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International Journal of Rheumatic Diseases ; 26(Supplement 1):373.0, 2023.
Article in English | EMBASE | ID: covidwho-2237259


Background: The COVID-19 pandemic has brought challenges especially for people with rheumatic and musculoskeletal disease (RMD). The COVID-19 Global Rheumatology Alliance reported patients with RMD had higher rates of COVID-19 infection and mortality compared with general population. The data regarding the prevalence, clinical characteristics, and outcomes of COVID-19 infection among RMD patients in Malaysia are limited. Objective(s): This study describes the clinical characteristics and outcomes of COVID-19 infection on RMD patients (including factors associated with poor outcomes) at Hospital Tuanku Jaa'far Seremban (HTJS), Malaysia. Method(s): This is a retrospective cross-sectional study. All RMD patients who confirmed COVID-19 infection either with COVID-19 PCR or RTK from 1st January 2021 to 28th February 2022 were identified. Data were collected from patients' clinic notes, hospital admission notes and electronic records. Data on RMD diagnosis, comorbidities, disease activity, medication, vaccination status, clinical staging of COVID-19 infection, outcomes including hospitalization, complications from COVID-19 infection and RMD disease flare within 1 month following COVID-19 infection were analyzed. Result(s): From the 2746 patients with RMD seen from 1st January 2021 to 28th February 2022, 2.8% (n = 77) patients were reported positive for COVID-19 infection. The most common underlying RMD were rheumatoid arthritis 35.1% (n = 27) followed by systemic lupus erythematosus 22.1% (n = 17) and psoriatic arthritis 13% (n = 10). Majority of the patients had mild COVID-19 infection symptoms which categorized into stage 2 (46.8%, n = 36). 53.2% (n = 41) patients were hospitalized, and 2.6% (n = 2) patients died of severe COVID-19 pneumonia. 13% (n = 10) developed complications from COVID-19 infection in which 6 patients complicated with organizing pneumonia, 2 with pulmonary embolism, 1 with cytokine release syndrome and 1 with acute respiratory distress syndrome. 16% (n = 10) patients reported flare of RMD within 1 month post COVID-19 infection in which 6 had arthritis flare, 5 mucocutaneous flare and 1 had renal flare. Hypertension (P = 0.021) and diabetes mellitus (P = 0.005) were associated with higher rate of hospitalization. Patients who received 3 doses of COVID-19 vaccination had lower rate of hospitalization compared with those without vaccination (P = 0.026). Patients with age more than 50 years old were associated with higher rate of complications from COVID-19 infection (P = 0.037) and flare of RMD (P = 0.038). Interestingly, RMD disease activity was not associated with poorer outcome of COVID-19 infection (P > 0.05). Conclusion(s): This single center experience on RMD patients with COVID-19 infection showed co-morbidities, no vaccination, age 50 and above were associated with poorer outcomes which was consistent with previous studies. In contrary, RMD disease activity was not associated with poorer outcomes of COVID-19 infection.

International Journal of Rheumatic Diseases ; 26(Supplement 1):156-157, 2023.
Article in English | EMBASE | ID: covidwho-2230419


Background/Purpose: Kikuchi-Fujimoto disease (KFD) is a rare, self-limited histiocytic necrotizing lymphadenitis. Although it is of uncertain aetiology, it is associated with viral infections and autoimmune diseases. Hence, it is crucial to identify KFD from other conditions with lymphadenopathy. Here we present a case of KFD after COVID-19 infection. Method(s): Medical records were traced and reviewed Results: A previously healthy 13-year- old girl was admitted in April 2022 with four weeks of fever, dry cough, loss of weight, followed by 1 week history of painful cervical lymphadenopathy and nonspecific maculopapular rash. She received her second dose of Covid 19 vaccine in January 2022. Unfortunately, she was diagnosed with CAT II, COVID 19 infection in March 2022. There was no history of allergy, recent traveling and cat scratch injury. Clinically there was no strawberry tongue, erythema of the lips, conjunctivitis or distal extremities changes to suggest Kawasaki disease. She was initially diagnosed with infection related lymphadenitis, treated with oral azithromycin for three days and intravenous ceftriazone for one week with no improvement. Her laboratory results showed hypochromic microcystic anaemia with leucopenia, raised inflammatory markers and lactate-dehydrogenese levels. Extensive workup for infection was unremarkable. Immunology test showed ANA, ANCA, ENA were negative with normal complements. Ultrasound abdomen was normal. Excisional lymph node biopsy revealed confluent areas of necrosis surrounded by histiocytes (CD68+) with absent of neutrophils. No granuloma or atypical lymphoid cells seen. Based on histopathology report, diagnosis of KFD was established. As she was not able tolerate orally, IV hydrocortisone was started and subsequently switched to oral prednisolone. She responded well to corticosteroids with fever subsided within a day and cervical lymphadenopathy reducing in size and resolved in one month. Prednisolone was able to taper off by two months. She showed complete recovery with no recurrence during follow-up. Conclusion(s): In persistent febrile painful lymphadenopathy, excision lymph node biopsy is essential to establish definite diagnosis. This case highlights the possible association between COVID-19 and KFD.

International Journal of Rheumatic Diseases ; 26(Supplement 1):125-126, 2023.
Article in English | EMBASE | ID: covidwho-2228960


Background: COVID-19 has severely influenced all aspects of life since its emergence and one of the strategies to end this pandemic rest on the vaccination to achieve herd immunity. While vaccinations are usually a safe and effective tool, the abbreviated development process of the available COVID -19 vaccines has increased uncertainties about the safety among the general population especially among patients with immune-mediated diseases (IMD) such as RMD. Method(s): This was a cross sectional study looking at the incidence of adverse events within a month following COVID-19 vaccination among the RMD patients attended rheumatology clinic at the Hospital Tuanku Ja'afar Seremban (HTJS) from 1 May 2021 to 31 September 2021. Result(s): 549 patients were recruited with mean age of 51.5 years. Majority (n = 417, 76%) were females. 414 (75.4%) received Pfizer/ BioNTech, 127 (23.1%) received Sinovac, 7 (1.3%) received Oxford/ AstraZeneca and 1 (0.2%) received Moderna. 35 (6.3%) patients had COVID-19 infection with half of them contracted the infection after at last 1 dose of vaccine. The underlying RMD included RA (n = 217, 39.5%), SLE (n = 122, 22.2%), gout (n = 65, 11.8%), osteoarthritis (n = 41, 7.5%) and psoriatic arthritis (n = 30, 5.5%). 288 (52.4%) patients did not report any side effects following the vaccination. Pain at the site of the injection (n = 169, 30.8%) was the most common side effects, followed by muscle pain (n = 91, 16.4%), fever (n = 90, 16.4%), joint pain (n = 55, 10%) and tiredness (n = 43, 7.7%). 30 (5.4%) cases of RMD flares were reported following the vaccination. 25 were arthritis flare, 3 were SLE flare (2 renal and 1 mucocutaneous involvement) and 2 were psoriasis flare. There were no serious adverse events that required hospitalization. Conclusion(s): This study supports the overall safety of COVID-19 vaccines in patients with RMD. This information can help to overcome vaccine hesitancy among this population.