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Annals of the Rheumatic Diseases ; 81:164-165, 2022.
Article in English | EMBASE | ID: covidwho-2008999


Background: RA has been associated with poor COVID-19 outcomes, but few studies have investigated outcomes in RA features such as interstitial lung disease. Objectives: To assess COVID-19 outcomes in patients with RA overall, and those with and without ILD, compared to general population comparators. Methods: A multicenter, retrospective cohort study was conducted at Mayo Clinic (19 hospitals and affiliated outpatient centers in 4 states) and Mass General Brigham (14 hospitals and affiliated outpatient centers in New England). Consecutive patients with RA meeting ACR/EULAR criteria and a positive COVID-19 test from March 1, 2020 through June 6, 2021 were matched 1:5 on age, sex, race, and COVID-19 test date with general population comparators without RA. RA features assessed included: RA-ILD per Bongartz criteria [1], duration, rheumatoid factor (RF), cyclic citrullinated peptide antibody (CCP), bone erosions, and treatments. The primary outcome was a composite of hospitalization or death following COVID-19 diagnosis. We used multivariable Cox regression to investigate the association of RA, and features such as ILD, with COVID-19 outcomes compared to matched comparators. Results: We analyzed 582 patients with RA and 2892 comparators without RA, all with COVID-19. Mean age was 62 years, 51% were female, and 79% were White. Mean RA duration was 11 years, 67% were seropositive (52% RF+ and 54% CCP+), 27% had bone erosions, 28% were on steroids, and 79% were on DMARDs. 50/582 (9%) patients with RA had ILD. The COVID-19 hospitalization or death rate for RA patients was higher than comparators (3.0 per 1,000 days [95% CI 2.5-3.6] vs. 1.9 per 1,000 days [95% CI 1.7-2.1], respectively). Overall, RA patients had a 53% higher risk of hospitalization or death than comparators after adjustment (95% CI 1.20-1.94). Among those with RA-ILD, the hospitalization or death rate was signifcantly higher than comparators (10.9 [95% CI 6.7-15.2] vs. 2.5 per 1,000 days [1.8-3.2], respectively). RA-ILD was associated with nearly 3-fold higher risk for hospitalization or death than comparators (multivariable HR 2.84 [95% CI 1.64-4.91], Table 1). There was a signifcant interaction between RA/comparator status and presence/absence of ILD for risk of severe COVID-19 (p<0.001, Figure 1). The elevated risk for severe COVID-19 was similar for RA subgroups defned by serostatus or bone erosions. Conclusion: We confrmed that RA was associated with severe COVID-19 outcomes compared to the general population. We found evidence that ILD may be an effect modifer for the relationship between RA and severe COVID-19 outcomes, but RA subgroups defned by serostatus and bone erosions had similarly elevated risk. These fndings suggest that ILD or its treatment may be a major contributor to severe COVID-19 outcomes in RA.

Annals of the Rheumatic Diseases ; 80(SUPPL 1):893-894, 2021.
Article in English | EMBASE | ID: covidwho-1358791


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.