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The problem of prevention of coronavirus disease 2019 (COVID-19) in patients with immune-mediated inflammatory rheumatic diseases (IMRD) remains highly relevant. The presence of IRD is associated with a high risk of disease and severe course of COVID-19 during immunosuppressive treatment, primarily anti-B cell therapy with rituximab (RTX), and a low level of post-vaccination response in such patients. A new strategy for the prevention and treatment of COVID-19 are virus-neutralizing monoclonal antibodies to coronavirus;currently, combined long-acting monoclonal antibodies tixagevimab and cilgavimab (Evusheld) are registered for prevention in the world and the Russian Federation. . Tixagevimab and cilgavimab (TC) show neutralizing activity against SARS-CoV-2, including the Omicron strain, primarily its variants BA.4, BA.5, BA.2.75 ("Centaur"). Objective - to evaluate the efficacy and safety of TC for pre-exposure prophylaxis of COVID-19 in rheumatic patients receiving RTX, based on a prospective observational study. Materials and methods. The main group included 86 patients with various IMRD receiving RTX: 50 of them had ANCA-associated systemic vasculitis (AAV), 15 - rheumatoid arthritis, 9 - Sjogren's syndrome (SS), 4 - IgG4-related disease, 3 - systemic lupus erythematosus (SLE), 3 - dermatomyositis (DM), 2 - systemic scleroderma (SSD). Median age was 59 (19-82) years;male: female ratio - 1:1,8. From March 26 to August 30 2022, patients received a single intramuscular injection of TC in a total dose of 300 mg, mainly after RTX (in 52% of cases, in 28% on the next day after RTX). The control group included 42 patients with AAV (median age - 45 (35-71) years;male: female ratio - 1:1), also treated with RTX, who did not receive pre-exposure prophylaxis of TC. The duration of observation was 7 months, until November 1 2022. At this time, 98% of confirmed cases of coronavirus in the Russian Federation were Omicron. A telephone and/or online survey of patient has been conducted to detect cases of COVID-19 and adverse reactions. Results. In the TC group, confirmed coronavirus infection have been detected in 17 (20%) patients (AAV - 10, SS - 3, SSD - 2, SLE - 1, DM - 1), with fever in 7 (8%), only in one case hospitalization was required (lung damage was not detected in computed tomography), in two cases, according to CT mild lung damage (CT 1-2), there were no deaths. Good TC's tolerability was noted, signs not associated with COVID-19 or progression of IMRD after administration of TC were observed in 8 (9%) patients (GPA - 3 MPA - 1, RA - 2, SLE - 1, IgG4-related disease - 1), adverse reactions definitely associated with the use of TC were not found. The most serious event not associated with coronavirus infection was the progression of polyneuropathy in a patient with RA. In the control group, 3 (7%) patients were diagnosed with COVID-19, one with severe lung injury (CT 3, pulmonary embolism) and death. Conclusions. The data of clinical studies and our own clinical experience evidence the effectiveness of the use of a combination of long-acting monoclonal antibodies TC (Evusheld), registered for indications for pre-exposure prophylaxis and treatment of COVID-19. Patients with IMRD treated with RTX have a favorable safety profile of TC. The introduction of virus-neutralizing monoclonal antibodies, a new drug class for the prevention and treatment of infectious diseases, opens significant prospects for improving the prognosis of patients with IRD.Copyright © 2023 Ima-Press Publishing House. All rights reserved.
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Background/Aims Cases of new autoimmune and autoinflammatory conditions have been reported among COVID-19 survivors. A literature review on newonset autoimmune connective tissue diseases (ACTDs) following infection with COVID-19 is lacking.This systematic literature review aimed to evaluate the potential association between COVID-19 infection and the development of new-onset ACTDs in adults. Methods Articles published until September 2022, investigating the association between COVID-19 infection and new-onset ACTDs were included. The ''population'' searched was patients with disease terms for autoimmune connective tissue diseases, including (but not limited to) systemic lupus erythematosus (SLE), Sjogren's syndrome, systemic sclerosis (SSc), any idiopathic inflammatory myositis (IIM), antisynthetase syndrome, mixed CTD and undifferentiated CTD (and related MeSH terms), with ''intervention'' as COVID-19 and related terms. For terms for COVID-19, a dedicated search strategy developed by the National Institute for Clinical Excellence was used.Medline, Embase, and Cochrane databases were searched, restricted to English-language articles only. Eligible articles were: case reports and series (of any sample size), observational studies, qualitative studies and randomised controlled trials. Patients developing ACTDs without prior COVID-19 or reporting flares of existing ACTDs were excluded. Information was extracted on patient demographics, new ACTDs' onset time, clinical characteristics, COVID-19 and ACTD treatment, and COVID-19 and ACTDs outcomes. The protocol was registered in PROSPERO (CRD42022358750). Results After deduplication, 2239 articles were identified. After screening title and , 2196 papers were excluded, with 43 proceeding to fulltext screening. Ultimately, 28 articles (all single case reports) were included. Of the 28 included patients, 64.3% were female. The mean age was 51.1 years (range 20-89 years). The USA reported the most cases (9/28). ACTD diagnoses comprised: 11 (39.3%) IIM (including 4 cases of dermatomyositis);7 (25%) SLE;4 (14.3%) anti-synthetase syndrome;4 (14.3%) SSc;2 (7.1%) other ACTD (one diagnosed with lupus/MCTD overlap). Of eight, four (14.3%) patients (including that with lupus/MCTD) were diagnosed with lupus nephritis. The average onset time from COVID-19 infection to ACTD diagnosis was 23.7days. A third of the patients were admitted to critical care, one for ACTD treatment for SLE with haemophagocytic lymphohistiocytosis (14 sessions of plasmapheresis, rituximab and intravenous corticosteroids) and nine due to COVID-19. The majority (80%) of patients went into remission of ACTD following treatment, while two (10%) patients died- one due to macrophage activation syndrome associated with anti-synthetase syndrome and two from unreported causes. Conclusion Our results suggest a potential association between COVID-19 infection and new-onset ACTDs, predominantly in young females, reflective of wider CTD epidemiology. The aetiology and mechanisms by which ACTDs arise following COVID-19 infection remain unknown and require more robust epidemiological data.
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Background/Aims There are sporadic reports about the development of new rheumatic immune-mediated inflammatory diseases (R-IMIDs) in adults after receiving SARS-CoV-2 vaccines. This systematic review (SR) aimed to critically review and summarize the clinical profile, patient demographics, treatment, and prognosis of new-onset R-IMIDs following SARS-CoV-2 vaccination. Methods We retrieved English-language articles (Case reports and series and observational studies) on new-onset R-IMIDs following SARS-CoV-2 vaccination, published until June 2022, from standard databases (MEDLINE, Embase, Cochrane). The search strings used during the literature search incorporated 'SARS-CoV-2 vaccination' (along with related MeSH terms) and various key terms for R-IMIDs [which included (but was not limited to) inflammatory arthritis, connective tissue disease (CTD), vasculitis, systemic lupus erythematosus, Sjogren's syndrome, sarcoidosis, systemic sclerosis, idiopathic inflammatory myositis, anti-synthetase syndrome, Adult-onset Stills disease (AOSD), giant cell arteritis (GCA), and polymyalgia rheumatica (PMR)]. The protocol was registered in PROSPERO (CRD42022318561). Results Of the total 2179 articles retrieved, 1986 articles were excluded following the title- screening, and 107 articles that did not meet inclusion criteria. We included the remaining 86 articles (130 cases) upon full-text screening. Furthermore, we added four articles (six cases) based on a manual search, comprising 90 articles (136 cases) for final analysis. These 136 new R-IMID cases were reported from 27 different countries. Of these, more than one-third of the cases were reported from three countries (viz., Italy, Japan, and the USA). The patients had a mean age of 57 (range:17-90) years, and the majority were females (63.0%). Most patients developed R-IMIDs after receiving Pfizer-BioNTech vaccine (76;55%), followed by Oxford AstraZeneca vaccine (35;25%). The mean duration between SARSCoV- 2 vaccination and R-IMIDs development was 9.2 (range:1-90) days. The second dose of the vaccine resulted in more R-IMIDs (74;54%) than the first (53;39%). CTDs (34;25%) and small vessel vasculitis (33;24%) were the commonest R-IMID manifestations, followed by inflammatory arthritis and AOSD, each in 13 (9.5%) cases. Nearly half of the patients with CTDs had Idiopathic Inflammatory Myositis. PMR and GCA accounted for 16 (11.7%) and 5 (3.6%) cases, respectively. However, no cases of axial spondylarthritis were reported. Most (118;86%) R-IMID patients were treated with corticosteroids, with a small number receiving steroid-sparing drugs, such as methotrexate, rituximab and cyclophosphamide. Most (125;91%) went into either disease remission or improvement following the treatment. Only three patients were admitted to the intensive care unit (ICU) to manage their disease;One of them died due to fatal myositis and rhabdomyolysis;two surviving ICU patients had ANCA-associated vasculitis with lung involvement. Conclusion Although rare, this SR highlights the emergence of de novo R-IMIDs following SARS-CoV-2 vaccination. We cannot confirm the causality between the vaccination and the onset of R-IMID. However, further research is warranted in this area.
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Background. Patients with autoimmune and inflammatory rheumatic diseases (AIRDs) are at high risk of developing COVID-19. Vaccination is an effective method of preventing this disease, which may be unsafe for patients with AIRDs. The aim of the study is to assess the safety of Gam-COVID-Vac in patients with IVRD in real clinical practice. Material and methods. A cross-sectional study was carried out. The main group consisted of patients with AIRDs, the control group consisted of individuals without AIRDs. All participants were interviewed by the research physician using a unified questionnaire, additional information was obtained from medical records. Results. The study included 222 patients with AIRDs (119 with rheumatoid arthritis, 36 with ankylosing spondylitis, 17 with psoriatic arthritis, 17 with Sjogren's disease, 10 with undifferentiated spondyloarthritis, 8 with systemic lupus erythematosus, 4 with metabolic arthritis, 3 with systemic scleroderma, 3 with systemic vasculitis, 2 with polymyalgia rheumatica, 2 with undifferentiated systemic connective tissue disease, 1 with adult Still's disease) and 111 patients without AIRDs. The number of patients with AIRDs who had a combination of local and systemic adverse events (AE) on the introduction of the first component of the vaccine was significantly less than in the control group (22.1 and 44.1%, respectively, P<0.001). Similar differences were also noted after the introduction of the second component (14.0 and 29.7%, respectively, P<0.001). AEs such as pain at the injection site without restriction of movement, weakness, fever, arthralgia/myalgia, headache, and chills were significantly more common in the control group after the introduction of the first component of the vaccine. After complete immunization, AEs were absent in 35.6% of patients with AIRDs and in 21.6% of control group patients (P=0.01). Exacerbations of AIRDs and new autoimmune phenomena were not registered in any cases. Conclusions. According to preliminary data, immunization of patients with AIRDs with the Gam-COVID-Vac combined vector vaccine appears to be quite safe.Copyright © Team of Authors, 2022.
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Introduction: There are similarities in the pathogenesis of COVID-19 and autoimmune diseases. In addition, due to the molecular similarities between the antigens of the virus and the antigenic structures in the human body, autoimmune diseases such as arthritis may occur or exacerbate after COVID-19 vaccines. In this publication, a retrospective evaluation of the patients who applied to the Rheumatology Outpatient Clinic with arthritis and other autoimmune complaints that developed or exacerbated after the COVID-19 vaccine was performed. Material(s) and Method(s): Patients who applied to the Rheumatology outpatient clinics of our hospital were screened retrospectively, and patients who presented with newly developed or exacerbated autoimmune complaints after COVID-19 vaccination were determined. The files of these patients were reviewed retrospectively. Demographic characteristics of the patients, history of rheumatological disease, COVID-19 vaccinations, mean time to symptom development after vaccination, localization of arthritis, laboratory findings, imaging findings, treatment and treatment response were evaluated. Result(s): There are seven patients who applied to Rheumatology clinics with newly developed or exacerbated autoimmune complaints after COVID-19 vaccination in the last year. Three patients (no previous history of rheumatological disease) had newly emerged inflammatory arthritis, one stable gout, and one Sjogrens syndrome patient had exacerbated arthritis and two dermatomyositis cases (one newly diagnosed and the other exacerbation). Conclusion(s): The benefits of the vaccines are greater than the side effects that may develop, and vaccination should be continued in line with the recommendations. Although the temporal connection between the appearance of symptoms and the vaccination procedure in our study supports the relationship with the COVID-19 vaccine, it should never be forgotten that vaccines are the most effective way to prevent the disease.Copyright © 2022 Bilimsel Tip Yayinevi. All rights reserved.
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Background: Primary Sjogren's syndrome (pSS) is a chronic, systemic, inflammatory autoimmune disease in which existing studies have found the presence of pSS-specific antibodies anti-SSA/ Ro in acute infection with COVID-19.1 The emergence of this phenomenon makes us aware that in the context of the long-term epidemic of COVID-19, it is necessary to further study the molecular mechanisms of the high susceptibility of pSS patients to COVID-19. Method(s): The gene expression profiles of 8 COVID-19 datasets and 5 pSS datasets were downloaded from the Gene Expression Omnibus (GEO) database. The differentially expressed genes (DEGs) between COVID-19 and PSS were identified using the limma software package and Weighted Gene Co-expression Network Analysis (WGCNA). A Venn diagram was used to discover common upregulated DEGs. To explore the possible pathogenesis of both diseases, common signaling pathways were explored by enriching DEGs using Gene Ontology (GO) and the Kyoto Gene and Genome Encyclopedia (KEGG) pathway. Protein-protein interactions (PPIs) were established to identify hub genes and key modules. The analysis of key gene expression characteristics by The Connectivity Map was used to predict potentially effective drugs. Finally, the CIBERSORT method was used to comprehensively evaluate the immune infiltrates of patients with COVID-19 and PSS to study the mechanisms that may have a common immune response or immune cell infiltration. Result(s): A total of 82 upregulated DEGs were identified in both COVID-19 and PSS (Figure 1 A-E). Functional enrichment analysis illustrated the important role of enhanced signaling pathways in response to virus defense and interferon-alpha in both diseases (Figure 1F).Three key modules including 25 hub genes were identified (Figure 1G). The correlation analysis of immune cell infiltration showed the expression of B cells memory resting decreased and NK cells resting increased significantly in the two diseases (Figure 1H, I). Finally, estradiol in drug prediction outcomes has been shown to reduce susceptibility to COVID-19 and its severity through its involvement in regulating immune cells, while the most common manifestation of dry eye in pSS patients is strongly associated with low estrogen. Conclusion(s): High defense response to virus and response to interferon-alpha in pSS patients might be a crucial susceptible factor for COVID-19 and predictive drugs such as estradiol, suggested by susceptibility genes common to COVID-19 and pSS, may help in the clinical treatment of both diseases.
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Purpose: To describe the outcome of Covid-19 infected patients with underlying rheumatic diseases in a rheumatology center in Malaysia. Introduction: Several risk factors for Covid-19 infection have been recognized since the onset of pandemic. Whether patients with rheumatic diseases are more susceptible to severe Covid-19 infection remain unclear. Method(s): This was a retrospective study. The electronic medical records of all Covid-19 infected patients with underlying rheumatic diseases who follow up in rheumatology clinic Hospital Sultan Ismail from March 2020 to December2021 were reviewed and identified. Result(s): There were total of 40 patients with 95% of them were female (38/40). Majority of them were Malay (31/40) followed by Chinese (6/40), Indian (2/40) and others (1/40). The mean age group was 46 (range from 21 to 75). 55% of them were diagnosed to have Systemic Lupus Erythematosus (SLE), followed by Rheumatoid Arthritis (RA, 27.5%), scleroderma (Ssc,5%) and 2.5 % each for Sjogren syndrome (Sjog), psoriatic arthritis (PsA), gout, antisynthetase syndrome and dermatomyositis (DM) overlap RA. 72.5% of them were unvaccinated and only 7.5% of them were completed 2 doses of covid-19 vaccine whereas the rest of them only had single dose. The results showed 17.5% of them succumbed to covid-19 infection and 5 of them succumbed for Covid-19 pneumonia stage 5. 70% of the patients who succumbed were unvaccinated during covid-19 infection. Conclusion(s): There were 5 patients from chronic inflammatory arthritis and 2 from systemic autoimmune conditions succumbed due to Covid-19 infection. Whether patients with chronic inflammatory arthritis more prone to infection required more data. Majority of patients who succumbed were unvaccinated. (Table Presented).
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Background. The National Sjogren's Patient Association (NVSP), the only Sjogren's patient association in the Netherlands, was founded on 10 December 1986 and currently has 2150 members. Our goals are to represent the interests of our members and to provide patients and their families with information. Objectives. The NVSP receives questions through several channels from patients with Sjogren's and non-Sjogren sicca. They are worried about the consequences of the restrictions on daily life and work and what corona can do to their disease. Methods. An attempt was made to get a picture of what the patients think by means of a survey. The results of the survey can lead to recommendations. In this way, their concerns can be addressed and the continuity of care among the many care providers with whom a Sjogren's patient comes into contact can be guaranteed also during the corona pandemic. Results. A total of 95 patients completed the survey in the period from 26 May to 20 July 2020, between the first and second lockdown. Concerns about corona in relation to daily life and work: 73% of respondents adjusted their daily activities during the pandemic due to government guidelines and the fear of getting corona. Hobbies outside the home and voluntary work have been drastically reduced. Working at home increased because employers did not consider it wise to come to work. Continuity of healthcare: A quarter of the participants think that healthcare has changed a lot to very much (Fig. 1). Relatively many appointments with GPs, dentists, oral hygienists, ophthalmologists and physiotherapists were cancelled, rescheduled or postponed compared to the other disciplines. The GP was virtually unavailable by phone. Concerned more than others: Corona contributes to uncertainty in Sjogren's patients for several reasons. It is not clear in which case the condition leads to a higher risk of corona and what it means for work. Conclusions. Concerns about corona in relation to daily life and work: people have started to work more inside than outside, both in business and in private. Continuity of healthcare: due to the sudden pandemic, many decisions were made about the patient and not with the patient. Even though many appointments continued, albeit in a different way, the patients were very satisfied with this. Alternatives to maintain face-to-face contact with patients (such as video calling) were not sufficiently explored. Concerned more than others: 66% indicated that they consider themselves vulnerable to corona because they have Sjogren's disease (Fig. 2), or take immunosuppressive medication, or because the specialist indicates that they are in a high-risk group. Several of the above factors may apply to a patient. (Figure Presented).
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SESSION TITLE: Challenges in Cystic Fibrosis Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Pulmonary involvement in Systemic Lupus Erythematosus (SLE) is seen in 30-50% of patients (most commonly Nonspecific Interstitial Pneumonitis) but cystic lung disease is extremely rare (1). Lymphoid interstitial pneumonia (LIP) is an inflammatory lung disease that is characterized by infiltration of lymphocytes and plasma cells (2), and associated with lung cysts. Oftentimes, it is associated with HIV, lymphoma, and primary Sjogren's Syndrome (SS) (2), however there are rare reports of LIP associated with SLE (1). We present a case of a young male with incidental lung cysts who was found to have a new diagnosis of SLE. CASE PRESENTATION: A 24-year-old male with a past medical history of premature birth at 5 months and prior mild COVID-19 infection presented with 3 weeks of abdominal pain, nausea, vomiting, fever, and unintentional 15-pound weight loss. He endorsed dry mouth, frequent cavities, and a new rash involving his chest, face, and lower extremities. Physical exam was significant for malar rash and dry mucous membranes. Labs revealed pancytopenia, sedimentation rate 61 mm/hour and C-reactive protein 5.54 mg/L. Computed tomography (CT) of the chest showed several thin-walled cysts in all bilateral lung lobes (predominant in right upper lobe) and bilateral axillary lymph nodes [Figure 1]. CT abdomen and pelvis was unremarkable. Autoimmune work-up resulted in a positive antinuclear antibody >1:1280, double stranded DNA antibody elevated at 34, elevated SSA and SSB antibodies (>8.0 and 1.4 respectively), and decreased Complement 3 (59.5 mg/dl) and 4 (10.1 mg/dl) levels. Peripheral smear, right axillary lymph node and bone marrow biopsies were negative for malignancy. He was started on prednisone and Plaquenil with symptomatic improvement. There is high suspicion of LIP given the clinical and radiological findings. He will follow up in clinic to obtain PFTs and schedule a lung biopsy. DISCUSSION: Interstitial lung disease in SLE presents in middle-aged patients at a later part of their disease course, with a female preponderance (2,3). An initial presentation of SLE and secondary SS in a young male and associated cystic lung disease is rare. The suspicion for LIP in association with SLE is high in our patient given variable size and distribution of lung cysts and coexisting secondary Sjogren's syndrome, although no ground glass or nodular opacities were found on CT chest as reported in typical LIP (3). Though this patient has no pulmonary symptoms, cysts/LIP in SLE tend to progress and have a high incidence of developing lymphomas, gammaglobulinemia and amyloidosis (2,3). CONCLUSIONS: It is important to establish a histopathological diagnosis and obtain baseline PFTs to monitor pulmonary disease manifestations. In addition to controlling the primary disease with antirheumatic drugs, steroids have been found to be useful in acute pulmonary flares (2). Reference #1: Maeda R, Isowa N, Miura H, Tokuyasu H. Systemic lupus erythematosus with multiple lung cysts. Interact Cardiovasc Thorac Surg. 2009 Jun;8(6):701-2. doi: 10.1510/icvts.2008.200055. Epub 2009 Mar 12. PMID: 19282324. Reference #2: Yood RA, Steigman DM, Gill LR. Lymphocytic interstitial pneumonitis in a patient with systemic lupus erythematosus. Lupus. 1995 Apr;4(2):161-3. doi: 10.1177/096120339500400217. PMID: 7795624. Reference #3: Filipek MS, Thompson ME, Wang PL, Gosselin MV, L Primack S. Lymphocytic interstitial pneumonitis in a patient with systemic lupus erythematosus: radiographic and high-resolution CT findings. J Thorac Imaging. 2004 Jul;19(3):200-3. doi: 10.1097/01.rti.0000099464.94973.51. PMID: 15273618. DISCLOSURES: No relevant relationships by Matthew Fain No relevant relationships by Christina Fanous No relevant relationships by Rathnavali Katragadda No relevant relationships by CHRISELYN PALMA
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SESSION TITLE: Unique Inflammatory and Autoimmune Complications of COVID-19 Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Viral infections can induce an immune cascade which may incite varied autoimmune disease to take action. One such disease is dermatomyositis, a rare inflammatory disease with multisystemic involvement. As we enter the post pandemic era, several unique complications related to COVID-19 are now surfacing. Here we present a case of a 57-year-old female who developed dermatomyositis after recent Covid-19 infection. CASE PRESENTATION: Patient is a 57-year-old female who presented to our pulmonary clinic with complaints of cough and shortness of breath (SOB). Patient reported feeling ill since contracting COVID-19 in November 2020. Two months after being diagnosed with COVID-19 she started to experience generalized muscle and joint pain;she underwent extensive rheumatological workup which was consistent with Sjogren disease for which she was started on hydroxychloroquine. A month after initiation of medication she started to experience worsening cough and SOB and underwent pulmonary function testing (PFT) in our clinic which showed evidence of restrictive lung disease. Chest CT was consistent with interstitial changes, therefore a diagnosis of ILD (interstitial lung disease) due to connective tissue disorder was made. Further assessment revealed positive CPK and anti-Jo1 antibodies indicative of dermatomyositis as a cause of her ILD. She was started on oral steroids which helped improve her symptoms. DISCUSSION: Several viruses including EBV, Hepatitis C, Rubella, HTLV-1 and Parvovirus have been associated with development of autoimmune diseases. Viral infections, like COVID-19 have shown to trigger an intense immune response which in turn may lead to autoimmune activity against host antigen. SARS-CoV2 has been found to enter muscle cells through ACE-2 receptors, allowing for transfer of genetic material and skeletal muscle damage. Another proposed mechanism of COVID induced myopathy has been T-cell clonal expansion by the virus up regulating TLR4 receptors increasing expression of ACE2, therefore facilitating entry of viruses leading to further inflammation. Identification of very specific T cell receptor epitopes for SARS-COv2 in patients with dermatomyositis has suggested COVID-19 as a trigger for CD8-T cells which leads to dermatomyositis in these patients. Autoimmune reactions occur from varying mechanisms like epitope spreading and bystander activation to molecular mimicry triggered by viral infections. CONCLUSIONS: SARS-COv2 presented with several challenges in the field of medicine. As we enter the post COVID period in medicine, we will continue to face several challenges proposed by the inflammatory surge caused by this disease. It is therefore important clinicians recognize and report these rare cases to increase awareness regarding several post covid diseases. Reference #1: HUSSEIN, H. M.;RAHAL, E. A. The role of viral infections in the development of autoimmune diseases. Critical Reviews in Microbiology, [s. l.], v. 45, n. 4, p. 394–412, 2019. DOI 10.1080/1040841X.2019.1614904. Disponível em: https://search-ebscohost-com.proxy.lib.wayne.edu/login.aspx?direct=true&db=a9h&AN=138199390&site=ehost-live&scope=site. Acesso em: 4 abr. 2022. DISCLOSURES: No relevant relationships by Kevser Akyuz No relevant relationships by Ranim Chamseddin No relevant relationships by Padmini Giri No relevant relationships by verisha khanam No relevant relationships by Emad Shehada No relevant relationships by Abdullah Yesilyaprak
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SESSION TITLE: Autoimmune Disorders: Both Primary and Secondary SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: SARS-CoV-2 has demonstrated an impact on the lungs, leads to hypercoagulable states, and has caused immune-mediated reactions. Myasthenia Gravis (MG) represents a neuromuscular junction autoimmune disorder, with only a few case reports associated with new-onset MG following COVID-19 vaccination. Very rarely, MG has been reported in coexistence with Primary Sjogren's Syndrome (PSS). Here we present a case of new-onset MG in a patient with a positive COVID-19 a nasopharyngeal RT-PCR swab test, who received 3 doses of the Moderna COVID-19 vaccine with the latest dose 2 weeks prior to presentation and demonstrated positive PSS antibodies (Abs). CASE PRESENTATION: A 67-year-old male with no known past medical history presented with complaints of progressive weakness for 2 weeks, which began as diffuse malaise, and progressed to upper and lower extremity weakness with associated neck weakness, and dysphagia. Physical exam was remarkable for bilateral ptosis and difficulty ambulating. The patient was admitted to the ICU for suspected new-onset neuromuscular junction disorder and for close monitoring of his respiratory function. COVID-19 PCR was positive. MG and autoimmune disease workup was sent along with COVID-19 antibody testing. Chest X-Ray, CT head, and CT thorax were unremarkable. The patient was started on Pyridostigmine and IVIG, with low dose prednisone initiated on day 3 of admission. On the fifth day, symptoms improved significantly. Antibodies (Ab) against Acetylcholine (Ach) receptors were elevated and the diagnosis of MG was made. PSS Abs were also detected. Lyme, HIV, RPR, thyroid, and B12 levels were within the normal range which may mimic NMJ dysfunction. DISCUSSION: MG represents an autoimmune disorder due to autoantibodies against nicotinic AChR at the neuromuscular junction;however, these Abs can also target non-AChR muscle-specific receptor tyrosine kinase (MUSK). The exact mechanism of the autoimmune response with MG is not fully understood;however, there have been associations found with thymus gland hyperplasia and neoplasm when anti-AChR Abs are involved. Genetic predisposition is also likely to play a role. Viral and bacterial infections are established triggers for a myasthenic crisis in patients with pre-existing MG;however, there is yet to be a clear consensus regarding infections causing MG in otherwise healthy patients. As our pt did receive the COVID-19 vaccine, we have to consider an autoimmune reaction secondary to his administration. CONCLUSIONS: COVID-19 vaccines have demonstrated autoimmune responses such as myocarditis and myasthenic crisis in individuals. There have also been documented cases of MG in symptomatic COVID-19 infections. Given these findings, this patient may have experienced an environmental insult on top of a genetic predisposition and may warrant further investigation in patients with similar presentations. Reference #1: Sriwastava S, Tandon M, Kataria S, Daimee M, Sultan S. New onset of ocular myasthenia gravis in a patient with COVID-19: a novel case report and literature review. J Neurol. 2021 Aug;268(8):2690-2696. doi: 10.1007/s00415-020-10263-1. Epub 2020 Oct 12. PMID: 33047223;PMCID: PMC7549728. Reference #2: Chavez A, Pougnier C. A Case of COVID-19 Vaccine Associated New Diagnosis Myasthenia Gravis. J Prim Care Community Health. 2021 Jan-Dec;12:21501327211051933. doi: 10.1177/21501327211051933. PMID: 34709075;PMCID: PMC8559213. Reference #3: Witberg G, Barda N, Hoss S, Richter I, Wiessman M, Aviv Y, Grinberg T, Auster O, Dagan N, Balicer RD, Kornowski R. Myocarditis after Covid-19 Vaccination in a Large Health Care Organization. N Engl J Med. 2021 Dec 2;385(23):2132-2139. doi: 10.1056/NEJMoa2110737. Epub 2021 Oct 6. PMID: 34614329;PMCID: PMC8531986. DISCLOSURES: No relevant relationships by Brooke Kania No relevant relationships by Anas Mahmoud No relevant relationships by Ahmed Salem No relevant elationships by Jessimar Sanchez No relevant relationships by Shivanck Upadhyay No relevant relationships by Deniz Yucel
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Upon COVID-19 infection, age-specific mortality rates in RADs patients notably began from 35 years old, while in the uninfected population, it was from 55. COVID-19 associated rheumatic signs and symptoms are myalgia, fatigue, Kawasaki-like signs, and skin rashes mimicking vasculitides and pernio (chilblains) like lesions. So a variety of rheumatic diseases may mimic or be mimicked by COVID-19. Rheumatologic Treatments During COVID-19 Epidemic: Prednisone caused an increased hospitalization rate, significantly when the dose exceeded 10 mg per day. It is reasonable to reduce glucocorticoids gradually to 5 - 7.5 mg/day, but discontinuation during the pandemic is not recommended. Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) reduce the risk of COVID-19 infection and the cytokine storm emerging in severe cases. Colchicine has reduced the mortality of COVID- 19 patients and the number of severe cases. Tapering or even discontinuing csDMARDs is suggested to recover immunity in severe cases, which may help rapidly eliminate the virus. Hydroxychloroquine is likely to increase survival in SLE patients, and it is not advisable to be discarded. Biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) may help reduce inflammatory cytokine storm under COVID-19 attack. Compared with RADs patients treated with CD20 monoclonal antibody rituximab or IL-17A antagonist secukinumab, patients receiving tumor necrosis factor (TNF) inhibitors etanercept and alemtuzumab or IL- 6 receptor antagonist tocilizumab may experience milder course. Applicable Laboratory Indicators: Elevation of ESR, CRP, ferritin, interleukin 6, and creatine kinase can be seen in COVID-19 and various rheumatic diseases. RADs related autoantibodies may present among non-RAD severe COVID- 19 cases. COVID-19 as a Risk Factor for Rheumatologic Diseases: Cases of Small vessel cardiac vasculitis/endothelium, immunoglobulin A (IgA) vasculitis in patients with Crohn disease, cutaneous vasculitis-like lesions, systemic arterial and venous thromboembolism including cryptogenic strokes and other vasculopathy features, systemic rheumatic diseases such as SLE, inflammatory arthritis, GCA, inflammatory myopathies, APS, Sjogren's syndrome, ANCA-associated vasculitides, seropositive rheumatoid arthritis, and Virus-associated or reactive arthritis and Crystal-related arthritis due to gout or calcium pyrophosphate disease has been reported. COVID-19, in the acute phase, may cause cytokine storm and severe inflammatory response;and in the chronic phase, patients become susceptible to autoinflammatory and autoimmune diseases. If a patient has signs and symptoms of rheumatic diseases after developing COVID-19, do not attribute these complaints entirely to COVID-19;consider starting a real dangerous rheumatic disorder.
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Background: In recent times, safety and potential adverse effects (AEs) of Sars-CoV-2 vaccines have gained great relevance and have been a central topic in Scientific discussion. Objectives: The aim of this study was to evaluate the incidence of AEs after Sars-CoV-2 vaccine administration in patients affected by Connective Tissue Disease, Vasculitis or Polymyalgia Rheumatica. Moreover, we assessed patients' adherence to the American College of Rheumatology (ACR)1 or Italian Rheumatology Society (SIR)2 recommendations. Methods: 139 patients affected by Connective Tissue Disease, Vasculitis or Polymyalgia Rheumatica were enrolled at the Rheumatology Units of University Hospitals of Bari and Foggia. All patients were given a questionnaire to evaluate vaccine type and dose number, AEs, potential pre-vaccine prophylaxis, immuno-suppressive therapy and its possible suspension according to the clinical guidance summary proposed by ACR or SIR. Results: Among the 139 enrolled patients (120 females and 19 males, mean age 54 ± 14,7 year, mean disease duration 8,6 ± 7, 4 years), 31 subjects (19%) received anti Sars-CoV-2 vaccination. 5 patients received the Astra-Zeneca COVID-19 vaccine, 23 the BioNTech-Pfzer COVID-19 vaccine and 3 the Moderna vaccine. Only 48% of subjects received two doses. 42% of patients reported non-severe AEs after the frst dose of vaccine, specifcally 45% of patients who received the BioNTech-Pfzer COVID-19 vaccine, 40% of those who were administered the AstraZeneca vaccine and 33% of those who received the Moderna vaccine. Most frequent AEs were site injection pain (19%), fatigue (13%), headache (13%), myalgia (6%), fever (6%), nausea (3%), rheumatic disease fare (3%) (the latest was reported only among the Polymyalgia Rheumatica patients). Considering the different diseases, the highest trend of AEs was observed in Polymialgya Rheumatica (66%), Systemic Sclerosis (57%), Sjogren Syndrome (40%) and undifferentiated connective tissue disease (23%) patients. 30% of patients who received the second vaccine dose reported AEs. All of them were administered the BioNTech-Pfzer COVID-19 vaccine. Most reported AEs after the second vaccine dose were site injection pain (6%), headache (3%), myalgia (6%), fever (6%). The highest trend of AEs was observed in undifferentiated connective tissue disease (60%) and Sjogren Syndrome (33%) patients. Only 13 % of subjects who reported AEs after the frst vaccine administration, reported AEs also after the second dose. Only 9,7% of patients did not comply with the COVID-19 vaccine clinical guidance prosed by ACR or SIR regarding immunosuppressive treatment management before and after immunization. Conclusion: Patients enrolled in this study developed mild AEs. Only among Polymyalgia Rheumatica patients were described disease fares and higher trend of AEs. Although patients affected by Systemic Lupus Erythematosus, Antiphospholipid Syndrome and Vasculitis were enrolled, none of them reported severe AEs, included the extensively discussed post-vaccine thrombosis. We found no signifcant dissimilarity of AEs relating to different types of vaccine and good patient compliance to physician recommendations about treatment management.
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Background: The preselection of patients with suspicion of an infammatory rheumatic disease is not easy for general practitioners and orthopedists. In countries with a limited number of practicing rheumatologists waiting lists are often long, since a full rheumatologic examination often needs a long consultation time. Objectives: To test the performance of an early triage strategy for early identif-cation of patients with infammatory rheumatic diseases. Methods: Prior to the SARS-CoV 2 pandemic, physicians caring for patients contacting a tertiary rheumatologic cente were frst contacted by a health-care professional (HPR) who offered an appointment the timing of which was based on the symptoms reported (Step 1). Patients were then seen by a rheumatolo-gist who, within a 10-minute consultation (Step 2), shortly examined the patient to determine the urgency of a planned full work up. The main outcome of the study was the comparison between the initial assessment and the fnal expert diagnosis (Step 3). Results: Within 9 months, physicians caring for 1.180 patients contacted the hospital, 972 of whom kept their appointment (82.4%). Most patients were transferred by GPs (73.1%) and orthopedists (22.1%). The mean time between Step 1 and Step 2 was 10.4 days, while 6.2% of patients were seen within 4 days, 24.4% within 7 days and 69.3% within 12 weeks. Only 36 patients (3.7%) of patients had an already established rheumatic disease. Complaints lasting between 0-4 weeks were reported by 69 (7.1%), of > 4-12 weeks by 100 (10.3%), and of > 12 weeks by 973 (82.6%) patients. Almost 90% of patients reported a pain intensity >4/10 (NRS) for < 2 weeks. An elevated CRP was found in 207 patients (24.5%). Prior treatment with glucocorticoids was reported in 163 (16.8%) and with NSAIDs in 730 (75.1% of) patients. The confirmed diagnosis at Step 3 was rheumatoid arthritis in 127 (13.1%), spondyloarthritis including pso-riatic arthritis in 72 (7.4%), systemic diseases including connective tissue diseases in 112 (11.5%), vasculitides in 41 (4.2%), and crystal arthropathy in 38 (3.9%) patients, while 38 (3.9%) had an infection, a malignancy or a differential diagnosis such as Raynaud's phenomenon or sicca syndrome. Degenerative joint diseases (n=254;26.1%) and non-inflammatory soft tissue syndromes such as fibromyalgia (n=369;38%) accounted for more than half of the patients. Conclusion: This study describes the performance of a standardized triage system hereby confrming the need for an early identifcation and preselection of patients with rheumatic musculoskeletal symptoms, including involvement of HPRs in the initial phase of contact. Based on the results, three patients with musculoskeletal complaints had to be examined in order to identify one patient with an infammatory rheumatic disease.
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Background: During the COVID-19 pandemic, the patients with rheumatic disease in the biopsychosocial perspective have been adversely affected by social isolation, uncertainty, and the thought that their chronic disease will worsen and increase in their symptoms. ACR/EULAR (American College of Rheumatology/European League Against Rheumatism) defnes recommendations about continuing current pharmacotherapy and the signifcance of the biopsychosocial approach and exercise for patients with rheumatic diseases during a COVID-19 infection 1, 2. Objectives: This study aims to investigate the effectiveness of the biopsychoso-cial exercise performed by telerehabilitation on biopsychosocial status, general health status, and anxiety-depression levels in the patients with infammatory and non-infammatory rheumatic diseases. Methods: Fourteen patients with infammatory rheumatic diseases (rheumatoid arthritis: 4;ankylosing spondylitis: 4;sjogren's syndrome: 3;polymyalgia rheumatica: 2;and vasculitis: 1) and eight patients with non-infammatory rheumatic diseases (fbromyalgia: 6;and osteoarthritis: 2) performed a biopsychoso-cial-based exercise model (named as 'Bilişsel Egzersiz Terapi Yaklaşimi'-(BETY) in original;'Cognitive Exercise Therapy Approach' in English) via telerehabilita-tion continued for three sessions per week for 12 months 3. Outcome measures were Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression Scale (HADS), and BETY-Biopsychosocial Questionnaire (BETY-BQ) 4. All outcomes were measured baseline and at the 12th month. The Wilcoxon's test was used for statistical analysis. Results: All of the 22 patients were female. The mean age was 57.4 and 55.8 years in the infammatory and non-infammatory rheumatic diseases groups respectively, and they had a mean BMI of 25.9 and 25.3 kg/m2. There was no signifcant difference by time for HAQ score (p = 0.125), HADS anxiety and depression (p = 0.916 and p = 0.663, respectively), and BETY-BQ score (p = 0.753) between the baseline and at the 12th month follow-up in the patients with infammatory rheumatic diseases. Similarly, in the patients with non-in-fammatory rheumatic diseases, there was no signifcant difference by time for HAQ score (p = 0.546), HADS anxiety and depression (p = 0.343 and p = 0.527, respectively), and BETY-BQ score (p = 0.068) between the baseline and at the 12th month follow-up. Conclusion: This study showed that biopsychosocial-based exercise through real-time telerehabilitation was able to maintain their conditions before pandemic in biopsychosocial status, general health, and anxiety-depression levels on the patients with infammatory and non-infammatory rheumatic diseases during COVID-19 pandemic period in one-year follow-up.
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Background: Although there have been expansion of knowledge about the course of COVID-19 in rheumatologic diseases, it still remains unclear the effect of vaccination status and variants on the disease course. Objectives: We aimed to investigate the general clinical characteristics of our patients with infammatory rheumatic disease (IRD) who had COVID-19 disease, their vaccination status and the time periods in which different variants were dominant during the disease. Methods: During the routine follow-up of our patient's with IRD, whether the patients had COVID-19 disease, when they were vaccinated (Pfzer/Biontech or Sinovac in our Country) and main clinical characteristics and their comor-bid diseases were recorded. The last patient was included in the study on January 25, 2022. They were divided into those who received insufficient or no vaccine and those who received a full dose of vaccine. The patients were divided into 3 groups according to the period they had the disease: Those who had the disease between March 2020 and June 2021accepted as '1st period patietns', the period when the Alpha and Beta variants, the initial forms of the disease, were dominant variants in populations;those who had the disease between July 2021 and November 2021, when the Delta variant dominated the World and in our country accepted as '2nd period patients';and those who had the disease in December 2021 and later, when the Omicron variant was dominant throughout the world and in our country, was accepted as ' 3rd period' patients. Results: Total 463 (294 woman) IRD patients enrolled to the study. Distrubution of these patients included Behcet's syndrome:15;familial mediterranean fever: 5 7, rheumatoid arthritis:134, Sjogren's syndrome:24, systemic lupus erythema-tosus:26, Spondyloarthritis:141, necrotising vasculitis:6 and Others:50 cases. Mean age of patients were 46±13,2 (18-83) years. 354 (77%) of our patients got sick in the 1st period, 80 (17%) in the 2nd period and 28 (6%) in the 3rd period. When patients were compared in terms of their clinical complaints in these periods, dyspnea was signifcantly higher in patients in the 1st period (1st. period 36% vs 3rd period 18%;p:0.039), but there was no difference between other complaints including lung involvement and the frequency of hospitalization (p>0.05). 53% of patients had received at least 2 doses of mRNA vaccine. 84% of the patient has had COVID19 before full vaccination with any valid vaccine. When the patients who were full vaccinated and those who were not vaccinated or inadequately vaccinated at the time of illness were compared in terms of clinical features, lung involvement frequency and hospitalization frequency, no difference was found between them. (p>0.05, for all). However, hospitalization and lung involvement were less in those who received a booster dose of any valid vaccine (p: 0.03). While the average hospitalization rate was 17% for all groups, this rate was 50% for necrotizing vasculitis and was signifcantly higher (p:0,005). The probability of lung involvement and hospitalization were found to be sig-nifcantly higher in patients using prednisolone 5mg (or equivalents) or more;(p:0.008 and p:0.000, respectively). Pulmonary involvement was signifcantly higher among patients receiving sulphasalasine (p:0.008). Among the patients on Rituximab, the probability of hospitalization was higher than those who did not (p: 0.01). There was no statistical difference in terms of hospitalization and pulmonary involvement between patients who took other drugs (p>0.05, for all). A total of 5 cases died, including 2 GPA, 1 EGPA, 1 RA and 1 FMF patients. Only 8 patients had a second history of COVID19. Conclusion: The frequency of COVID-19 among IRD cases seems to decrease over time. Full vaccination seems effective for the prevention of COVID-19. It should be recommended that IRD patients have the full dose of vaccines and boosters. The risk of lung involvement and hospitalization increases in patients using certain drugs, such as corticosteroids, sulphasalasine and ituximab. These patients should be followed more closely.
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Background: The study of the features of the course and mutual influence of the new coronavirus disease COVID-19 and various rheumatic diseases (RD) in children can still give us new lessons, warnings and fears. Objectives: To update the analysis in a retrospective study the course of covid-19 in children with RD based on the results of two years of the pandemic. To analyze the impact of COVID-19 on the course of RD in children. Methods: Retrospective analysis based on data from single center. The study included patients with RD and confirmed COVID-19 for 2 years (2020-2021). Results: Were registered 320 cases of COVID-19 in children with RD. 158 (49%) patients were asymptomatically infected, 162 (51%) had clinical symptoms. A detailed description of the groups is presented in Table 1. Clinical symptoms were fever (67%), anosmia (47%), rhinitis (34%), cough (19%), arthralgia/myalgia (16%), dyspepsia (5%), rash (2.5%), pneumonia (3%). In the majority of cases (98%), COVID-19 proceeded in mild to moderate severity. Hospitalization due to COVID-19 was required just in 5 cases. 2 children were admitted to the intensive care unit. First, an 11-year-old girl with sJIA with the history of recurrent episodes of MAS resolved by regular administration of canakinumab. 2nd, a 12-year-old girl with Sjogren's syndrome, who received Rituximab and 1 month later she developed the COVID-19 with MIS-like clinical picture, pneumonia with 25%CT lessions. Both cases have a favorable outcome. The clinical characteristics of the patients are presented in Table 1. COVID-19 didǹt affect the course of RD in the 86% of pts. However, 15% developed a fare of the RD with average of 3 months after COVID-19. In this group for 13 pts (girls mostly F/M-9/4, mean age 15 years [9;16]), COVID-19 triggered the new onset of RD (non-systemic JIA-4, Uveitis-1, non-bacterial osteomyelitis-3, systemic JIA-2, Scleroderma-2, Sjögren's syndrome-1. 12 from 13 these children had clinical symptoms on COVID-19. Whether this is Long-COVID syndrome or an independent RD is not known. Conclusion: Our study suggests that the new coronavirus infection in most cases in children with RD, had mild or asymptomatic course, regardless of therapy with immunosuppressive drugs and bDMARD, except of 1 observation with the previous therapy of Rituximab. Worsening of RD after coronavirus infection developed in 15% of cases, regardless of its clinical manifestations. In 13 patients, the RD were started just after COVID-19. The explosive increasing of the incidence of a new strain of COVID-19 for a past month may change the current results and conclusions.
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Background: Data from multiple rheumatological cohorts have shown that treatment with rituximab (RTM) is associated with higher COVID-19 morbidity and mortality. Information about the course of COVID-19 in patients (pts) with Sjogren's syndrome (SjS) is still lacking. Objectives: To compare clinical course of COVID-19 in pts with SjS treated with anti-CD20 monoclonal antibody (RTM) and treated with synthetic disease-modifying antirheumatic drugs and low doses of glucocorticoids. Methods: Single center observational study. Pts with SjS were screened for SARS-CoV-2 infection anamnesis via telephone interview. Diagnosis of SjS was based on ECR/EULAR 2016 criteria. COVID-19 diagnosis was based on positive PCR test and typical clinical features (CT signs, fever and anosmia). RTM was administered as two infusions of 1000 mg each 2 weeks apart, and then 500 mg every 6 months. Results: 387 pts with SjS were interviewed, 142 of them with confrmed SARS-CoV-2 were included in the study and divided into 2 groups. The frst group (gr) consisted of 86 pts (79 women and 7 men) receiving RTM (gr R), median age was 56 years (33-66,5 years), and median rituximab treatment duration was 36 months (12-42 months). Pts in the control gr (gr C), 56 pts did not receive RTM (55 women and 1 man), their median age was 50 years (35-69 years). Median time from last RTM administration to COVID-19 symptoms onset was 4 months (2-6 months). Ten pts had concomitant RA, 4 pts-SLE, 5 pts-Systemic sclerosis. Fifteen pts had MALT-lymphoma anamnesis. Additionally, 15 pts (10.5%) had pulmonary involvement secondary to rheumatic disease. In total 37 pts had chronic ischemic heart disease and/or severe arterial hypertension, diabetes mellitus type 2. In gr R 31 pts (36%), and in gr C 13 (23%) required hospitalization due to marked shortness of breath and long febrile period (p=0,1). Anti-IL6 treatment or/and Jak inhibitors were prescribed to 17 of 31 pts (54.8%) in gr R and to 5 of 13 (38%) in gr C (p=0,1). The risk of hospitalization was slightly higher in pts with comorbidity (p=0.06) and with a history of lymphoma (p=0.056) and didn't correlate with the following parameters: age, the duration of RTM therapy, lung damage. A high rate of hospitalization correlated with a shorter period between the administration of the RTM and the development of COVID-19 (R=0,387, Spearmaǹs Rank Correlation). Anti-SARS-CoV-2 IgG were measured in 66 pts, 47 (71%) of them were positive. Positive Anti-SARS-CoV-2 IgG were signifcantly more often detected in gr C (84% vs. 57,6%). No correlation was found between the formation of antibodies and the duration of RTM therapy or the time from the last RTM administration. Conclusion: According to our data anti-CD20 therapy doesn't predispose SjS pts to severe course of COVID-19. Lymphoma anamnesis, cardiovascular diseases and diabetes have greater impact on COVID-19 severity. Obviously, anti-CD20 therapy negatively affected the formation of specifc anti-SARS-CoV-2 humoral immunity.
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Background: there are some concerns among patients (pts) with rheumatic diseases regarding the tolerability and efficacy of SARS-CoV-2 vaccination. The impact effect of vaccination on the course of Sjogreǹs syndrome (SjS) is not entirely clear. Objectives: to evaluate the efficacy and tolerability of the heterologous recombinant adenovirus (rAd)-based vaccine Sputnik in pts with SjS receiving various types of therapy. Methods: single center observational retrospective study. Diagnosis of SjS was based on ACR/EULAR 2016 criteria. Rituximab (RTM) was administered in two 1000 mg infusions 14 days apart for the 1 st course, then 500 mg every 6 months. Results: 70 pts with a defnite diagnosis of SjS were included in the study. Four out of 70 were women. The mean age was 52.5±14.6 years, the average duration of the SjS was 72 (36-120) months. Three pts had concomitant RA, 3 pts-SLE, 2 pts-Systemic sclerosis. Extraglandular manifestations of SjS were detected in 35 cases. Five pts received single-dose rAd26 vector-based COVID-19 vaccine 'Sputnik Light', other 65 pts received 2 doses of Gam-COVID-Vac (Sputnik V). Eighteen pts did not receive any immunosuppressive therapy and were vaccinated before RTM therapy. One patient of them just diagnosed with lymphoma, 8 pts had extraglandular manifestations of the SjS (hypergam-maglobulinemic purpura, cryoglobulinemic vasculitis with polyneuropathy, interstitial lung disease). 20 pts at the time of vaccination received various immunosuppressive drugs: 1-cyclophosphamide (CYC), 1-lefunomide, 1-Azathioprine, 3-methotrexate, 2-mycophenolate mofetil (MMF), 10-hydroxychloroquine, 13-low doses of methylprednisolone. Thirty-two pts received anti B-cells therapy with RTM. The duration of RTM therapy before vaccination was 18 (12-36) months, the period of time between the last injection of the RTM and the vaccine was on average 6 (5-8) months. B-cells level was determined in 18 pts immediately before vaccination and it was normal only in 10 pts. The level of neutralizing antibodies after vaccination was monitored in 44 pts. The level of IgG antibodies against SARS-CoV-2 was positive in 15 of 22 pts who did not receive RTM and in 10 of 22 pts who received the RTM (p>0.05). Neutralizing antibodies did not develop in 4 pts despite complete recovery of B cells. It is important that none of the vaccinated pts was infected COVID-19 within at least 6 months after vaccination. Various types of adverse reactions were observed in 8 pts. The most common was fu-like syndrome. In one case this syndrome required the prescription of dexameth-asone. In 3 cases disease exacerbation occurred after vaccination. These pts had extraglandular manifestations of SjS and received immunosuppressants (CYC, MMF or RTM), 2 of them required treatment intensifcation, in one case the exacerbation was self-limiting. Conclusion: vaccination against SARS-CoV-2 infection was well tolerated by pts with SjS even in the absence of immunosuppressive therapy. In most cases, there were no exacerbation of the SjS and pts could continue immunosuppres-sive therapy without becoming infected COVID-19.
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Background: It is assumed that patients with immuno-infammatory rheumatic diseases (IIRDs) in old age are susceptible to a more severe course of COVID-19 both due immunological disorders (autoimmune disease and its activity, immuno-suppressive therapy, immunosenescence leading to systemic subclinical chronic infammation with increased secretion of IL-6, IL-1, IL-18, TNF-α) and due to the presence of comorbid pathology. There are no Russian data on the course of COVID-19 in elderly patients with IIRDs. Objectives: To study the features of the course of COVID-19 in elderly patients with IIRDs. Methods: The study included 93 patients with IIRDs: 72 women, 21 men, average age 67.5±6.1 years. Of them, 62 patients suffered from rheumatoid arthritis, 9-systemic sclerosis, 5-ankylosing spondylitis, 4-Sjogren's disease, 4-systemic vasculitis, 3-psoriatic arthritis, 2-osteoarthritis, 1 systemic lupus erythematosus, 1-polymyositis, 1-rheumatic polymyal-gia, 1-gout. At the moment of COVID-19, 10 patients had high activity of IIRDs, 26-moderate, 40-low, 17-remission. 69 patients were treated with disease-modifying antirheumatic drugs-DMARDs (40-methotrexate, 12-lefunomide, 8-sulfasalazine, 7-hydroxychloroquine), 45-glucocorticoids (34-low doses, 11-medium or high doses). 36 patients received biologic or target DMARDs: 24-rituximab (the interval from the last administration to the development of COVID-19 symptoms averaged 7 months), 4-TNF-α inhibitors, 3-abatacept, 2-secukinumab, 1-tofacitinib, 1-baricitinib, 1 ustekinumab. Comorbidities included hypertension (n=74), coronary artery disease (n=27), obesity (n=17), diabetes mellitus (n=8), bronchial asthma (n=5), chronic obstructive pulmonary disease (n=4), chronic kidney disease (n=3). The patients were interviewed by a research doctor, additional information was obtained from medical documentation. Results: The most common symptoms of COVID-19 were fever-67.7%, weakness/drowsiness-53.7%, cough-48.4%, as well as anosmia and dyspnea-35.5% each, headache-20.4%, body aches-16.1%, congestion nose-8.6%, chest pain-7.5%, dysgeusia-5.4%, diarrhea/vomiting-3.2%. According to CT chest scan, 8 patients had 0% of lung damage, 31-25%, 32-50%, 12-75%, in other cases the study was not carried out (n=9) or data are not available (n=1). In 2 patients the course of COVID-19 was complicated by bacterial pneumonia, in 1-bacterial-fungal. An asymptomatic course was noted only in 2 patients (PCR+/IgM +, CT 0, close contact with a confrmed case of COVID-19). Recovery was noted in 90 patients, fatal outcome-in 3. Exacerbation of IIRDs after COVID-19 was noted in 48.4% of patients, which required intensifying antirheu-matic therapy. Conclusion: Preliminary data indicate that COVID-19 is characterized by moderate and severe course in elderly patients with IIRDs. Further studies are required to identify risk factors for severe course and complications in order to provide timely qualifed care.