included information about adults (over 18 years old) patients with different IIRD who underwent COVID-19. Results: Data were obtained on 132 patients (100 women, 75%) aged 51.814.4 years, of which 29 (21.9%) were 65 years old and older. In 40.2% of patients, the condition was aggravated by concomitant arterial hypertension, in 13.6% -by ischemic heart disease, in 7.6% -by diabetes mellitus and in 14.4% -by obesity (BMI 30). IIRZ activity at the time of COVID-19 disease was assessed in 122 patients, incl. high -in 19 (15.7%), moderate -in 43 (35.2%), low -in 43 (35.2%), remission -in 17 (13.9%). The most frequent clinical manifestations of COVID-19 were fever (60.6%), cough (40.2%), anosmia (38.6%), shortness of breath (35.5%), headache (27.3%), malaise (27.3%). When conducting a correlation analysis, the deterioration in the course of IIRD after suffering COVID-19 was associated with the male sex (r = 0.22, P < 0.05), a high level of C-reactive protein (75 mg /l) (r = 0.2, P < 0.05) and high activity of IIRZ (r = -0.3, P < 0.05) at the time of development of COVID-19. Conclusion: The course of COVID-19 was predominantly favorable, despite the presence of signs of clinical and laboratory activity of IIRZ and comorbid conditions. Further research in a larger cohort is needed to study in detail the characteristics of the course of COVID-19 in patients with IIRD.

The course of COVID-19 infection in patients with arthritis receiving targeted dmards

Background: WHO declared the COVID-19 outbreak as a pandemic on March 12th, 2020. Assessing the risk of severe course in patients with rheumatic diseases, especially those who receive targeted immunosuppressive treatment, is an urgent problem for rheumatologists. Objectives: determine the relationship between used targeted biologic and synthetic DMARDs (tDMARDs) and the severity of course of COVID-19 infection. Methods: The analysis included the data of patients with chronic arthritis and COVID-19, used tDMARDs. COVID-19 infection was confirm by serology tests or immune system molecules (immunoglobulins/antibodies). The presence of symptoms, the need for hospitalization, and the need for oxygen therapy were considered as indicators of the severity of the infection. We also analyzed the spread of the lung involvement according to CT data, symptoms during the disease (fever, cough, anosmia, diarrhea). Results: Analyses included 78 patients, among them 32 patients has ankylosing spondylitis, 31 patients -rheumatoid arthritis, 12 patients has psoriatic arthritis, 3 patients -juvenile arthritis. The average age of the included patients was 51,8 ± 11,69. Most of patients used TNF inhibitors -43 (Adalimumab -10, Golimumab -4, Infliximab -4, Certolizumab pegol -3, Etanercept -22), JAK inhibitor tofacitinib used 13 patients, 5 patients each was treated with Abatacept and Tocilizumab, 3 patients used Rituximab and 2 patients each used Netakimab and Ustekinumab (Table 1). None of the patients included in the analysis required treatment in the ICU and/or mechanical ventilation. The course of the disease in patients treated with tDMARDs did not seem to be more severe than in 5 patients with arthritis who stopped treatment with tDMARDs before the onset of the pandemic. There was a direct correlation between the severity of the infection and the age of the patients (p=0.007). There were no significant differences in the severity of the infection depending on the drug, including when adjusting for age. Conclusion: COVID-19 does not look extremely dangerous in patients with rheumatic diseases, used target DMARDs. Used of tsDMARDs doesn't reliably increase the risk of COVID-19 severity. There is reliable correlation between age and COVID-19 severity.