ABSTRACT
Background. Several studies and cohorts with adult populations with rheumatic diseases (RD) were performed since pandemic outbreak. RD patients were more susceptible to infections and may develop severe forms of COVID-19, since they present immunosuppressive mechanisms inherent to the disease itself and to its treatment. Healthy children and adolescents seem to be less infected and present milder diseases. However, juvenile dermatomyositis patiets and immunosuppressed children have not been extensively studied. The objectives of the study are to evaluate asymptomatic SARS-CoV-2 infection in pediatric RD patients, to identify the risk factors related to contagion and to describe demographics and the profile of COVID-19 in juvenile dermatomyositis (JDM) patients followed. Methods. A cross-sectional study was conducted in March 2021, including 77 pediatric RD patients followed at a Brazilian tertiary hospital and 45 healthy controls. Data was obtained through a questionnaire applied to outpatients during the month of March 2021, before the vaccine, and contained demographic data, symptoms compatible with COVID-19 over the past year, and contact with people with confirmed COVID-19. Patients' medical records were reviewed to access data regarding disease and current medications. A qualitative immunochromatographic SARS-CoV-2 test was performed in all participants. All patients who were using rituximab or intravenous human immunoglobulin, or had symptoms of COVID-19, were excluded. Results. Patients' group included 11 (14.3%) JDM patients, 31 (40.2%) JIA, 25 (32.4%) JSLE, six patients with vasculitis, two with SS, one MCTD and one with autoinflammatory syndrome. Patients and controls were similar in terms of female gender (70.1% vs. 57.8%, p=0.173), median age (14 vs. 13 years, p=0.269) and SARS-CoV-2 serology positivity (22% vs. 15.5%, p=0.481). 80.5% of rheumatic patients were in use of immunosuppressive drugs, 27.3% of them using corticosteroids, 33.3% in high doses, and 7.8% on immunobiologicals. No statistical differences were found between positive (n=17) and negative serology (n=60) patients regarding demographic/socioeconomic data, contact with people with confirmed COVID-19, use and number of immunosuppressive drugs, use and dose of corticosteroids, use of hydroxychloroquine and immunobiological drugs (p>0.05). Regarding the profile of JDM patients, 6/11 (54%) were female, the median age was 13 years (range 9-17) and 3/11 (27%) presented COVID-19 serology positivity. 2/11 were in immunosuppressive treatment, however none of them were in use of glucocorticoids and biologic agents. Conclusions. Pediatric JDM and other rheumatic diseases patients were infected at the same rate as healthy ones. Neither the underlying pathology nor its treatment seemed to interfere with the contagion risk.
ABSTRACT
Objectives: To describe the characteristics of patients with autoimmune systemic rheumatic diseases admitted to a Sentinel Hospital and compare them with a control group. Methods: Descriptive and observational study. We reviewed the medical records of patients with autoimmune systemic rheumatic diseases and compared their variables with a control group matched for age, gender, body mass index, and hospitalization date. The study was carried out during the first six months of the pandemic in 2020. We collected the variables demographic, clinical, laboratory, the days of hospitalization, the need for supplemental oxygen, the need for admission to the intensive care unit (ICU) and / or mechanical ventilation, admission to the ICU and / or ventilator use, and the mortality in the two groups. Results: We included six patients with autoimmune systemic rheumatic diseases and eighteen controls. The demographic and clinical variables are described in Table 1, where we only observed that diffuse interstitial lung disease presented statistically significant differences. Rheumatoid Arthritis was the most frequent pathology, four patients had disease activity at the time of hospitalization and methotrexate was the most used drug. Table 2 describes the variables clinical and laboratory associated with COVID-19. We show that lymphocytes, hemoglobin, thrombocytes and creatinine were statistically significant differences between both groups, on the other hand, there were no differences between the need for supplemental oxygen, days of hospitalization, criteria for admission to ICU and / or mechanical ventilation, admission to ICU and/or ventilator use and mortality between the two study groups. Conclusion: Our results show that patients with autoimmune systemic rheumatic diseases required the same frequency of supplemental oxygen, had similar criteria for admission and similar frequency of admission to ICU and / or use of mechanical ventilation, in addition to the same mortality compared to a control group matched by age, gender, body mass index and hospitalization date.
ABSTRACT
Objectives: To describe a series of cases of deaths of patients with rheumatic diseases and COVID-19. Methods: Descriptive, medical records review study, of patients with rheumatic diseases who died from COVID-19 and other healdeterminants in a Sentinel Center (La Portada Hospital) and exclusive management of the disease during the year 2020. Results: During the year 2020 the hospital admitted around 500 patients. We observed a mortality of 27.8% in the common room and 64.5% in the intensive care unit (ICU). Within these percentages, three patients died with rheumatic disease and COVID-19. Which we describe below: First case: 64-year-old female patient, with Rheumatoid Arthritis (RA) and cardiac arrhythmia, admitted to the emergency room with data of Acute Respiratory Distress Syndrome (ARDS) and pulmonary bacterial superinfection, with indication of admission to ICU, however, she was admitted to the Hospital in July (Figure 1), month in which there were no ICU units, dying on the fourth day in the common room. Second case: 60-year-old female patient with Systemic Lupus Erythematosus with skin and joint involvement, likewise admission with ARDS and pulmonary bacterial superinfection in July, also with indication for admission to ICU, dying on the second day in the common room (Figure 2). Third case: 56-year-old female patient with RA, proximal interphalangeal synovitis and data of bacterial superinfection in the skin, on the sixth day she presented multisystemic involvement due to sepsis at the cutaneous focus, admission to ICU in October (month with availability of beds, Figure 1), however, she died a few hours later from SEPSIS due to a cutaneous focus. Conclusion: The present clinical cases show the susceptibility to fatal outcomes of patients with rheumatic diseases, COVID-19 and other health determinants in a country with an oversaturated health system.