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Objectives: To evaluate vaccination among patients with inflammatory rheumatic diseases initiating disease-modifying antirheumatic drugs (DMARD) Methods: Data from the real-world life PANLAR's register of consecutive patients diagnosed with RA, PsA, and axSpa (2010 ACR-EULAR /2006 CASPAR-2009 ASAS) from Dec 2021 to Dec 2022 were analyzed. Prevalence of recommended vaccinations were compared between different inflammatory rheumatic diseases. Categorical variables were expressed as %. Tables were analyzed with chi2 or Fisher tests, continuous variables (median, IQR)with the Kruskal-Wallis test, according with the variables type. A p value <=0.05 was considered significant. Result(s): 608 patients were included. Among patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial Spondyloarthritis (axSpA) are presented in the table. RA and axSpA seemed to have lower vaccination rate of pneumococcal vaccines than PsA. (p = 0.045 for conjugate anti pneumococcal vaccine in RA vs PsA). A large percentage of the population was vaccinated against COVID-19. There was a high rate of influenza vaccination in all three diseases. Conclusion(s): In Latin America, anti-pneumococcal vaccination is low, especially in patients with RA and axSpA. For other vaccines there was an acceptable level of vaccination without differences between diseases.
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Background: Some factors associated with severe COVID-19 outcomes have been identifed in patients with psoriasis (PsO) and infammatory/autoimmune rheumatic diseases, namely older age, male sex, comorbidity burden, higher disease activity, and certain medications such as rituximab. However, information about specifcities of patients with PsO, psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), including disease modifying anti-rheumatic drugs (DMARDs) specifcally licensed for these conditions, such as IL-17 inhibitors (IL-17i), IL-23/IL-12 + 23 inhibitors (IL-23/IL-12 + 23i), and apremilast, is lacking. Objectives: To determine characteristics associated with severe COVID-19 outcomes in people with PsO, PsA and axSpA. Methods: This study was a pooled analysis of data from two physician-reported registries: the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), comprising patients with PsO/PsA, and the COVID-19 Global Rheumatology Alliance (GRA) registry, comprising patients with PsA/axSpA. Data from the beginning of the pandemic up to 25 October, 2021 were included. An ordinal severity outcome was defned as: 1) not hospitalised, 2) hospitalised without death, and 3) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics (age, sex, time period of infection), comorbidities (hypertension, other cardiovascular disease [CVD], chronic obstructive lung disease [COPD], asthma, other chronic lung disease, chronic kidney disease, cancer, smoking, obesity, diabetes mellitus [DM]), rheumatic/skin disease (PsO, PsA, axSpA), physician-reported disease activity, and medication exposure (methotrexate, lefunomide, sulfasalazine, TNFi, IL17i, IL-23/IL-12 + 23i, Janus kinase inhibitors (JAKi), apremilast, glucocorticoids [GC] and NSAIDs). Age-adjustment was performed employing four-knot restricted cubic splines. Country-adjustment was performed using random effects. Results: A total of 5008 individuals with PsO (n=921), PsA (n=2263) and axSpA (n=1824) were included. Mean age was 50 years (SD 13.5) and 51.8% were male. Hospitalisation (without death) was observed in 14.6% of cases and 1.8% died. In the multivariable model, the following variables were associated with severe COVID-19 outcomes: older age (Figure 1), male sex (OR 1.53, 95%CI 1.29-1.82), CVD (hypertension alone: 1.26, 1.02-1.56;other CVD alone: 1.89, 1.22-2.94;vs no hypertension and no other CVD), COPD or asthma (1.75, 1.32-2.32), other lung disease (2.56, 1.66-3.97), chronic kidney disease (2.32, 1.50-3.59), obesity and DM (obesity alone: 1.36, 1.07-1.71;DM alone: 1.85, 1.39-2.47;obesity and DM: 1.89, 1.34-2.67;vs no obesity and no DM), higher disease activity and GC intake (remission/low disease activity and GC intake: 1.96, 1.36-2.82;moderate/severe disease activity and no GC intake: 1.35, 1.05-1.72;moderate/severe disease activity and GC intake 2.30, 1.41-3.74;vs remission/low disease activity and no GC intake). Conversely, the following variables were associated with less severe COVID-19 outcomes: time period after 15 June 2020 (16 June 2020-31 December 2020: 0.42, 0.34-0.51;1 January 2021 onwards: 0.52, 0.41-0.67;vs time period until 15 June 2020), a diagnosis of PsO (without arthritis) (0.49, 0.37-0.65;vs PsA), and exposure to TNFi (0.58, 0.45-0.75;vs no DMARDs), IL17i (0.63, 0.45-0.88;vs no DMARDs), IL-23/IL-12 + 23i (0.68, 0.46-0.997;vs no DMARDs) and NSAIDs (0.77, 0.60-0.98;vs no NSAIDs). Conclusion: More severe COVID-19 outcomes in PsO, PsA and axSpA are largely driven by demographic factors (age, sex), comorbidities, and active disease. None of the DMARDs typically used in PsO, PsA and axSpA, were associated with severe COVID-19 outcomes, including IL-17i, IL-23/IL-12 + 23i, JAKi and apremilast.
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Background: It has already been published the existence of an association between ABO blood groups and COVID-19 severity. These studies have reported that the ABO blood group is statistically associated with the acquisition of SARS-CoV-2 and survival after the virus infection. Researchers have found that blood group A was associated with a higher risk for COVID-19 infection and severity compared with others blood groups, whereas blood group O was associated with a significantly lower risk compared with non-O blood groups. Aims: This study aimed to demonstrate, in a population-based cohort study in the Valencian Community (Spain), the relationship between the ABO blood group and COVID-19 severity. Methods: A total of 567 regular blood donors from the Valencian Community (Spain) who had been infected by SARS-CoV-2 were recruited. They were divided into three different cohorts based on their symptoms and their requirements during the infection: asymptomatic donors, mild donors, and severe donors. Demographic data were also included. Asymptomatic donors did not have any symptoms;mild donors had the most common symptoms associated with COVID-19 without the need for hospitalization and severe donors needed hospitalization due to severity. For the statistical analysis, we compared the three cohorts with regular blood donors who donated blood in the last 3 years (256,203 donors) in the Valencian Community. Data were analysed using Chi-Square tests. p-values <0.05 were considered significant, standardized residuals were calculated to assess the contribution of each cell to the significance of the test. GraphPad Prism v.7.0 software was used. Results: Our results show that 63.33% of blood donors who had passed COVID-19 disease and required hospitalization (severe donors) were from blood group A while only 26.67% were from blood group O (p-value = 0.0002). The same results were observed in the established cohort for mild donors, with 47.01% and 39.08% from blood groups A and O (p-value<0.0001), respectively (Table 1). These data suggest that blood group A could be a risk factor for COVID-19 infection and group. Regarding asymptomatic donors, only 38.52% were donors from blood group A while 13.12% were donors from blood group B (Table 1). This data indicate that blood group B could be protective against COVID-19 severity (pvalue< 0.0001). Summary/Conclusions: Blood group A and blood group O donors showed a significantly higher and lower risk (p-value = 0.0002), respectively, to require hospitalization after the infection of COVID- 19. However, belonging to blood group B seemed to be associated with low-risk SARS-CoV-2 infection (p-value<0.0001).
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Objectives: The COVID-19 pandemic has led to unexpected changes in rheumatology1, forcing physicians to implement telemedicine2 in order to prevent contagion, due to a limited access to personal protective equipment and the increased risk of rheumatology patients of contracting COVID-19 due to their underlying diseases or immunosuppressive treatment3. The purpose of the study was to determine the impact of COVID-19 in the practice of rheumatologists. Methods: Cross-sectional study done using online surveys. We included demographics, COVID-19 infection and factors related to the care of patients with COVID-19. Participants completed the PHQ-9 questionnaire, subjective happiness scale and Maslach Burnout inventory. Data were analyzed using SPSS v22. Results: 297 rheumatologists were included, 62% women, 65% married, mainly of mixed race (52.9%). The countries with higher responses were Argentina 28.3%, Brazil 26.3%, Mexico 12.8%, Colombia 9.1% and Ecuador 7.7%. Of the entire group, 10.1% had already contracted COVID-19. Of the 30 infected, 53.3% had headache, 63.3% fatigue, 43.3% anosmia, 43.4% myalgia, 40% odynophagia, 33.3% ageusia, 30%cough, 30% chills, 30%arthralgia, 26.6% diarrhea, 23.3% fever, 16.6% abdominal pain, 13.3% dyspnea, 13.3% nausea/vomiting, and 6.7% skin lesions. Complications occurred in 20% of them. The mean duration of quarantine in the 15 Latin American countries was 40 ± 9 weeks. 48.5% had cared for patients with a presumed diagnosis of COVID-19 and only 32% had received personal protective equipment (Figure 1). The majority (77.4%) responded that doctors and health personnel in their country had received mistreatment by society and/or governments (figure 2). 83.8% have practiced telemedicine during the pandemic. Those who were in the front lines had similar scores as those who were not in the first line in terms of happiness scale (p > 0.05), emotional exhaustion score (p > 0.05), personal accomplishment (p > 0.05), depersonalization (p > 0.05) and practice satisfaction (p > 0.05). However, they did have higher PHQ-9 scores (p = 0.013). Those who were infected with COVID-19 had higher means in emotional exhaustion (p = 0.028) and depersonalization (p = 0.008) than those who were not infected. Conclusion: The pandemic opened the doors to the use of telemedicine and has shown that this could be an alternative for the follow-up of stable patients, in remission or those who have difficulties to move around, and in those who do not need a procedure to be performed.
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Objectives: To compare characteristics of patients with rheumatic disease and COVID-19 in Argentina (SAR-COVID Registry), in contrast to the data reported at the Latin American and global level (Global International Alliance RheumCOVID Registry). Methods: A national, multicenter, longitudinal and observational registry was carried out. Patients older than 18 years, with a diagnosis of rheumatic disease and SARS-CoV-2 infection by PCR or positive serology, were included between August 13, 2020 and April 11, 2021. Demographic data, underlying rheumatic disease, comorbidities, clinical-laboratory characteristics of the SARS-CoV-2 infection, as well as treatments and outcomes. Characteristics of the patients included were compared with the data reported at the Latin American and global level. Descriptive statistics were performed. Comparisons between groups were made using ANOVA, chi2 or Fisher's test. Results: 863 patients from Argentina, 74 patients from Latin America and 583 from the rest of the world were included, mostly women in the three groups (79.4%, 73% and 71% respectively). The most frequent rheumatic diseases in the three groups were rheumatoid arthritis (45.8%, 35%, and 39%, respectively) and systemic lupus erythematosus (18%, 22%, and 14%) (Table 1). In Argentina, fewer patients received specific pharmacological treatment for COVID-19 in relation to the other 2 groups (41.4%, 68% and 43% respectively, p < 0.0001), and there was a lower requirement for non-invasive/invasive mechanical ventilation than in the rest of Latin America and theworld (8.6%vs 31% vs 13%, p < 0.0001). Hospitalization requirement in Argentina was lower than in the rest of Latin America and the rest of theworld (32.8%vs 61% vs 45%, p < 0.0001), as well as mortality (5.8%, 12%and 11%;p 0.0010). 86.9% of patients did not present any complications in Argentina, with a statistically significant difference with the rest of the groups (62% and 77%, with p < 0.0001) (Figure 1). Conclusion: Patients with rheumatic diseases and SARS-CoV-2 infection from Argentina reported in this registry received less specific pharmacological treatment for COVID-19 than those registered in other countries, presented fewer complications and required less ventilatory support. In relation to mortality, although a lower mortality was found in the Argentine registry. The fact that registries have information collected at different periods of the pandemic and different local epidemiological situations, does not allow major conclusions to be drawn.
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Background: SARS CoV-2 infection has recently burst onto the global scene, and the knowledge of the course of this infection in patients with rheumatic diseases receiving immunomodulatory treatment is still insufficient. The Argentine Society of Rheumatology (SAR) designed a national registry called SAR-COVID in order to get to assess our reality. Objectives: To identify the particular characteristics of patients with rheumatic diseases and COVID-19 in Argentina (SAR-COVID Registry), and to compare them with the data reported at the Latin American and Global level (Global International Alliance Rheum-COVID Registry). Methods: A national, multicenter, prospective and observational registry was carried out. Patients older than 18 years, with a diagnosis of rheumatic disease and SARS-CoV-2 infection by PCR or serology, were included between August 13, 2020 and January 17, 2021. Demographic data, underlying rheumatic disease (activity of the disease, current treatment), comorbidities, clinical-laboratory characteristics of the SARS-CoV-2 infection, as well as received treatments (pharmacological, oxygen therapy / ventilatory support) and outcomes (hospitalization, mortality) were recorded. The characteristics of the included patients were compared with the data reported at the Latin American and global level. Descriptive statistics were performed. Comparisons between groups were made using ANOVA, chi2 or Fisher's test, according to the type of variable. Results: Four hundred sixty-five patients from Argentina, 74 patients from Latin America and 583 from the rest of the world were included, mostly women (79.6%, 73% and 71% respectively), with a mean age of 50.2 (SD 15.3), 53.5 (DE 15.6) and 55.8 (15.5), years respectively. The most frequent rheumatic diseases in the three groups were rheumatoid arthritis (43.9%, 35%, and 39%) and systemic lupus erythematosus (16.1%, 22%, and 14%) (Table 1). In Argentina, fewer patients received specific pharmacological treatment for COVID-19 (40.9%, 68% and 43% respectively, p <0.0001), and there was a lower requirement of NIMV / IMV (Non-Invasive Mechanical Ventilation/Invasive Mechanical Ventilation) than in the rest of Latin America and the world (10.5% vs 31% vs 13%, p <0.0001). Hospitalization was lower in Argentina than in the rest of Latin America (37.4% vs 61% p 0.0002) and of the world (37.4% vs 45% p 0.0123), and mortality was numerically lower in Argentina, but without statistically significant differences between the three groups (6.9%, 12% and 11%;p 0.6311). Most of the patients, (86.9%) did not present any complications in Argentina, with a statistically significant difference with the rest of the groups (62% and 77%, p <0.0001) (Graph 1). Conclusion: The patients with rheumatic diseases and SARS-CoV-2 infection reported in this argentinian registry received less specific pharmacological treatment for COVID-19, presented fewer complications and required less ventilatory support, than those reported in the Latinoamerican and Global registry. However, no statistically significant differences were observed in terms of mortality.