ABSTRACT
Objective. The coronavirus disease 2019 (COVID-19) pandemic has limited healthcare delivery for patients with chronic diseases, including Systemic Lupus Erythematosus (SLE). This study aims to describe the outcomes of patients with SLE in a national COVID-19 referral center in the Philippines. Methods. A review of records of all adult patients with SLE seen in the University of the Philippines-Philippine General Hospital (UP-PGH) from March 2020 to December 2021 was done. Data about patient characteristics, health encounters, and outcomes before and after the first visit during the study period were extracted. Descriptive statistics were employed. Results. Our population of 403 patients was predominantly young (mean age 34.53 ± 11.14 years), female, and unemployed. This consisted of 370 known cases of SLE, 92 were diagnosed in institutions outside UP-PGH, and 33 new patients. Over the 22-month study period, there were 2,093 medical encounters, most of which were teleconsultations (81.70%). During an average gap of 53.6 ± 26.7 weeks between the last consultation and the first visit within the pandemic study period, 84 patients (22.70%) discontinued at least one of their SLE control medications, 68 (18.38%) patients developed a lupus flare, and 79 (21.35%) were hospitalized for various reasons. On their return to the rheumatology clinic during the pandemic, 37.47% were in lupus flare, 28.29% needed to be hospitalized, and 20 died. However, 86.75% of flares were controlled. During subsequent health encounters, 48 patients had a new flare (43 of these were controlled) and 20 died. The most common reason for hospitalization (n=160) was lupus disease flare and the most common cause of death (n=40) was pneumonia. Sixty patients acquired COVID-19 infection from which most recovered and four died. Conclusion. Audio teleconsultation was the most common method used by our lupus cohort to interact with their doctors during the pandemic. There was an average of a year-long interruption in medical care for 62.70%. More than a third developed a disease flare and 15% acquired COVID-19 but outcomes were good in more than 85%. Despite the challenges posed by the pandemic, the majority of our lupus cohort who were able to continue their treatment had favorable outcomes. © 2023 University of the Philippines Manila. All rights reserved.
ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) pandemic has limited healthcare delivery for patients with chronic diseases, including Systemic Lupus Erythematosus (SLE). This study aims to describe the outcomes of patients with SLE in a national COVID-19 referral center in the Philippines. Method(s): A review of records of all patients with SLE seen in the University of the Philippines-Philippine General Hospital (UP-PGH) from March 2020 to December 2021 was done. Data about patient characteristics, health encounters, and outcomes before and after the first visit during the study period were extracted. Descriptive statistics were employed. Result(s): Our population of 403 patients was predominantly young (mean age 34.53 +/- 11.14 years), female, and unemployed. This consisted of 370 known cases of SLE, 92 were diagnosed in institutions outside UP-PGH, and 33 new patients. Over the 22-month study period, there were 2,093 medical encounters, most of them were teleconsultations (81.70%). During an average gap of 53.6 +/- 26.7 weeks between the last consultation and the first visit within the pandemic study period, 84 patients (22.70%) discontinued at least one of their SLE control medications, 68 (18.38%) patients developed a lupus flare, and 79 (21.35%) were hospitalized for various reasons. On their return to the rheumatology clinic during the pandemic, 37.47% were in lupus flare, 28.29% needed to be hospitalized, and 20 died. However, 86.75% of flares were controlled. During subsequent health encounters, 48 patients had a new flare (43 of these were controlled) and 20 died. The most common reason for hospitalization (n = 160) was lupus disease flare and the most common cause of death (n = 40) was pneumonia. Sixty patients acquired COVID-19 infection from which most recovered and four died. Conclusion(s): Audio teleconsultation was the most common method used by our lupus cohort to interact with their doctors during the pandemic. There was an average of a year-long interruption in medical care for 62.70%. More than a third developed a disease flare and 15% acquired COVID-19 but outcomes were good in more than 85%. Despite the challenges posed by the pandemic, the majority of our lupus cohort who were able to continue their treatment had favorable outcomes.
ABSTRACT
Objective: To describe the outcomes of COVID-19 infection among hospitalized patients with rheumatic diseases referred to the Division of Rheumatology, University of the Philippines-Philippine General Hospital, from March to December 2020. Methods: Design: This is a retrospective study approved by the UP Manila Research Ethics Board as part of the Global Rheumatology Alliance physician-reported registry protocol. Background: Patients with autoimmune rheumatic diseases and immunosuppressed are at high risk of dying from COVID-19. The pandemic has also significantly affected the delivery of healthcare to these patients. Results: Out of 2,500 inpatients with COVID-19, 31 had rheumatic diseases. There was male predominance (n = 18) and the median age was 50 years. There was an average of 10 (+7.94) day-interval between onset of acute symptoms and hospitalization. Their comorbidities were vascular and metabolic (hypertension n = 11, diabetes n = 7, chronic kidney disease n = 7, ischemic heart disease n = 5, dyslipidemia, n = 2 and cerebrovascular disease n = 1). The most common rheumatic diagnoses were gout (n = 15) and systemic lupus erythematosus (SLE, n = 9). Most gout patients (n = 15) had uncontrolled disease (n = 7). Two patients had bacterial or tuberculous arthritis concomitant with COVID-19. Four patients (six in remission) had lupus flare, resulting in intrauterine fetal death for one patient. They were given intravenous high-dose glucocorticoids. One patient, with rheumatoid arthritis, was advised to discontinue disease-modifying anti-rheumatic drug (azathioprine) temporarily. Two had nosocomial COVID-19;the rest were community-acquired. Majority had moderate (n = 15) or milder infection (n = 8). Eight had severe to critical disease and seven of them died. Four deaths were from acute respiratory failure, two from thromboembolism (pulmonary and cerebral), and one from septic shock. Both patients with thrombotic events had confirmed or suspected SLE. The rest had gout (n = 3), RA (n = 1) and TB arthritis (n = 1). Conclusion: Most of our patients with COVID-19 and RMD had good recovery. The mortality rate (23%) was slightly higher than the PGH mortality rate for COVID-19 (17.5%).
ABSTRACT
Background: During the first three months of the COVID-19 pandemic in the Philippines, there was a supply shortage of hydroxychloroquine and methotrexate. Limited access to medication and the life changes resulting from the COVID-19 pandemic may predispose patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) to disease flares. Objective: This study aimed to investigate self-reported symptoms of disease flares among patients with rheumatoid arthritis or systemic lupus erythematosus during the COVID-19 pandemic. Methods: A total of 512 completed online surveys from patients with SLE or RA were collected. The data included sociodemographic characteristics, self-reported physical symptoms, health service utilization, and availability of hydroxychloroquine and methotrexate. Results: Seventy-nine percent of respondents had lupus, while 21% had RA. One-third of the cohort had contact with their attending physician during the two-month quarantine period prior to the survey. Eighty-two percent were prescribed hydroxychloroquine and 23.4% were prescribed methotrexate;but 68.6% and 65%, respectively, had “irregular” intake of these medicines due to unavailability. The current health status was reported as good by 66.2%;24% had no symptoms during the two-week period prior to the survey. The most common symptoms experienced were joint pain (51%), muscle pain (35%), headache (26.8%), and skin rash (19.1%). Five percent had a combination of these four most common symptoms. Irregular supply of hydroxychloroquine among patients with SLE (n=323) was associated with more frequent occurrence of muscle pain (40.6% vs 27.9%, p=0.03) or rash (27.4% vs 11.7%, p<0.001). Irregular supply of methotrexate among RA patients prescribed hydroxychloroquine and methotrexate (n=36) was associated with more frequent occurrence of joint pains with or without swelling (73.9% vs 38.5%, p=0.04). Irregular supply of hydroxychloroquine was associated with less frequent occurrence of dizziness (0 vs 66.7%, p<0.001) among RA patients (n=18). Conclusion: In our cohort of RA and SLE, the majority reported at least one symptom that may indicate disease flare. There was a significant association between the irregular supply of hydroxychloroquine or methotrexate with the presence of muscle pain, rash, or joint pains during the 14-day period prior to the survey.