Psychological and quality of life effects of vaccination against COVID-19 in patients with systemic autoimmune diseases.

To verify the psychological and quality of life benefits of vaccination against COVID-19 in patients with systemic autoimmune diseases. In this study, levels of psychological stress, psychopathological symptoms, quality of life, and satisfaction with life were compared in patients with systemic autoimmune diseases vaccinated against COVID-19 (n = 132) versus unvaccinated patients (n = 254). To this end, we used the Perceived Stress Scale (PSS), Symptom Checklist-90-Revised (SCL-90-R), EUROQoL-5Q health questionnaire, and Satisfaction with Life Scale (SWLS), respectively. Statistically significant differences were found with better scores in the vaccinated group in the following quality of life dimensions: mobility (p ≤ 0.010), domestic activities (p ≤ 0.004), pain/discomfort (p ≤ 0.001), and anxiety/depression (p≤ 0.005). The scores were also significantly higher in the vaccinated group for the total values of quality of life (p ≤ 0.001), health status self-assessment on the EUROQoL-5Q (p ≤ 0.043), and satisfaction with life (p ≤ 0.015). In addition, the unvaccinated group presented higher scores with clinically pathological levels in depression and psychoticism for somatizations (p ≤ 0.006), depression (p ≤ 0.015), anxiety (p ≤ 0.003), and phobic anxiety (p ≤ 0.001). Finally, participants vaccinated with the complete regimen showed better levels of psychological well-being than those who were not vaccinated or those that had not completed the vaccination regimen. Our results reflect and confirm the positive effects reported elsewhere of the COVID-19 vaccine in autoimmune patients with systemic diseases, both in terms of quality and satisfaction with life as well as psychopathological symptoms and perceived stress. These benefits increased as the patients completed their vaccination schedule.

Clinical course of Covid-19 in a cohort of patients with Behçet disease.

Objective: The implications of Covid-19 in patients with Behçet's disease (BD) are unknown. Patients with BD usually take long-term therapy with therapeutic agents that have been tested in Covid-19 patients. We aimed to assess the prevalence of Covid-19 in a cohort of patients with BD and investigate whether those patients with a long-term treatment with colchicine, tumor necrosis factor inhibitors (TNFi) or glucocorticoids are at reduced or increased prevalence of Covid-19 related clinical outcomes. Methods: A retrospective study was conducted among 244 patients with BD (86.1% females; mean age 43.95 ± 11.11 years). Each participant completed an online questionnaire regarding demographics, medical conditions, dispensed colchicine, TNFi or oral glucocorticoids, Covid-19 infection, clinical symptoms and recovery. Results: The prevalence of Covid-19 infection was 14.75%. Regarding dose of colchicine, the presence of ageusia was lower in patients taking 0.5 mg/day of colchicine compared to those taking 1.5 mg/day (p = 0.021). The prevalence of dyspnea was significantly higher in patients taking TNFi compared with those without therapy (p = 0.032). With regards to oral glucocorticoids, no significant differences were found. Conclusions: The prevalence of Covid-19 among patients with BD seems to be higher than that among the general population in Spain. Continuous TNFi therapy might increase the prevalence of worse clinical outcomes such as dyspnea; oral glucocorticoids and colchicine apparently provided no protection against the Covid-19 related clinical outcomes of patients with BD.

Objetivo: Se desconocen las implicaciones de la Covid-19 en pacientes con enfermedad de Behçet (EB). Los pacientes con EB generalmente tienen tratamiento de larga duración con agentes terapéuticos que se han probado en pacientes con Covid-19. Nuestro objetivo fue evaluar la prevalencia de la Covid-19 en una cohorte de pacientes con EB e investigar si los pacientes con un tratamiento de larga duración con colchicina, inhibidores del factor de necrosis tumoral (TNFi) o glucocorticoides tienen una prevalencia reducida o aumentada en los resultados clínicos de la Covid-19. Métodos: Se realizó un estudio retrospectivo en 244 pacientes con EB (86,1% mujeres; edad media, 43,95 ± 11,11 años). Cada participante completó un cuestionario en línea sobre datos demográficos, afecciones médicas, tratamiento con colchicina, TNFi o glucocorticoides orales, infección por Covid-19, síntomas clínicos y recuperación. Resultados: La prevalencia de la infección por Covid-19 fue del 14,75%. En cuanto a la dosis de colchicina, la presencia de ageusia fue menor en los pacientes que tomaban 0,5 mg/día de colchicina en comparación con los que tomaban 1,5 mg/día (p = 0,021). La prevalencia de disnea fue significativamente mayor en los pacientes que tomaban TNFi en comparación con aquellos sin terapia (p = 0,032). Con respecto a los glucocorticoides orales, no se encontraron diferencias significativas. Conclusiones: La prevalencia de Covid-19 en pacientes con EB parece ser superior a la de la población general en España. La terapia continua con TNFi podría aumentar la prevalencia de peores resultados clínicos como la disnea; los glucocorticoides orales y la colchicina aparentemente no proporcionan protección contra los resultados clínicos relacionados con la Covid-19 en pacientes con EB.

Clinical course of Covid-19 in a cohort of patients with Behçet disease Evolución clínica de la Covid-19 en una cohorte de pacientes con enfermedad de Behçet

Objective The implications of Covid-19 in patients with Behçet's disease (BD) are unknown. Patients with BD usually take long-term therapy with therapeutic agents that have been tested in Covid-19 patients. We aimed to assess the prevalence of Covid-19 in a cohort of patients with BD and investigate whether those patients with a long-term treatment with colchicine, tumor necrosis factor inhibitors (TNFi) or glucocorticoids are at reduced or increased prevalence of Covid-19 related clinical outcomes. Methods A retrospective study was conducted among 244 patients with BD (86.1% females;mean age 43.95 ± 11.11 years). Each participant completed an online questionnaire regarding demographics, medical conditions, dispensed colchicine, TNFi or oral glucocorticoids, Covid-19 infection, clinical symptoms and recovery. Results The prevalence of Covid-19 infection was 14.75%. Regarding dose of colchicine, the presence of ageusia was lower in patients taking 0.5 mg/day of colchicine compared to those taking 1.5 mg/day (p = 0.021). The prevalence of dyspnea was significantly higher in patients taking TNFi compared with those without therapy (p = 0.032). With regards to oral glucocorticoids, no significant differences were found. Conclusions The prevalence of Covid-19 among patients with BD seems to be higher than that among the general population in Spain. Continuous TNFi therapy might increase the prevalence of worse clinical outcomes such as dyspnea;oral glucocorticoids and colchicine apparently provided no protection against the Covid-19 related clinical outcomes of patients with BD.

The Relationship Between Health Literacy and Quality of Life, Attitudes and Perceptions of Covid-19 and Vaccination Among Patients with Systemic Autoimmune Diseases.

This study aimed to evaluate health literacy in patients (n=395) with systemic autoimmune diseases (SAD) and analyze their relationships with health-related quality of life (HRQoL), attitudes and beliefs about Covid-19 and vaccination, and perceptions of changes in medical care during the pandemic. This study was cross-sectional and the majority (81%) of particpants resided in Spain. An anonymous online survey was distributed to an online SAD association. Health literacy was measured using the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the SF-36 tool was used to assess HRQoL. More than half of patients (57.7%) have inadequate health literacy and the mean health literacy level was 9.63(5.66). Patients with inadequate health literacy levels presented the lowest HRQoL scores in all SF-36 domains (p < .001). Health literacy scores were positively correlated with all SF-36 domains (p < .001). The reservations to get vaccinated against Covid-19 were linked to health literacy level (p = 0.024). There are high levels of inadequate health literacy among patients with SAD and it is associated with worse HRQoL and risk attitudes about Covid-19 vaccination and medical care during the pandemic.

Clinical course of Covid-19 in a cohort of patients with Behçet disease.

OBJECTIVE: The implications of Covid-19 in patients with Behçet's disease (BD) are unknown. Patients with BD usually take long-term therapy with therapeutic agents that have been tested in Covid-19 patients. We aimed to assess the prevalence of Covid-19 in a cohort of patients with BD and investigate whether those patients with a long-term treatment with colchicine, tumor necrosis factor inhibitors (TNFi) or glucocorticoids are at reduced or increased prevalence of Covid-19 related clinical outcomes. METHODS: A retrospective study was conducted among 244 patients with BD (86.1% females; mean age 43.95±11.11 years). Each participant completed an online questionnaire regarding demographics, medical conditions, dispensed colchicine, TNFi or oral glucocorticoids, Covid-19 infection, clinical symptoms and recovery. RESULTS: The prevalence of Covid-19 infection was 14.75%. Regarding dose of colchicine, the presence of ageusia was lower in patients taking 0.5mg/day of colchicine compared to those taking 1.5mg/day (p=0.021). The prevalence of dyspnea was significantly higher in patients taking TNFi compared with those without therapy (p=0.032). With regards to oral glucocorticoids, no significant differences were found. CONCLUSIONS: The prevalence of Covid-19 among patients with BD seems to be higher than that among the general population in Spain. Continuous TNFi therapy might increase the prevalence of worse clinical outcomes such as dyspnea; oral glucocorticoids and colchicine apparently provided no protection against the Covid-19 related clinical outcomes of patients with BD.

COVID-19 vaccine literacy in patients with systemic autoimmune diseases.

COVID-19 related infodemic is a threat to the successful COVID-19 vaccination campaigns. This might be especially apparent for patients with autoimmune diseases since there is no data available about the balance between benefits and risks of the newly developed COVID-19 vaccines in this population. We aim (i) to evaluate vaccine literacy skills in a population of patients with systemic autoimmune diseases, (ii) to examine the potential associations between vaccine literacy skills and sociodemographic characteristics and (iii) to analyze the relationships between attitudes, perceptions and beliefs about current vaccinations and vaccine literacy skills and sociodemographic characteristics. A cross-sectional study was conducted among 319 patients with systemic autoimmune diseases (92% females; 49.5% of patients in the 31-50 years age category). The vaccine literacy levels were determined using the Health Literacy about Vaccination in adulthood in Italian (HLVa-IT). Sociodemographic characteristics including gender, age, country and area of residence, civil status, socioeconomic status, educational attainment and occupational status were evaluated. The mean vaccine literacy functional and interactive-critical scores were 2.59 ± 0.74 and 3.07 ± 0.60, respectively. The vaccine literacy interactive-critical score was higher in females than in males (p = 0.048). Interactive-critical scores were associated with the area of residence, civil status and socioeconomic status, with the highest score in urban area of ≥ 100.000 inhabitants (p = 0.045), in widow patients (p = 0.023) and in patients with high socioeconomic status (p = 0.018). Significant differences were observed between the different education levels, for both the functional and the interactive-critical scores (p = 0.002 and p < 0.001, respectively), the highest score was observed in patients who completed a university degree. The level of vaccine literacy for functional and interactive-critical scales were medium. Area of residence, civil status and socioeconomic status represented determinants of vaccine literacy interactive-critical scale. Educational attainment also contributes to vaccine literacy functional scale. Insight into these factors is required to ensure an optimal vaccine literacy level in patients with autoimmune diseases. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-022-02713-y.

Effect of COVID-19 confinement on the mental status of patients with systemic lupus erythematosus.

BACKGROUND AND OBJECTIVE: Patients with systemic lupus erythematosus (SLE) are more vulnerable to higher levels of stress and psychopathological symptoms than the general healthy population. Therefore, the COVID-19 outbreak could alter their psychological state. The objective was to analyze the psychological impact of the pandemic and confinement on stress levels and psychopathological symptoms in patients with SLE. PATIENTS AND METHOD: In this cross-sectional study, stress levels were compared with the Perceived Stress Scale, the Stress Vulnerability Inventory and psychopathological symptoms of the SCL-90-R Symptom Inventory in patients with SLE during the period of confinement (group 1; n = 276) in comparison to patients with SLE evaluated in a period before the pandemic (group 2; n = 152). RESULTS: The comparison between both groups showed there were statistically significant differences in vulnerability to stress (p < 0.0001), depression (p ≤ 0.05), anxiety (p ≤ 0.05), phobic anxiety (p < 0.0001), interpersonal sensitivity (p ≤ 0.043), and psychoticism (p ≤ 0.023). In these variables, the group of patients with lupus in confinement obtained higher scores. CONCLUSIONS: The confinement and threat of the COVID-19 outbreak had important repercussions on the psychological state of patients with SLE with high levels of stress, anxiety, and depression. These findings show their vulnerability to a public health alert and indicate the need to carry out a psychological approach to these patients while the state of health emergency lasts as well as to possible outbreaks of the virus.

ANTECEDENTES Y OBJETIVO: Las pacientes con lupus eritematoso sistémico (LES) son más vulnerables a presentar mayores niveles de estrés y síntomas psicopatológicos que la población general sana, por lo que el brote de la COVID-19 podría alterar su estado psicológico. El objetivo fue analizar el impacto psicológico de la pandemia y del confinamiento sobre los niveles de estrés y sintomatología psicopatológica en pacientes con LES. PACIENTES Y MÉTODO: En este estudio transversal se compararon niveles de estrés mediante la Escala de Estrés Percibido y el Inventario de Vulnerabilidad al Estrés, y síntomas psicopatológicos mediante el Inventario de síntomas SCL-90-R, en pacientes con LES durante el período de confinamiento (grupo 1; n = 276) con respecto a pacientes con LES evaluadas en un período anterior a la pandemia (grupo 2; n = 152). RESULTADOS: La comparación entre ambos grupos mostró que existían diferencias estadísticamente significativas en vulnerabilidad al estrés (p < 0,0001), depresión (p ≤ 0,05), ansiedad (p ≤ 0,05), ansiedad fóbica (p < 0,0001), sensibilidad interpersonal (p ≤ 0,043), y psicoticismo (p ≤ 0,023). En estas variables el grupo de pacientes con lupus en confinamiento obtuvo puntuaciones superiores. CONCLUSIONES: El confinamiento y la amenaza del brote por COVID-19 ha tenido importantes repercusiones en el estado psicológico de las pacientes con LES, mostrando altos niveles de estrés, ansiedad y depresión. Estos hallazgos muestran su vulnerabilidad ante una alerta de salud pública, y señala la necesidad de realizar un abordaje psicológico de estas pacientes mientras dure el estado de emergencia sanitaria, así como ante posibles rebrotes del virus.

[Effect of COVID-19 confinement on the mental status of patients with systemic lupus erythematosus]. / Efecto del confinamiento por COVID-19 en el estado mental de pacientes con lupus eritematoso sistémico.

BACKGROUND AND OBJECTIVE: Patients with systemic lupus erythematosus (SLE) are more vulnerable to higher levels of stress and psychopathological symptoms than the general healthy population. Therefore, the COVID-19 outbreak could alter their psychological state. The objective was to analyze the psychological impact of the pandemic and confinement on stress levels and psychopathological symptoms in patients with SLE. PATIENTS AND METHOD: In this cross-sectional study, stress levels were compared with the Perceived Stress Scale, the Stress Vulnerability Inventory and psychopathological symptoms of the SCL-90-R Symptom Inventory in patients with SLE during the period of confinement (group 1; n=276) in comparison to patients with SLE evaluated in a period before the pandemic (group 2; n=152). RESULTS: The comparison between both groups showed there were statistically significant differences in vulnerability to stress (P<.0001), depression (P≤.05), anxiety (P≤.05), phobic anxiety (P<.0001), interpersonal sensitivity (P≤.043), and psychoticism (P≤.023). In these variables, the group of patients with lupus in confinement obtained higher scores. CONCLUSIONS: The confinement and threat of the COVID-19 outbreak had important repercussions on the psychological state of patients with SLE with high levels of stress, anxiety, and depression. These findings show their vulnerability to a public health alert and indicate the need to carry out a psychological approach to these patients while the state of health emergency lasts as well as to possible outbreaks of the virus.

Effectiveness of corticoid pulses in patients with cytokine storm syndrome induced by SARS-CoV-2 infection.

INTRODUCTION: Cytokine storm syndrome (CSS) is a serious complication of COVID-19 patients. Treatment is tocilizumab. The use of glucocorticoids (GC) is controversial. In other very similar CSS, such as macrophage activation syndrome (MAS) and hemophagocytic syndrome (HFS), the main treatment are corticosteroids. Our objective is to evaluate the efficacy of GC in the CSS by COVID-19. PATIENTS: We included 92 patients with CSS associated to COVID-19 who received GC, GC, and tocilizumab and only tocilizumab. We determine CSS markers. We evaluated mortality, intubation, and a combined variable. RESULTS: In all cases the percentages of events were lower in the group of patients with GC was administered. The hazard ratio of the final variables with GC versus the group in which only tocilizumab was administered was lower as CGs were considered, with statistical significance for survival. DISCUSSION: The early use of GC pulses could control SLC, with a lower requirement to use tocilizumab and a decrease in events such as intubation and death.

INTRODUCCIÓN: El síndrome de liberación de citocinas (SLC) es una complicación grave de los pacientes COVID-19. La base del tratamiento es tocilizumab. El uso de glucocorticoides (GC) es controvertido. En otros SLC muy parecidos, como son el síndrome de activación macrofágica (SAM) y el síndrome hemofagocítico (SHF) el tratamiento con los corticoides es fundamental. Nuestro objetivo es evaluar la eficacia de los GC en el SLC por COVID-19. PACIENTES: Incluimos 92 pacientes con SLC por COVID-19 que recibieron GC, GC y tocilizumab y sólo tocilizumab. Determinamos marcadores de SLC. Evaluamos mortalidad, intubación y una variable combinada. RESULTADOS: En todos los casos los porcentajes de eventos fueron menores en el grupo de pacientes en los que se administraron GC. Las razones de riesgo de las variables finales de los grupos con GC frente al grupo en el que se administró sólo tocilizumab fue menor conforme se consideraron los GC, con significación estadística para la supervivencia. DISCUSIÓN: El uso precoz de pulsos de GC puede controlar el SLC, con un menor requerimiento de uso de tocilizumab y una disminución de eventos como la intubación y muerte.

[Effectiveness of corticoid pulses in patients with cytokine storm syndrome induced by SARS-CoV-2 infection]. / Eficacia de los pulsos de corticoides en pacientes con síndrome de liberación de citocinas inducido por infección por SARS-CoV-2.

INTRODUCTION: Cytokine storm syndrome (CSS) is a serious complication of COVID-19 patients. Treatment is tocilizumab. The use of glucocorticoids (GC) is controversial. In other very similar CSS, such as macrophage activation syndrome (MAS) and hemophagocytic syndrome (HFS), the main treatment are corticosteroids. Our objective is to evaluate the efficacy of GC in the CSS by COVID-19. PATIENTS: We included 92 patients with CSS associated to COVID-19 who received GC, GC, and tocilizumab and only tocilizumab. We determine CSS markers. We evaluated mortality, intubation, and a combined variable. RESULTS: In all cases the percentages of events were lower in the group of patients with GC was administered. The hazard ratio of the final variables with GC versus the group in which only tocilizumab was administered was lower as CGs were considered, with statistical significance for survival. DISCUSSION: The early use of GC pulses could control SLC, with a lower requirement to use tocilizumab and a decrease in events such as intubation and death.