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2.
J Rheumatol ; 2022 Jun 15.
Article in English | MEDLINE | ID: covidwho-1893009

ABSTRACT

OBJECTIVE: To describe which parameters were collected by rheumatologists to monitor patients with rheumatoid arthritis (RA) during teleconsultation and identify which ones have more impact on clinician intervention. METHODS: Retrospective monocentric routine care cross-sectional study including RA patients seen in teleconsultation between March and September 2020. Available parameters assessing disease status were collected in teleconsultation files. Clinician intervention was defined by treatment escalation and/or the need for a rapid face-to-face consultation or day hospitalization. RESULTS: 143 RA patients were included (117 females, mean age of 58±16 years, mean disease duration of 14±11 years). The presence or absence of patient self-reported RA flares was mentioned in all medical files, followed by the presence and/or the number of tender joints (76%), the duration of morning stiffness (66%), the number of pain-related nocturnal awakenings (66%) and the CRP value (54%). Teleconsultation led to a clinician intervention in 22/143 patients (14%), representing 51% of patients with self-reported flares (22/43 patients). Therapeutic escalation was necessary in 13 patients and/or face-to-face consultation or day hospitalization were organized for 10 patients. Multivariate analysis identified RA flares (Odds Ratio, OR: 15.6 95% CI 3.37-68.28) and CRP values >10 mg/L (OR: 3.32, 95% CI % 1.12-13.27) as the variables independently associated with clinician intervention. CONCLUSION: Our study identified patient reported RA flares and increased CRP values as 2 red flags in teleconsultation, independently associated with therapeutic modification and/or the need for a rapid face-to-face consultation. These indicators may help clinician's decision making in teleconsultation.

4.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-318409

ABSTRACT

Background: In clinical practice, the striking similarities observed at computed tomography (CT) between the diseases make it difficult to distinguish a COVID-19 pneumonia from a progression of interstitial lung disease (ILD) secondary to Systemic sclerosis (SSc). The aim of the present study was to identify the main CT features that may help distinguishing SSc-ILD from COVID-19 pneumonia. Methods: This multicentric study included 22 international readers divided in the radiologist group (RAD) and non-radiologist group (nRAD). A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study.Findings: Fibrosis inside focal ground glass opacities (GGO) in the upper lobes;fibrosis in the lower lobe GGO;reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT features most frequently associated with SSc-ILD. The CT features most frequently associated with COVID- 19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONS in the lower lobes (p <0.0001) and signs of fibrosis in GGO in the lower lobes (p <0.0001) remained independently associated with COVID-19 pneumonia or SSc-ILD, respectively. A predictive score weas created which resulted positively associated with the COVID-19 diagnosis (96.1% sensitivity and 83.3% specificity).Interpretation: The CT differential diagnosis between COVID-19 pneumonia and SSc-ILD is possible through the combination our score and the radiologic expertise. If an overlap of both diseases is suspected, the presence of consolidation in the lower lobes may suggest a COVID-19 pneumonia while the presence of fibrosis inside GGO may indicate a SSc-ILD.Funding: No Funding were received for this study.Declaration of Interests: SC reports personal fees from NOVARTIS-SANOFI-LILLY-CELTHER-PFIZER-JANSSEN;MK reports grants and personal fees from Boehringer-Ingelheim, personal fees from Corbus, grants and personal fees from Chugai, grants and personal fees from Ono Pharmeceuticals, personal fees from Tanabe-Mitsubishi, personal fees from Astellas, personal fees from Gilead, personal fees from Mochida;ST reports personal fees from Boehringer Ingelheim, personal fees from Roche, outside the submitted work;GS reports personal fees from Boehringer Ingelheim;CB reports personal fees from Actelion, personal fees from Eli Lilly, grants from European Scleroderma Trial and Research (EUSTAR) group, grants from New Horizon Fellowship, grants from Foundation for Research in Rheumatology (FOREUM), grants from Fondazione Italiana per la Ricerca sull'Artrite (FIRA);CV reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from F. Hoffmann-La Roche Ltd.;FL reports lectures fee from Roche and from Boehringer- Ingelheim;CPD reports grants and personal fees from GSK, personal fees from Boerhinger Ingelheim, grants from Servier, grants and personal fees from Inventiva, grants and personal fees from Arxx Therapeutics, personal fees from Corbus, personal fees from Sanofi, personal fees from Roche;FL reports grants and personal fees from GSK, personal fees from Boehringer Ingelheim, personal fees from Orion Pharma, personal fees from AstraZeneca, grants from MSD, personal fees from HIKMA, personal fees from Trudell International, grants and personal fees from Chiesi Farmaceutici, personal fees from Novartis Pharma;MH reports personal fees from Speaking fees from Actelion, Eli lilly and Pfizer;D K reports personal fees from Actelion, grants and personal fees from Bayer, grants and personal fees from Boehringer Ingelhem, personal fees from CSL Behring, grants and personal fees from Horizon, grants from Pfizer, personal fees from Corbus, grants and personal fees from BMS, outside the submitted work;and Dr Khanna is the Chief Medical officer of Eicos Sciences Inc and has s ock options. All the mentioned authors declared previous feed outside the submitted work. All other authors declare no competing interests.Ethics Approval Statement: This retrospective, observational, multicentric, international study was approved by the Institutional Ethics Committee of Florence Careggi hospital (protocol number 17104_oss).

6.
Rheumatology (Oxford) ; 2021 Nov 02.
Article in English | MEDLINE | ID: covidwho-1493952

ABSTRACT

OBJECTIVE: To identify which factors influence humoral response to COVID-19 vaccination in RTX-treated patients. METHODS: Observational prospective usual care study including consecutive patients with inflammatory rheumatic diseases in maintenance therapy with RTX. All patients received a two-dose regimen COVID-19 vaccination. Serum IgG antibody levels against SARS-CoV-2 spike proteins were measured at the time of the new RTX infusion. RESULTS: From the recruited patients, 16/45 (36%) produced antibodies reaching the assay cut-off value of 15 AU/ml and 29/45 (64%) had a negative serology. Within RTX treated patients, 25 (56%) had undetectable B cells. Negative serology was associated with undetectable B cells (24/25 vs 5/20, p< 0.001). Moreover, SARS-CoV-2 spike antibodies correlated with CD19 counts (r = 0.86, p< 0.001). The effect of RTX and Methotrexate was additive in terms of seroconversion rates (23% vs 50% in patients receiving RTX in monotherapy, p= 0.12) and SARS-CoV-2 spike antibody levels (3.80 AU/ml, 95% confidence interval, CI 3.80-7.50 AU/ml vs 75 AU/ml, 95% CI 3.8-353 AU/ml in patients receiving RTX in monotherapy p= 0.025). Multivariate analyses including demographics, disease characteristics, gammaglobulin levels, RTX and other therapies used, CD19 counts, and the time between the last RTX infusion and vaccination, identified detectable B cells as the only variable independently associated with seropositivity (Odds ratio: 35.2, 95% CI: 3.59-344.20). CONCLUSIONS: B cell depletion is the main independent contributing factor of antibody response to SARS-COV-2 vaccination in RTX treated patients. Monitoring CD19 may be of interest to identify the most appropriate period to perform vaccination.

7.
Rheumatology (Oxford) ; 61(4): 1600-1609, 2022 Apr 11.
Article in English | MEDLINE | ID: covidwho-1328934

ABSTRACT

OBJECTIVE: The aim of this study was to identify the main CT features that may help in distinguishing a progression of interstitial lung disease (ILD) secondary to SSc from COVID-19 pneumonia. METHODS: This multicentric study included 22 international readers grouped into a radiologist group (RADs) and a non-radiologist group (nRADs). A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study. RESULTS: Fibrosis inside focal ground-glass opacities (GGOs) in the upper lobes; fibrosis in the lower lobe GGOs; reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT features most frequently associated with SSc-ILD. The CT features most frequently associated with COVID- 19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONs in the lower lobes (P < 0.0001) and signs of fibrosis in GGOs in the lower lobes (P < 0.0001) remained independently associated with COVID-19 pneumonia and SSc-ILD, respectively. A predictive score was created that was positively associated with COVID-19 diagnosis (96.1% sensitivity and 83.3% specificity). CONCLUSION: CT diagnosis differentiating between COVID-19 pneumonia and SSc-ILD is possible through a combination of the proposed score and radiologic expertise. The presence of consolidation in the lower lobes may suggest COVID-19 pneumonia, while the presence of fibrosis inside GGOs may indicate SSc-ILD.


Subject(s)
COVID-19 , Lung Diseases, Interstitial , Scleroderma, Systemic , COVID-19/complications , COVID-19/diagnostic imaging , COVID-19 Testing , Fibrosis , Humans , Lung/diagnostic imaging , Lung/pathology , Lung Diseases, Interstitial/complications , Lung Diseases, Interstitial/etiology , Scleroderma, Systemic/complications , Scleroderma, Systemic/diagnostic imaging , Scleroderma, Systemic/pathology , Tomography, X-Ray Computed
9.
Ann Rheum Dis ; 79(6): 724-726, 2020 06.
Article in English | MEDLINE | ID: covidwho-155085

ABSTRACT

Due to the frequent presence of interstitial lung disease and widespread use of immunosuppressive treatment, systemic sclerosis (SSc) patients may be considered at risk for a more severe disease course and higher mortality when they develop Severe Acute Respiratory Syndrome - Coronavirus - 2 (SARS-CoV-2) virus infection. Therefore, with World Scleroderma Foundation endorsement, experts from different specialties including rheumatology, virology and clinical immunology gathered virtually to answer to the main practical clinical questions regarding SARS-CoV-2 infection coming from both patients and physicians. This preliminary advice is aligned with other national and international recommendations, adapted for SSc patients.


Subject(s)
Coronavirus Infections/drug therapy , Coronavirus Infections/physiopathology , Pneumonia, Viral/drug therapy , Pneumonia, Viral/physiopathology , Scleroderma, Systemic/therapy , Scleroderma, Systemic/virology , Antibodies, Monoclonal, Humanized/therapeutic use , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Lung Diseases, Interstitial/immunology , Lung Diseases, Interstitial/virology , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Respiratory Distress Syndrome/drug therapy , Respiratory Distress Syndrome/virology , SARS-CoV-2 , Scleroderma, Systemic/epidemiology , Scleroderma, Systemic/immunology
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