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Background: The emergence of autoinflammatory/autoimmune disorders in COVID-19 patients has necessitated the development of new strategies for the management of these phenomena. Several viruses have been shown to cause autoimmunity by boosting the production of autoreactive lymphocytes, resulting in a lack of tolerance in the host's immune response. The SARS-CoV- 2 virus and/or its proteins can cause autoimmunity by molecular mimicry, superantigen activity, and disruption of type I IFN production. Method(s): The data of three patients who applied to the outpatient clinics of pediatric immunology and rheumatology at Uludag University Hospital between March 2020 and December 2021 and were followed up with autoimmune/autoinflammatory disease following CCovid-19- 19 infection were analyzed retrospectively. Result(s): All patients were female and aged between 2-17 years. They had SARS-COV- 2 infection which was mild a few months ago. Before the Covid-19 infection, all of the patients were in good health. The patients had no history of frequent infections or familial predisposition to rheumatic diseases. Following the Covid-19- infection, all of our patients showed fever, rash, joint discomfort, and muscle soreness. Despite the fact that myalgia affects the whole body, arthralgia was present on the wrists and knees of patients. CRP, sedimentation rate, and acute phase reactants increased in all of them. According to the American College of Rheumatology's diagnostic criteria, our first patient was diagnosed with systemic lupus erythematosus (SLE) and was treated with hydroxychloroquine, intravenous immunoglobulin treatment and anakinra. Two of three were diagnosed with systemic juvenile idiopathic arthritis (sJIA) according to the League of Associations for Rheumatology (ILAR) criteria. Only one patient had low IgG and IgA levels (Table 1). Two patients showed a decrease in CD19+ naive cells percent and numbers. Conclusion(s): Following SARS-CoV- 2 infection, autoimmune and autoinflammatory disorders such as rheumatoid arthritis, psoriatic arthritis, type 1 diabetes and Still disease have been documented in adult cases. There are limited pediatric cases on this issue. It has been suggested that the persistence of the latent immune response after COVID-19 infection happens by sensitizing the immune system to viral particles long after they have been eliminated from organisms. Is the autoimmune process the effect of a viral infection or mis-targeted immune system? These questions need deep research and discussion.
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BackgroundPatients with rheumatic diseases significantly suffer during and after infection with coronavirus disease (COVID-19). Post-COVID-19 syndrome (PCS) refers to signs and symptoms occurring during or following a COVID-19 infection that continue beyond 12 weeks. The study aimed to assess PCS symptoms in rheumatic disease patients compared to a control group not suffering from a rheumatic disease or any other chronic illness.ResultsThe prevalence of PCS symptoms was significantly higher in rheumatic disease patients compared to the control group: fatigue (69.1% vs. 41.25%), myalgia (73.5% vs. 37.5%), attention deficits (57.4% vs. 40%), and muscle weakness (33.8% vs. 13.8%). Objectively, the study group had significantly higher scores for the Fatigue Severity Scale (FSS) (35.46 ± 13.146 vs. 25.1 ± 7.587), Short-form McGill Pain Questionnaire (SF-MPQ-2) (21.66 ± 10.3 vs. 11.6 ± 3.433), and higher grades of functional disability in the Post-COVID-19 Functional Status scale (PCFS). Rheumatic disease patients had significantly higher frequencies of anxiety and depression, as assessed by the Hospital Anxiety and Depression Scale (HADS), and cognitive impairment, as assessed by the Mini-Mental State Examination (MMSE), than the controls (P = 0.023, P = 0.003, P = 0.0001, respectively). Moreover, SLE patients had the most symptoms and the highest FSS, SF-MPQ-2, PCFS, and HADS scores, as well as the lowest MMSE scores (P = 0.0001 for all except cough (P = 0.043), weakness (P = 0.015), paresthesia (P = 0.027), and anosmia (P = 0.039)). Lower disease duration, hospitalization during acute COVID-19, steroid use, smoking, and biologics non-use were significantly associated with higher PCS symptoms. Smoking was a significant risk factor (P = 0.048), and biologics use was protective (P = 0.03). Rheumatic disease patients who received two doses of the COVID-19 vaccinations had better scores on the FSS, HADS for anxiety and depression, and MMSE than those who received a single dose (P = 0.005, P = 0.001, P = 0.009, P = 0.01).ConclusionRheumatic disease patients have a higher prevalence and risk of PCS, so strict follow-up, avoiding smoking, controlling disease activity, and COVID-19 vaccinations are essential for decreasing the morbidity of PCS.
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Secukinumab is a fully human anti-interleukin-17A monoclonal antibody for the treatment of moderate-to-severe plaque psoriasis. In a previous analysis of the ongoing, longitudinal pharmacovigilance register BADBIR (data cutoff 31 August 2020), secukinumab showed sustained drug survival over 24 months in biologic-naive patients (86%) comparable to that of biologic-naive patients treated with ustekinumab (84%) and greater than that of biologic-naive patients treated with adalimumab (71%). In this updated analysis, we report drug survival for a larger cohort of biologic-naive and biologic-experienced patients with psoriasis treated with secukinumab (- data cutoff 31 August 2021). Patients prescribed secukinumab at baseline (biologic-naive) or after switching therapies during follow-up (biologic-experienced) were included. Drug survival up to 24 months (Kaplan-Meier method) was defined as the duration between date of first secukinumab exposure and date of stopping secukinumab or the end of the study censoring period. Data from 2850 patients were analysed (949 biologicnaive;1901 biologic-experienced). Mean duration of followup was 2.9 years (median 2.9 years) for biologic-naive and 2.7 years (median 2.5 years) for biologic-experienced patients. Among biologic-naive and biologic-experienced patients, respectively, most were male (61.3% and 55.6%), mean age was 46.5 and 45.1 years, mean body mass index was 31.6 and 32.5 kg m-2, mean age of disease onset was 25.6 and 23.7 years, and mean disease duration was 20.9 and 21.4 years. For biologic-experienced patients, the mean (SD) number of prior biologics received was 1.8 (1.0). Fewer biologicnaive patients had psoriatic arthritis (21.2% vs. 33.2%) and had received prior ciclosporin (50.1% vs. 60.1%), and prior methotrexate use was similar between subgroups (74.3% vs. 76.8%). Overall drug survival for biologic-naive and biologicexperienced patients was comparably high after 12 months (89% vs. 78%) and 24 months (78% vs. 62%). Drug survival for biologic-experienced patients was similar to that previously reported [77% (12 months) and 59% (24 months)]. With a median follow-up of 2.9 and 2.5 years for biologic-naive and biologic-experienced patients, respectively, these data represent the longest follow-up of any BADBIR analysis to date supporting and extending previous findings of sustained drug survival of secukinumab in patients with moderate-to-severe plaque psoriasis in real-world practice. As expected, drug survival was higher in patients who initiated secukinumab at baseline than those who switched to secukinumab after other biological therapy. However, overall drug survival of 78% and 62% at 12 and 24 months in biologic-experienced patients was similar to that reported previously [77% (12 months) and 59% (24 months)], and just slightly lower than was reported before the COVID-19 pandemic [81% (12 months) and 63% (24 months)].
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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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OBJECTIVE: To investigate the influence of COVID-19 vaccination on disease activity in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients under targeted therapies. PATIENTS AND METHODS: 1765 vaccinated patients COVID-19, 1178 (66.7%) with RA and 587 (33.3%) with PsA from the COVID-19 registry in patients with rheumatic diseases (COVIDSER) project, were included. Demographics, disease characteristics, Disease Activity Score in 28 joints (DAS28) and targeted treatments were collected. DAS28-based flare rates and categorised disease activity distribution prevaccination and post vaccination were analysed by log-linear regression and contingency analyses, respectively. The influence of vaccination on DAS28 variation as a continuous measure was evaluated using a random coefficient model. RESULTS: The distribution of categorised disease activity and flare rates was not significantly modified by vaccination. Log-linear regression showed no significant changes in the rate of flares in the 6-month period after vaccination compared with the same period prior to vaccination in neither patients with RA nor patients with PsA. When DAS28 variations were analysed using random coefficient models, no significant variations in disease activity were detected after vaccination for both groups of patients. However, patients with RA treated with Janus kinase inhibitors (JAK-i) (1) and interleukin-6 inhibitor (IL-6-i) experienced a worsening of disease activity (1.436±0.531, p=0.007, and 1.201±0.550, p=0.029, respectively) in comparison with those treated with tumour necrosis factor inhibitor (TNF-i). Similarly, patients with PsA treated with interleukin-12/23 inhibitor (IL-12/23-i) showed a worsening of disease activity (4.476±1.906, p=0.019) compared with those treated with TNF-i. CONCLUSION: COVID-19 vaccination was not associated with increased rate of flares in patients with RA and PsA. However, a potential increase in disease activity in patients with RA treated with JAK-i and IL-6-i and in patients with PsA treated with IL-12/23-i warrants further investigation.
Subject(s)
Arthritis, Psoriatic , Arthritis, Rheumatoid , COVID-19 , Humans , Arthritis, Psoriatic/drug therapy , Arthritis, Psoriatic/pathology , Interleukin-6 , COVID-19/epidemiology , COVID-19/prevention & control , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/pathology , Interleukin-12ABSTRACT
OBJECTIVES: To investigate Covid-19-associated risk of hospitalization and death in rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) in comparison with the general population during pandemic's first year and compare their overall mortality with 2019. METHODS: Interlinking nation-wide electronic registries, we recorded confirmed Covid-19-associated infections, hospitalizations and deaths, and all-cause deaths between 1-March-2020 and 28-February-2021 in all adults with RA, AS, PsA, SLE, and SSc under treatment (n = 74 970, median age 67.5, 51.2, 58.1, 56.2, 62.2 years, respectively) and in matched (1:5) on age, sex, and region of domicile random comparators from the general population. Deaths from all causes during 2019 were also recorded. RESULTS: Compared with the general population incidence rates (IR) for Covid-19-associated hospitalization were higher in RA [IR ratio (IRR):1.71(1.50-1.95)], SLE [2.0(1.4-2.7)] and SSc [2.28(1.29-3.90)], while Covid-19-associated death rates were higher in RA [1.91(1.46-2.49)]. When focusing only on SARS-CoV-2 infected subjects, after adjusting for age and gender, the odds ratio for Covid-19 associated death was higher in RA [1.47(1.11- 1.94)] and SSc [2.92(1.07-7.99)] compared with the general population. All-cause mortality rate compared with the general population increased in RA during the first pandemic year (IRR : 0.71) with reference to 2019 (0.59) and decreased in SSc (IRR : 1.94 vs 4.36). CONCLUSION: Covid-19 may have more severe impact in patients with systemic rheumatic disease than the general population. Covid-19-related mortality is increased in subgroups of patients with specific rheumatic diseases, underscoring the need for priority vaccination and access to targeted treatments.
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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 Sjögren'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.
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OBJECTIVES: To evaluate humoral responses to three doses of the inactivated SARS-CoV-2 vaccine (CoronaVac) in patients with spondyloarthritis (SpA) and the effect of therapy, compared with a control group (CG). METHODS: Prospective cohort of axial SpA/psoriatic arthritis patients and age/sex-balanced CG from the CoronavRheum phase 4 trial (NCT04754698). CoronaVac was given in two doses (28-days interval) with a booster at day 210. Blood samples were collected in the days 0/28 (D28)/69 (D69) and 240 (D240) to evaluate anti-SARS-CoV-2 IgG seropositivity (SP) and neutralising antibodies (NAb). RESULTS: One hundred and ninety-four SpA patients were enrolled and 183 patients were age/sex-balanced with 183 CG. At D69, SpA patients showed a high SP (80.2% vs. 95.7%, P<0.001) and moderate NAb positivity (61.6% vs. 82.7%, P<0.001), but lower than CG. In patients, older age prednisone (P<0.001), methotrexate (MTX) (P<0.001) and TNF inhibitors (TNFi) (P<0.001) were independently associated with lower SP, while Caucasian ethnicity (P<0.05) and prednisone (P<0.01) were associated with diminished NAb. In contrast, sulfasalazine (SSZ) use was associated with NAb presence (P<0.05). In monotherapy, only TNFi was also associated with absence of SP (P<0.05). Further comparison with CG revealed that TNFi and/or MTX negatively impacted SP/NAb (P<0.05). In contrast, patients under SSZ monotherapy achieved 100% SP (P>0.999) and 83.3% NAb positivity (P>0.999). SSZ+TNFi combination resulted in a similar response than CG [SP (P=0.153) and NAb (P=0.715)]. After third dose (D69-D240), a major increment occurred for SP (81.3% to 93.1%, P<0.001) and NAb (63.2% to 86.1%, P<0.001), but still lower than CG (P<0.05), and only TNFi impaired both SP (P=0.016)/NAb (P=0.002). CONCLUSIONS: We provided novel data demonstrating that TNFi attenuates immunogenicity in SpA patients while SSZ has a positive impact on vaccine antibody production. We also confirmed that MTX in combination with TNFi had a major negative impact in vaccine humoral response (CoronavRheum clinicaltrials.gov #NCT04754698).
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Telemedicine was accelerated in adoption in low to middle-income countries because of the COVID-19 pandemic. Institutions and societies new to this modality released recommendations that extrapolate from Western practices or more developed regions of Asia. Besides cultural differences, many areas do not have similar staffing set up as in the West. Many doctors provide direct to patient telemedicine. Framing telemedicine as part of hybrid care instead of a competitor to in-person care may be key for telemedicine to secure its place in healthcare. We would need to examine workflows that may help us in this endeavor. Infographics is short for information graphics. They are digital tools used to enhance education, improve memory, and comprehension, and develop new communication skills. In pandemic remote care studies, surgeons use infographics to teach patients post op wound care at home. How about medical photography? Medical photography has been used as a prehospital assessment for ER cases. In some dermatology studies, photos are used as a form of triage to avoid unnecessary in-person consults. Orthopedic surgeons use photography to assess post op range of motion. One psoriatic arthritis study incorporated photography as a pre-visit screening with staff members assisting patients. With the advances in personal smartphone technology, is there a role for patients or caregivers themselves to use medical photography in telemedicine? Since many clinics may not have adequate staff members, a simple instruction guide on lighting, framing and technique could be used for patients to take their own photos and then send it to their doctors prior to their telemedicine visit. We take a look at the studies on medical photography and the possibility of incorporating it to our own telemedicine workflow. In addition, we would present out proposal for a mixed method study using a simplified infographic for patients to copy pre-visit.
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Background: Telemedicine became the emergent means of providing and continuing medical care due to the COVID 19 pandemic. This study aims to evaluate the knowledge, perception, and satisfaction with the use of telemedicine among patients with rheumatic diseases. An understanding of our patients' experiences can be utilized to provide access to care, improve gaps in delivery of care, and improve healthcare disparities. Method(s): Filipino patients with rheumatic disease who had telehealth visits between June 2020 and August 2021 in St Luke's Medical Center Outpatient Department participated in an online survey. Information on demographics, diagnosis, knowledge and experience on telemedicine, and perspectives on benefits and limitations of telemedicine were collected. Result(s): There were 70 respondents: 52.9% with SLE, 25.7% with RA, 10% with osteoarthritis, 5.7% with psoriatic arthritis, 2.9% with scleroderma. Results showed that 64.3% are familiar with the use of video conference platforms. Facebook messenger was the most used (85.7%). Half of respondents have used telemedicine on their own, while 33% required assistance. The remaining respondents have not used telemedicine due to lack of experience or awareness on how to proceed with consults. The reasons for using telemedicine were restrictions of the pandemic (82.9%), limited access to clinics (31.4%), and disability (1.4%). Most remain satisfied with telemedicine (75.7%), 50% of patients stated that telemedicine was comparable to an in-clinic visit, and 85.7% (N = 60) would recommend its use. Conclusion(s): Filipinos with rheumatic disease are knowledgeable on online platforms and telemedicine, however, it is important to note the digital divide. Patients need assistance and improved awareness on accessing remote care. Providing continuity of healthcare can lead to less complications and better outcomes despite pandemic restrictions. There is an overall favorable satisfaction for care. Half the respondents remain satisfied with telemedicine. Rheumatologists need further studies on benefits and outcomes on providing remote healthcare.
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Background: According to newspaper Bernama, 87.6% of adolescents in Malaysia aged between 12 and 17 have completed their vaccination and 97.7% of the adult population have completed theirs as of 2nd January 2022.The acceptance of patients with rheumatic diseases on Covid-19 vaccination are crucial in the successful long term protection against Covid-19 infection. We conducted a phone interview to determine the acceptance of Covid-19 vaccination amongst adolescents with underlying rheumatic diseases. Objective(s): To determine the acceptance of Covid-19 vaccination amongst adolescents with underlying rheumatic diseases. Method(s): This was a phone survey. The electronic medical records of all rheumatology patients follow up in rheumatology clinic Hospital Sultan Ismail, Malaysia from 1st January 2012 to 31th December 2021 were reviewed and patients with age group from 12 to 21 were identified. Demographic and diagnosis of the patients collected. Result(s): Phone survey was done after data extracted from medical records. For those under the age of 18, guardian of the patients was interviewed. A total of 50 patients were identified. 36 of them were having systemic lupus erythematosus (SLE), 5 of them were having juvenile idiopathic arthritis (JIA),2 of them were having psoriatic arthritis (PSA) and another 2 of them were having Rheumatoid arthritis (RA), followed by rheumatoid arthritis (RA) overlapped SLE, juvenile dermatomyositis, Henoch-Schonlein purpura, SLE overlapped with JIA and mixed connective tissue disease, 1 each respectively. Most of the patients were female (46/50) and majority of them were Malay (33/50). This was followed by Chinese (10/50), Indian (4/50) and others (3/50). The mean age group was 18 (range from 13 to 21). Majority of them patients are keen or already completed Covid-19 vaccination with the acceptance rate as high as 92% (46/50). Only 8% of them not keen for vaccination with the reason of worrying the risk of myocarditis post vaccination. Conclusion(s): The overall acceptance rate of Covid-19 vaccination amongst adolescents with rheumatic diseases are very encouraging with the percentage of >90% despite of lacking knowledge about vaccine Covid-19. This result can assist our Ministry of Health plan for future battle to improve vaccine uptake that hopefully can lead to herd immunity against COVID-19 infection.
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Background: Autoimmune inflammatory rheumatic diseases (AIRD) were associated with an increased risk for COVID-19 infection, worse clinical outcomes, and COVID-19- related deaths. Vaccines carry the potential benefit of reducing disease transmission and disease severity. Issues on vaccine safety, trigger of an autoimmune reaction or disease flares has been a long issue. Thus this study describes the COVID-19 vaccination status and adverse events following SARS-COV 2 vaccine in a tertiary hospital in Manila, Philippines. Method(s): This retrospective cross-sectional study included patients diagnosed with AIRD and seen in the clinics over 12 months (March 2021-March 2022).We collected data from patients' clinic records and analyzed the clinicodemographic profile, vaccination status, adverse events and development of new onset autoimmune reaction and disease flares post vaccination and those who developed COVID-19 infection even after vaccination. Result(s): There were 204 respondents included in this study: 174 (85%) were female and 30 (14%) were male;63.2 % with SLE, 10.8% rheumatoid arthritis, 8.3% psoriatic arthritis, 6.4% ankylosing spondylitis and other systemic autoimmune disease. Others included were scleroderma and inflammatory arthritis and myopathies. The median age is 38.4 years. 100% of the respondents were fully vaccinated;87 (42.6%) received inactivated vaccine, 63 (30.8%) viral vector vaccine and 54 (26.4%) mRNA vaccine. 133 (65.2%) reported no adverse events while 71 (34.8%) experienced constitutional symptoms, musculoskeletal, cutaneous, respiratory, gastrointestinal and cardiovascular symptoms after vaccination. There were 9 (4.4%) of the respondents who developed new onset autoimmune reaction and disease flares 7-28 days post vaccination;1 patient had new onset amyopathic dermatomyositis;3 SLE patients developed severe hematologic, cutaneous and renal flare;2 rheumatoid arthritis, 1 spondyloarthritis, and 1 inflammatory arthritis patients in long remission had disease flares and 1 patient with henoch schonlein purpura developed flare. Twenty two (10.8%)of the respondents developed COVID-19 infection after 30-120 days post vaccination;19 (86.4%) had mild symptoms, 2 (9.1%) moderate infection and 1 (4.5%) had severe infection and all of the patients recovered. Conclusion(s): This study showed that patients with AIRD experienced varied organ system adverse events following vaccination ranging from mild side effects, disease flares and new onset autoimmune reactions. The development of an autoimmune reaction following SARS-COV 2 vaccination is of scientific and public importance and still needs to be investigated. Even after a complete vaccination, some patients still had COVID-19 infection, however preventing them from worse complications, hospitalization and mortality.
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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: 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.
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The proceedings contain 539 papers. The topics discussed include: advances in the understanding and management of atherosclerosis in inflammatory arthritis;long-term safety and efficacy of voclosporin in Asian patients with lupus nephritis;clinical profile of four children with juvenile dermatomyositis and anti-SAE antibody positivity: a single center experience from north India;the MMP degraded and citrullinated vimentin (VICM) is a diagnostic and treatment response biomarker;incidence and outcome of covid-19 in AIRD patients on concomitant treatment with tofacitinib- results from KRA covid cohort (KRACC) subset;are we treating-to-target in spondyloarthritis (SPA)? a cross-sectional analysis from the Asia Pacific league of associations for rheumatology (APLAR) SPA registry;utilities of low-dose computed tomography (LDCT) on identifying patient with axial psoriatic arthritis (AXPSA) a cross-sectional study;age-related genes USP2 and ARG2 are involved in the reduction of immune cell infiltration in elderly patients with rheumatoid arthritis;and MICRORNA-27a-3p inhibits lung and skin fibrosis of systemic sclerosis by negatively regulating SPP1.
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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.
ABSTRACT
Background: A few studies on vaccination in patients with rheumatic diseases, including arthritis, connective tissue diseases, vasculitis, and psoriatic arthropathy (PsA), demonstrated reduced production of neutralizing antibodies to SARS-CoV-2 Spike RBD (receptor-binding domain contained in the N-terminal of the S1 globular head region) when compared to the general population. Objective: The aim of our study was to observe whether different therapies for PsA [methotrexate, anti-TNF antibodies, soluble TNF receptor (etanercept) or IL-17 inhibitors] have a different impact on SARS-CoV-2 vaccination in a homogeneous population of patients. Methods: We enrolled 110 PsA patients in remission, assessed with Disease Activity in PSoriatic Arthritis (DAPSA). Of these: 63 were in treatment with anti-TNF-α therapy (26 etanercept, 15 certolizumab, 5 golimumab, 17 adalimumab); 37 with anti-IL17 secukinumab; 10 with methotrexate. All patients underwent vaccination for SARS-CoV-2 with mRNA BNT162b2 vaccine. Assessment of absolute and percentage lymphocyte subsets and anti-SARS-CoV-2 Spike RBD IgG antibody value 3 weeks after the second vaccine dose were performed. In addition, the serum antibody levels of 96 healthy healthcare workers (HCW) were analyzed. Results: The mean disease activity assessed with DAPSA score was 2.96 (SD = 0.60) with no significant differences between patients under different medications (p = 0.779). Median levels of neutralizing antibodies to SARS-CoV-2 Spike RBD were 928.00 binding antibody unit (BAU)/mL [IQR 329.25, 1632.0]; 1068.00 BAU/ml [IQR 475.00, 1632.00] in patients taking MTX, 846.00 BAU/ml [IQR 125.00, 1632.00] in patients taking etanercept, 908.00 BAU/mL [IQR 396.00, 1632.00] in patients taking anti-IL17 and 1148.00 BAU/ml [IQR 327.00, 1632.00] in patients taking TNF-α inhibitors, without statistically significant differences between these groups. Mean serum antibody level of HCW group was 1562.00 BAU/ml [IQR 975.00, 1632.00], being significantly higher than in the patient group (p = 0.000816). Absolute and percentage count of lymphocyte subsets were not statistically different between the subgroups under different treatments and when compared with HCW. Conclusions: As for other rheumatic diseases on immunomodulatory treatment, our data showed a reduced humoral response in PsA patients compared to the control group. However, antibody response did not significantly differ between groups treated with different medications.