ABSTRACT
Background: The best way to manage disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatic and musculoskeletal diseases (RMDs) undergoing the Coronavirus disease (Covid)-19 vaccination and the recommendations regarding the use and timing of immunomodulatory therapies around the time of vaccination are still a matter of debate, due to the difficulties in balancing the vaccination efficacy and safety. Objectives: To assess the impact of different strategies of antirheumatic treatment management on disease activity around the time of vaccination for Coronavirus disease (Covid)-19 in patients with psoriatic arthritis (PsA). Methods: We prospectively evaluated patients with PsA in remission or low-disease activity candidate to receive Covid-19 vaccination with mRNA vaccines. Methotrexate (MTX) and lefunomide were withheld 7 days after each dose, whilst biological DMARDs (bDMARDs), were either continued (46.8% of the patients) or withheld (53.2%) from the day of the frst dose until 7 days after the second dose. Patients were reassessed after 3 months from enrollment or in case of disease fare. Results: After the second dose of Covid-19 vaccination 7 patients (5.6%) (6 females) had an articular disease fare each (mean involved joints: 1.29), one patient presented a concomitant worsening of psoriasis, and four patients had an isolated worsening of their psoriasis. All patients received additional treatments with oral GC (n=2) or non-steroidal anti-infammatory drugs (n=5). Two fares lasted more than one week and required a modifcation of the ongoing bDMARD. Articular fare incidence (6.8% vs 3%, p=0.259), involved joints (1.4 vs 1.5, p=0.846), disease fare severity, and changes in antirheumatic therapies (1 vs 1, p=0.928) did not differ signifcantly between the two different bDMARD management strategy groups (continued vs temporary withheld). There was no signifcant difference in disease activity score for psoriatic arthritis (DAPSA) and C-reactive protein (CRP) after vaccination, but patients who fared up had a higher mean basal DAPSA (7.3 vs 4.1, p=0.046). On binomial logistic regression analysis, we did not fnd any signifcant association with gender, age, basal CRP, basal DAPSA, active psoriasis, conventional synthetic DMARDs, or bDMARDs and disease fare. Conclusion: Our fndings suggest that a temporary short halt of bDMARDs could be a viable option in patients with well-controlled PsA undergoing Covid-19 vaccination without increasing the risk of fares, which could be useful to increase T cell response and antibody titres after Covid-19 vaccination.
ABSTRACT
Background: So far, few studies provided detailed data for the incidence of disease fare after the vaccination against Coronavirus (Covid)-19 in patients with psoriatic arthritis (PsA). Results from small cohorts report an incidence of fares after Covid-19 vaccination of 0-7.7% and disease activity does not seems to be influenced by Covid-19 vaccination in patients with PsA. However, since PsA is a highly fuctuating disease with prolonged remission and irregular reactivation, it is difficult to establish a causal relationship between the Covid-19 vaccination and disease fares. Objectives: To defne the impact of Covid-19 vaccination and disease activity on the incidence of disease fare in patients with psoriatic arthritis (PsA). Methods: We prospectively evaluated patients with PsA in remission or low-disease activity candidate to receive Covid-19 vaccination with mRNA vaccines, collecting demographic, clinical, and therapeutic data and assessing DAPSA 28, PCR before and after vaccination. We assessed fares using patients and clinician concordance. We retrospectively evaluated fare incidence in the same timeframe of the previous year. We performed statistical analysis to fnd possible predictors of fares after vaccination. Results: A total of 57 patients with PsA were prospectively evaluated, and retrospective analysis was possible for 53 of them. DAPSA 28 and CRP did not differ signifcantly before and after the vaccination. The incidence of fares in the two periods (2020 vs 2021) did not differ signifcantly (18.8% vs 8.8%, p=0.166). We found a higher basal mean DAPSA 28 in patients who fared up after vaccination (7.3 vs 4.1, p-value 0.046). Only having a fare in the previous year was associated with a higher chance of recurrence after Covid-19 vaccination (p=0.02) in the logistic regression analysis, while other predictors (age, gender, disease activity, ongoing DMARD therapy, ongoing bDMARD therapy) did not. Conclusion: Our fndings suggest that, in patients with PsA, disease activity could be the main driver of disease fares rather than Covid-19 vaccination.
ABSTRACT
Background: Although disease activity is a significant outcome in rheumatology, few studies have investigated the relationship between routine care of rheumatic conditions and disease activity control. Objectives: To determine the association between delay in routine care of chronic inflammatory arthritides (CIAs) and disease activity during the first wave of coronavirus disease 19 pandemic in Verona, Italy. Methods: This study enrolled patients with an established diagnosis of rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) and undifferentiated arthritis (UA). Between 01/04/2020 and 30/06/2020, participants were emailed an online questionnaire. Items comprised multiple or single-choice questions evaluating routine rheumatology care disruptions/delays and disease characteristics, treatments, comorbidities, and demographics. Compliance to anti-rheumatic medications was evaluated with I-CQR5. Disease activity was assessed with RAPID3, and active disease was defined as a RAPID3 score≥1. Study period referred to the time between the last rheumatology assessment and the date of enrolment. Results: Of 1210 patients contacted, 450 participated, of whom 219 CIAs patients were included (RA 55.3%, PsA 35.2%, AS 15.1%, UA 3.7%). One hundred twenty-five patients (57.1%) had their routine clinical assessment delayed (median days 68.4;IQR 66.8, 85.9). Patients in this group had significantly higher MDHAQ (p=0.001) and RAPID3 (p=0.031) scores, while they did not differ for disease severity, medications or compliance. Most (87.7%) reported good compliance to therapy;only 5.9% had difficulties in supplying anti-rheumatic medications, and 13.2% discontinued medications for at least four weeks for any reason. However, several patients (37.9%) reported moderate-to-high worse disease activity perception due to routine care delay, and 31.1% self-reported a disease flare (median RAPID3 score 3.8;IQR 2.0, 5.4). One hundred one patients (46.1%) had high disease activity, while only 15.1% were in remission. In logistic regression, active disease was significantly associated with delay of scheduled routine care visit, independent of disease duration, time from last rheumatology assessment, therapy with b/tsDMARDs, and compliance (Table 1, Figure 1 below). Conclusion: In patients with established CIAs, a relatively short delay in routine assessment by a rheumatologist resulted in higher disease activity. Frequent rheumatology referrals appear to be a critical factor for disease activity control in CIAs.
ABSTRACT
The role of 25-OH-vitamin D in the assessment of coronavirus disease 19 (COVID-19) has not been investigated. We sought to investigate the prevalence of 25-OH-vitamin D deficiency among COVID-19 patients, and to determine the associations between 25-OH-vitamin D status and the severity of the disease. We have conducted a retrospective observational study of COVID-19 patients admitted to the University of Verona Hospital Trust. Demographic, clinical and biochemical parameters were collected at hospital admission, and serum 25-OH-vitamin D levels were measured. The following outcomes were assessed: arterial partial oxygen pressure (PaO2); C-reactive protein (CRP); length of hospitalization; requirement of oxygen therapy; non-invasive ventilation (NIV); mechanical ventilation; and death. Among 61 patients enrolled, 72.1% was 25-OH-vitamin D deficient (<20 ng/mL) and 57.4% had 25-OHvitamin D <15 ng/mL. Patients with arterial PaO2 <60 mmHg had significantly lower mean 25-OH-vitamin D levels compared to patients with PaO2 ≥60 mmHg (13.3 ng/mL vs 20.4 ng/mL respectively, p=0.03). Vitamin D deficiency was associated with 3-fold higher risk of having arterial pO2 <60 mmHg. 25-OH-vitamin D deficiency was associated with increased CRP and dyspnea. 25-OH-vitamin D deficiency was associated with more severe systemic inflammatory response and respiratory failure in COVID-19 patients.