ABSTRACT
Background: The COVID-19 pandemic continues worldwide and has had a strong impact on public health. As the pandemic evolves, efforts have been inten-sifed to identify persistent symptoms associated with the infection once resolved have intensifed. Objectives: We aimed to describe persistent symptoms and sequelae in patients with rheumatic and musculoskeletal diseases (RMD) after admission due to Covid-19. We also compared the role of autoimmune rheumatic diseases (ARD) with that of non-autoimmune rheumatic and musculoskeletal diseases (NARD) in persistent symptoms and sequelae. Methods: We performed an observational study of patients with RMD who attended a rheumatology outpatient clinic in Madrid and required admission to hospital due to Covid-19 (1st March-30th May 2020) and survived. The study began at discharge and ran until 1st October 2020. The main outcomes were persistence of symptoms and sequelae related to Covid19. The independent variable was the RMD group (ARD and NARD). The covariates were sociode-mographic data, clinical fndings, and treatment. We ran a multivariate logistic regression model to assess the risk of the main outcomes by RMD group. Results: We included 105 patients, of whom 51.5% had ARD and 68.57% reported at least 1 persistent symptom. The most frequent were dyspnea, fatigue, and chest pain. Sequelae were recorded in 31 patients. These included lung damage in 10.4% of patients, lymphopenia in 10%, central retinal vein occlusion (1 patient), and optic neuritis (1 patient). Two patients died. Eleven patients required readmission owing to Covid-19 problems (16.7% ARD vs 3.9% NARD;p=0.053). No statistically signifcant differences were found between RMD groups in the fnal models. Conclusion: Many RMD patients have persistent symptoms, as in other populations. Lung damage is the most frequent sequela. Compared to NARD patients, ARD patients do not seem to differ in terms of persistent symptoms or sequelae, although ARD patients might generate more readmissions due to Covid-19.
ABSTRACT
Background: Spain has been one of the countries most impacted by the COVID-19 pandemic. Among Spanish patients, 56,799 deaths have been reported. Although we have been in this situation of pandemic for a year, studies that show risk mortality rates in patients with rheumatic diseases continue to be scarce. Objectives: In patients with rheumatic and musculoskeletal diseases (RMDs) and infected with Covid -19, a) we want to assess the mortality rate (MR) related to COVID-19;and b) to analyze the role of RMDs in mortality risk. Methods: An observational longitudinal study was conducted during the epidemic peak in Madrid (1stMar to 20thMay2020). All patients attended at the rheumatology outpatient clinic of a tertiary hospital with a diagnosis of RMDs and SARS -CoV 2 infection were included (according to a medical diagnosis or confirmed with a positive SARS-CoV-2 PCR diagnostic test). All patients were included since the time of COVID-19 diagnosis. Main outcome: death related to COVID-19 infection. Independent variable: type of RMDs including: autoimmune (systemic autoimmune conditions (SAC) and inflammatory joint disease (IJD)) and non-autoimmune (mechanical diseases and inflammatory diseases (microcrystalline arthritis and tendonitis)). Covariates: sociodemographic, comorbidities, chronic use of corticoids prior to COVID-19 infection. Survival techniques were used to estimate the MR related to COVID-19, given per 1,000 persons-month with a 95% confidence interval [CI]. The time of observation comprised the elapsed time between the date of COVID-19 diagnosis of infection until the date of patient's death, or end of study. Cox multiple regression analysis was run to examine the effect of autoimmune RMDs compared to non-autoimmune RMDs on mortality risk adjusted by sex, age and comorbidities. Results were expressed by Hazard Ratio (HR) and [CI]. Results: 406 patients were included with RMD and Covid -19 infection with a total follow-up 642.5 patients-month. 69.21% were women with a mean age at diagnosis of 60 ± 15.26 years. The evolution time from the diagnosis of rheumatic disease was 8 ± 8.38 years. 26% had comorbidity at baseline. 25% were chronically on corticoids prior to the infection. Of the 406 patients, 244 (60.09%) had non-autoimmune RMD (157 mechanic, 87 inflammatory) and 162 (39.9%) (106 (65.43%) IJD, 56 (34.56%) systemic condition) had autoimmune RMD. Of the 406 patients, 45 (11%) died during the follow-up, being 12± 14 days the mean time from infection to death (P50: 6[2-12] and a maximum of 60 days). MR was estimated in 70.03 [52.28-93.79] per 1,000 persons-month. MR was higher for men (MR 105[68-163]) than for women (MR 55 [37.2-81.6]) and in older people (MR <60: 4.4, [0.6-31.7];MR 60-75 years: 38.7[17.3-86.2];MR ≥75Years: 486 [354-1668]). The HR of mortality in autoimmune RMDs compared to non-autoimmune RMDs did not achieved statistical significance (HR: 1.39 [0.77-2.5], p=0.27). After adjusting for confounders, we did not find higher risk of mortality among the different types of RMDs (HR autoimmune vs non-autoinmunes: HR: 1.12 [0.6-2.02], p=0.7;HR IJD vs SAC;1.5 [0.6-3.6], p=0.34;HR non-autoimmune vs SAC: 1.1 [0.5-2.5], P=0.7). Age (HR: 1.12;[1.10-1.15], p<0.001), and the presence of comorbidities (HR: 2.05;[1.08-3.89], p=0.027) increased the Mortality risk. Conclusion: In patients with RMD and COVID-19 infection, we found a mortality rate of 7 per 100 persons-month. This study shows that the mortality risk related to COVID-19 is similar between autoimmune and non-autoimmune diseases after adjusting by confounders. We also found that age and comorbidities are risk factors for mortality related to COVID-19 infection.
ABSTRACT
Background: The COVID-19 pandemic continues worldwide and has had a strong impact on public health, quality of life and economy of the general population. To date, the number of infections and deaths are still increasing. From the beginning of the pandemic, efforts were intensified to identify risk factors for development of the severe form of COVID-19. In this sense underlying medical comorbidities have been shown to have a worse prognosis in these patients. Objectives: In patients with rheumatic and musculoskeletal diseases (RMDs) and infected with Covid -19, we aim to investigate the role of systemic autoimmune conditions compared to other type of RMDs in severity of COVID-19 in terms of hospital admissions. Methods: An observational longitudinal study was conducted during the epidemic peak in Madrid (1stMar to 20thMay2020). All patients attended at the rheumatology outpatient clinic of a tertiary hospital with a diagnosis of RMDs and COVID-19 infection were included (according to a medical diagnosis or confirmed with a positive SARS-CoV-2 PCR diagnostic test). All patients were included since the time of COVID-19 diagnosis. Main variable: hospital admission related to Covid -19 infection. Independent variable: type of RMD including: autoimmune (systemic autoimmune conditions and inflammatory joint disease (IJD)) and nonautoimmune (mechanical diseases, and inflammatory diseases (microcrystalline arthritis and tendonitis)). Covariates: sociodemographic, clinical and therapy used. Statistical analysis: description of the sociodemographic, clinical and treatment characteristics of the patients. A multivariate logistic regression adjusted by age, sex and comorbidities was used to evaluate the risk of the different types of RMDs in hospital admissions related to Covid-19. The results were expressed as OR with its corresponding confidence interval (95% CI). Results: 406 patients were included with RMDs and Covid-19 infection. 69.21% were women with a mean age at diagnosis of 60 ± 15.26 years. The evolution time from the diagnosis of RMD was 8 ± 8.38 years. 26% had comorbidity at baseline. 25% were chronically on corticoids prior to the infection. Of the 406 patients, 244 (60.09%) had non-autoimmune RMD (157 mechanic, 87 inflammatory) and 162 (39.9%) (106 (65.43%) IJD, 56 (34.56%) systemic autoimmune condition) had autoimmune RMD. 36% of all patients were admitted (31% from not autoimmune RMDs and 43% from autoimmune RMD (p = 0,013). The risk of hospital admission in autoimmune RMD compared to non-autoimmune RMD was higher (OR: 1.68;[1.11-2.54], p=0.013), being the risk of systemic autoimmune condition compared to both IJD and non-autoimmune RMD higher (OR IJD: 0.41 [0.21-0.51], p=0.01;OR non-autoimmune: 0.33;[0.18-0.61];p=0.000). After adjusting by confounders, autoimmune RMD had higher risk of hospital admissions compared to the rest (OR: 1.75;[1.04-2.95];p=0.03), and specifically systemic autoimmune condition had higher risk compared to IJD (OR of IJD 0.33;[0.14-.076];p=0.009) and compared to non-autoimmune (OR non autoimmune 0.28;[0.13-0.59], p=0.001). Advanced age (OR: 1.10;[1.07-1.12], p<0.001), male (OR 0.58;[0.33-1.02], p=0.06), and more number of comorbidities (OR 1.39;[1.02-1.90] p=0.03) also increased the risk of hospitalization related to COVID-19. Conclusion: One third of the RMD patients infected with COVID-19 required hospital admission. This study shows that patients with autoimmune and specifically with systemic autoimmune conditions have a higher risk of hospitalization related to COVID-19. We also show that advanced age, male sex and a higher number of comorbidities can contribute to worsen the prognosis of the COVID-19 disease.
ABSTRACT
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), triggers the innate immune system, leading in severe cases, an excessive immune response, which can lead to high levels of pro-inflammatory cytokines promoting a “cytokine storm”. To modulate this exaggerated inflammatory response, several clinical trials with already approved and well-known therapeutic agents that inhibit the inflammatory response, are being carried out. However, none of these drugs seems to achieve the desired results when treating COVID19. Colchicine, a drug often used in the management of patients with Rheumatic and Musculoskeletal diseases (RMDs), is one of the several drugs that are being currently tested for efficacy in COVID19 due to its anti-inflammatory effects. Objectives: To analyze association between colchicine prescription and COVID19-related hospital admissions in patients with Rheumatic and Musculoskeletal diseases (RMDs). Methods: Patients attending a rheumatology outpatient clinic from a tertiary care center in Madrid, Spain, from 1st September 2019 to 29th February 2020 were included. Patients were assigned as exposed or unexposed based on whether they were prescribed with colchicine in their last visit to the clinic during the 6 months before the start of the observation period. Treatment changes during the observation period were also considered. The primary outcome was COVID19-related hospital admissions occurring between March 1st and May 20th, 2020. Secondary outcome included COVID19-related mortality. Several weighting techniques for data balancing, based and non-based on the propensity score, followed by Cox regressions were performed to estimate the association of colchicine prescription on both outcomes. Results: 9,379 patients entered in the study, with 406 and 9,002 exposed and unexposed follow-up periods, respectively. Generalized Boosted Models (GBM) and Empirical Balancing Calibration Weighting (EBCW) methods showed the best balance for COVID19-related hospital admissions. Colchicine prescription did not show a statistically significant association after covariable balancing (p-value = 0.195 and 0.059 for GBM and EBCW, respectively). Regarding mortality, the low number of events prevented a success variable balancing and analysis. Conclusion: Colchicine prescription does not play a significant protective or risk role in RMD patients regarding COVID19-related hospital admissions. Our observations could support the maintenance of colchicine prescription in those patients already being treated, as it is not associated with a worse prognosis.