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BackgroundPatients with immune-mediated rheumatic diseases (IRD) have poorer outcomes of SARS-CoV-2 infection compared to the general population.ObjectivesTo assess and compare clinical course, severity and complications of SARS-CoV-2 infection in patients with rheumatic immune-mediated inflammatory diseases (IMIDs) from Mexico and Argentina.MethodsData from both national registries, CMR-COVID (Mexico) and SAR-COVID (Argentina), were combined. Briefly, adult IRD patients with SARS-CoV-2 infection were recruited between 08.2020 and 09.2022 in SAR-COVID and between 04.2020 and 06.2022 in CMR-COVID. Sociodemographic data, comorbidities, and DMARDs were recorded, as well as clinical characteristics, complications, and treatment for SARS-CoV-2 infection. Descriptive analysis. Chi square, Fisher, Student T, Mann Whitney U tests and multiple logistic regression analyses were performed.ResultsA total of 3709 patients were included, 1167 (31.5%) from the CMR-COVID registry and 2542 (68.5%) from the SAR-COVID registry. The majority (82.3%) were women, with a mean age of 50.4 years (SD 14.4). The most frequent IRD were rheumatoid arthritis (47.5%) and systemic lupus erythematosus (18.9%). Mexican patients were significantly older, had a higher female predominance and had higher prevalence of rheumatoid arthritis, antiphospholipid syndrome, and axial spondyloarthritis, while the Argentine patients had more frequently psoriatic arthritis and ANCA-associated vasculitis. In both cohorts, approximately 80% were in remission or low disease activity at the time of infection. Mexicans took glucocorticoids (43% vs 37%, p<0.001) and rituximab (6% vs 3%, p<0.001) more frequently. They also reported more comorbidities (48% vs 43%, p=0.012).More than 90% of patients presented symptoms related to SARS-CoV-2 infection. The frequency of hospitalization was comparable between the groups (23.4%), however, the Mexicans had more severe disease (Figure 1) and a higher mortality rate (9.4% vs 4.0%, p<0.0001). After adjusting for risk factors, Mexicans were more likely to die due to COVID-19 (OR 2.2, 95%CI 1.5-3.1).ConclusionIn this cohort of patients with IRD from Mexico and Argentina with SARS-CoV-2 infection, the majority presented symptoms, a quarter were hospitalized and 6% died due to COVID-19. Mexicans presented more severe disease, and after considering risk factors they were two times more likely to die.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsCarolina Ayelen Isnardi Grant/research support from: SAR-COVID is a multi- sponsor registry, where Pfizer, Abbvie, and Elea Phoenix provided unrestricted grants. None of them participated or infuenced the development of the project, data collection, analysis, interpretation, or writing the report. They do not have access to the information collected in the database, Deshire Alpizar-Rodriguez: None declared, Marco Ulises Martínez-Martínez: None declared, Rosana Quintana: None declared, Ingrid Eleonora Petkovic: None declared, Sofia Ornella: None declared, Vanessa Viviana Castro Coello: None declared, Edson Velozo: None declared, David Zelaya: None declared, María Severina: None declared, Adriana Karina Cogo: None declared, Romina Nieto: None declared, Dora Aida Pereira: None declared, Iris Jazmin Colunga-Pedraza: None declared, Fedra Irazoque-Palazuelos: None declared, GRETA CRISTINA REYES CORDERO: None declared, Tatiana Sofía Rodriguez-Reyne: None declared, JOSE ANTONIO VELOZ ARANDA: None declared, Cassandra Michele Skinner Taylor: None declared, INGRID MARIBEL JUAREZ MORA: None declared, Beatriz Elena Zazueta Montiel: None declared, Atzintli Martínez: None declared, Cesar Francisco Pacheco Tena: None declared, Guillermo Pons-Estel: None declared.
ABSTRACT
Background: Due to the SARS-CoV-2 pandemic, an increase in stress, anxiety, and depression has been seen, as well as greater use of substances and a decrease in prenatal care in pregnant women. (1) Women of childbearing age with autoimmune rheumatic diseases (ARDs) experience greater psychological stress, which can negatively influence behavior. (2) Objectives: This study aims to compare changes in prenatal laboratory and ultrasound tests by trimester, as well as the detection of anxiety and depression in pregnant women with ARDs due to the SARS CoV-2 pandemic. Methods: This study was carried out on pregnant patients with ARDs from the Pregnancy and Rheumatic Diseases clinic of the rheumatology department of the University Hospital 'Dr. José Eleuterio González' during the period from February 2018 to August 2021. Two standardized evaluations of anxiety and depression were carried out using the Inventory of Trait and State Anxiety (IDARE) and the Edinburgh Postpartum Depression Scale (EPDS) respectively in the third trimester of pregnancy. Maternal report of alcohol consumption during any trimester of pregnancy, as well as adherence to routine laboratory studies such as structural ultrasound and gesta-tional diabetes screening, was addressed. Positive COVID-19 nasopharynx PCR results were evaluated during pregnancy beginning in the pandemic period (March 2020). The pre-pandemic recruited group was compared with the pandemic group. The comparison of the groups was carried out using the Chi-Square and Fisher tests. A significant value of p < 0.05 was considered. Statistical analysis was performed using the IBM SPSS v.25 program. Results: 50 pregnant patients with ARDs were recruited, of which 24 were included in the pre-pandemic group and 26 in the pandemic group. Compared with the pre-pandemic group, pregnant women recruited during the pandemic had a statistically signifcant higher positivity for state anxiety (p=0.023), likewise trait anxiety, depression, and suicidal ideation were detected more frequently, but the difference was not statistically signifcant, a higher rate of adherence to laboratory and cabinet studies was found, being signifcant for laboratories performed in the 1st and 2nd trimesters (0.005 and 0.025 respectively). See Table 1. Conclusion: A higher frequency of positivity for state anxiety was demonstrated in pregnant women with ARDs recruited during the pandemic, as well as higher trait anxiety, depression, and suicidal ideation, although this increase was not statistically signifcant. On the other hand, concern about the pandemic and health status could positively influence better adherence to screening and routine studies during pregnancy.
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Objectives: We aimed to describe the fear of COVID-19 scale in women with autoimmune rheumatic diseases (ARDs) from Mexico. Methods: A cross-sectional study was conducted from September to November 2020 at the Pregnancy and Rheumatic Diseases Clinic from the University Hospital Dr. JoseE. Gonzalez in Monterrey, Mexico. Women with ARDs were invited to participate. The Fear of COVID-19 scale (FCV-19S) was applied. The instrument consists of seven items, each with a five-point Likert scale of options. The maximum possible total is 35 points, with cutoff point score of 16.5. The validated Spanish FCV-19S version was used. Also, sociodemographic data were collected from the medical charts. Results: A total of 83 women were included: 46 were in childbearing age, 32 were postpartum women, 4 were pregnant and 1 was going through menopause. The most frequent diagnosis was rheumatoid arthritis in 41 (49.4%), followed by systemic lupus erythematosus 31 (37.3%), 8 (9.6%) with other diagnosis (Sjogren's syndrome 2, antiphospholipid syndrome 3, and dermatomyositis 2 and psoriatic arthritis 1 patient). The demographic variables are shown in Table 1. The mean level of fear was 18.09 points, which means the fear of COVID-19 screening was highly positive. Regarding the rheumatic diseases group, women in the category of Other diagnoses had a greater mean FCV-19S score (19.0), than patients with systemic lupus erythematosus (17.45) and rheumatoid arthritis (18.8). Also, in the reproductive status classification the postpartum women had the highest mean score (19.68). Only the group of Non diagnostic yet, had a score below the cutoff point. Conclusion: Postpartum women with ARDs had a higher FCV-19S score than women with a different reproductive status. Women with ARDs and especially postpartum women should receive psychological support and be screened for symptoms of depression and anxiety.
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Background: Pregnant women represent a high-risk population during the COVID-19 pandemic. The main cause of maternal deaths in Mexico during 2020 was COVID-19 with 191 (21.2%) deaths registered until December 2020. The age group most affected was 30 to 34 years. Women during their third trimester and during puerperium were the most affected. Information regarding pregnant and postpartum women with autoimmune rheumatic diseases remains scarce. Objectives: The aim of this study was to describe a COVID-19 case series from a clinic of pregnancy and rheumatic diseases. Methods: We conducted a descriptive, retrospective study in patients from the clinic of pregnancy and rheumatic diseases of the University Hospital “Dr. Jose Eleuterio Gonzalez” in Monterrey, Mexico. Pregnant patients with RD and documented COVID-19 between March and November 2020 were included. Demographic and clinical features were obtained. Results are shown in descriptive statistics. Results: From the 18 women with autoimmune rheumatic disease in follow-up during this period, 2 (11.1%) pregnant women, 2 (11.1%) postpartum women, and 1(5.5%) post-miscarriage woman developed COVID-19. The mean age was 28 ± 6.3 years, 3 (60%) had systemic lupus erythematosus, 1 (20%) had rheumatoid arthritis, and 1 (20%) had the antiphospholipid syndrome. Clinical features and treatments are shown in Graphic 1 and Table 1. The most frequent symptoms were fever (80%), cough (60%) and anosmia (60%). Four (80%) had mild symptoms, and 1 (20%) had severe symptoms requiring intensive care unit admission and mechanical ventilation. Three (60%) referred history of contact with a person who had COVID-19. All the patients were using hydroxychloroquine and prednisone. No patient in our study died. Conclusion: From our population, a total of 27.8% presented COVID-19. Most of our patients had a mild course of SARS-CoV-2 infection consistent with data from the general population. Additionally, none of our patients had risk factors such as hypertension, diabetes, chronic kidney disease or lung disease. Nonetheless, pregnant women remain a vulnerable population. Prevention measures must continue worldwide to avoid additional COVID-19 morbidity and mortality.
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Background: In Mexico, the SARS-CoV-2 pandemic has totaled almost two million cases and exceeded 150,000 deaths (29/01/2021). Currently, COVID-19 has become the leading cause of death in pregnant women in Mexico. COVID-19 has additionally impacted the psychological health of individuals including women with rheumatic diseases. Objectives: The aim of this study is to compare the Fear of COVID-19 Scale (FCV-19S) in postpartum women with and without autoimmune rheumatic diseases. Methods: A cross-sectional, descriptive, and comparative study was conducted. The Spanish FCV-19S version was applied by telephone or e-mail. The instrument consists of seven items, each with a five-point Likert scale of options. The participant must choose the options that best represent their perception about the statements presented. The maximum possible total is 35 points. Sociodemographic information was collected from the clinical charts. The Kolmogorov-Smirnov test was used to determine normality of the data. Statistical analysis was done using the Mann-Whitney U test. Results: Forty-four postpartum women were included (22 from the Pregnancy and Rheumatic Diseases Clinic and 22 from the Obstetrics Department, both groups from the University Hospital Dr. José E. González in Monterrey, México). The mean level of fear found in women with rheumatic disease was 16 (6.6) points versus 14 (4.6) points in the non-rheumatic patients group. No significant difference was found between groups (p=0.65). Regarding the rheumatic diseases group, women in the category of other diagnoses (that included Sjögren's Syndrome, antiphospholipid syndrome, and dermatomyositis) had a greater mean FCV-19S score (20.2), than patients with systemic lupus erythematosus (17.3) and rheumatoid arthritis (15.4). Conclusion: Women with postpartum rheumatic disease had a higher FCV-19S score than postpartum women without rheumatic diseases, although this difference was not statistically significant.
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Background: The SARS-CoV-2 pandemic has directly impacted the psychological and physical health of individuals worldwide, as well as the global economy. Food insecurity rates have risen especially in vulnerable countries like Mexico. Furthermore, social isolation and economic uncertainty have multiplied depression and anxiety disorders. Pregnant and postpartum women are particularly vulnerable to food insecurity, increased stress, depression, and anxiety. Objectives: The aim of this study is to determine the perception of food insecurity (FI) and perceived stress in pregnant and postpartum women with rheumatic disease during the SARS-CoV-2 pandemic. Methods: An observational, cross-sectional and descriptive study was conducted. Patients from to the pregnancy and rheumatic diseases clinic of the University Hospital Dr. José E. González in Northeast Mexico evaluated between August to October 2020 were included. The Spanish validated versions of the Household Food Security Access Scale (HFIAS) and the Perceived Stress Scale (PSS-10) were applied by telephonic interview. The WHO recommendations were employed to determine the appropriate intake for each food group in a week. The Kolmogorov-Smirnov test was used to determine normality of the data. The Spearman correlation coefficient and the Kruskal-Wallis test were used for statistical analysis. Results: A total of 29 women were included. Six (20.6%) women were found to have moderate or severe degrees of food insecurity. In addition, 12 (40.30%) perceived moderate and severe levels of stress in the PSS-10. No relationship was found between food insecurity and perceived stress (p= 0.059). The food groups that exceeded the recommended weekly frequency were oils and sugars exceeded 3.9 and 2.9 frequencies, respectively. Conclusion: We found that 20.6% women suffered household food insecurity and 40.3% suffered moderate and severe levels of stress. No relationship was found between food insecurity with the HIFAS scale and perceived stress measures with the PSS-10. We found that oils and sugars exceeded more by the double of the recommended frequency per week.