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1.
Archives of Neuropsychiatry / Noropsikiatri Arsivi ; 59(3):177-182, 2022.
Article in English | CINAHL | ID: covidwho-2026435

ABSTRACT

Introduction: The study aims to evaluate the motor, non-motor, cognitive and psychiatric conditions of our patients diagnosed with Idiopathic Parkinson's Disease (IPD) before and after the COVID-19 pandemic and to investigate the effect of the pandemic on male and female genders. Methods: Ninety patients were included in the study. Demographic data such as age, gender, and duration of disease, type of disease of the patients were recorded. Patients were then divided into 2 groups: male and female. Movement disorders of both groups before the pandemic, disease stage determined by H&Y and UPDRS at the admission and after the pandemic, Levodopa equivalent dose used were recorded and all patients were surveyed to evaluate their motor, non-motor, cognitive, and psychiatric conditions during the COVID-19 pandemic. The effects of the COVID-19 pandemic on male and female genders were investigated. Results: Of the patients, 40 were male and 50 were female. Daytime drowsiness, weakness, impaired walking, constipation, sleep disorders, and inability to turn in the bed worsened compared to the period before the pandemic. Yet, of the psychiatric symptoms, boredom, unhappiness, anhedonia, irritability, and tension were found to increase during the pandemic. There was a statistically significant difference in UPDRS, H&Y and disease stages before and after the COVID-19 pandemic in both groups, especially in the female group (p<0.05). Conclusion: Although it was more pronounced in female patients with IPD diagnosis, both motor and non-motor symptoms were found to worsen during the COVID-19 pandemic in both groups.

2.
Noropsikiyatri Arsivi ; 59(2):158-160, 2022.
Article in English | APA PsycInfo | ID: covidwho-2012727

ABSTRACT

We present a case with acute respiratory distress syndrome due to COVID-19 who had poliomyelitis sequelae. He was hospitalized in the intensive care unit and supported by non-invasive mechanical ventilation for 7 days. IL-6 inhibitor was administered due to cytokine storm. No steroid or sedative agents were administered. Early mobilization was performed in the intensive care unit. One month after discharge, physical examination revealed COVID-19 infection did not cause significant changes in muscle strength and physical performance in this patient with poliomyelitis sequelae. It is important to promote early mobilization in the intensive care unit to prevent post-intensive care syndrome in COVID-19 acute respiratory distress syndrome. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

3.
Mediterranean Journal of Rheumatology ; 33(2):268-270, 2022.
Article in English | EMBASE | ID: covidwho-2010602

ABSTRACT

Anti-MDA5 antibodies characterise a distinct phenotype of dermatomyositis in adults as well as children, with ethnic disparity in clinical presentation and severity. They often present as a diagnostic conundrum with rash, ulceration, and polyarthritis, but minimal muscle disease. Mechanic's hands are typically associated with anti-synthetase syndrome, but their presence in anti-MDA5 antibody positive patients, although reported, is not well known. We present the case of a boy in whom mechanic's hand heralded a relapse of juvenile dermatomyositis which was suspected based on remotely assessed patient-reported outcome measures on teleconsultation. This report suggests that mechanic's hands should also prompt testing for myositis antibodies including anti-MDA5 in Indian children with JDM. Diligent awareness of the condition, and timely use of patient reported outcome measures of muscle power and skin assessment may guide management while delivering remote care in challenging situations such as a global pandemic.

4.
Archives of Academic Emergency Medicine ; 10(1), 2022.
Article in English | EMBASE | ID: covidwho-2010568

ABSTRACT

Jejunal Dieulafoy’s lesion is difficult to diagnose due to its rarity, intermittent hemorrhage, and lesion site, which is largely inaccessible to conventional endoscopes. A 39-year-old man, who had no underlying disease, presented to the emergency department (ED) with weakness, dizziness, and dry cough with a history of several rectal bleeding episodes in the last few years. Endoscopywas normal, and the colonwas full of clots on colonoscopy, and no gross pathology was found. On computed tomography (CT) angiography, a hyperdensity was seen in the middle of the jejunum, possibly suggesting contrast extravasation. Due to decreased hemoglobin of the patient, and hemodynamic instability, the patient became a candidate for surgery. A palpable lesion in the Jejunum was touched that opened longitudinally, which revealed active arterial bleeding fromthe nipple-like lesion. This segment was resected, and an anastomosis was performed. Histopathological examination of the small intestine confirmed a Dieulafoy’s lesion. It seems that, when upper endoscopy and colonoscopy fail to identify the cause of gastrointestinal bleeding, a Dieulafoy’s lesion should be included in the differential diagnoses.

5.
Russian Archives of Internal Medicine ; 12(4):302-309, 2022.
Article in Russian | EMBASE | ID: covidwho-2010561

ABSTRACT

Background: assessment of type, prevalence and duration of residual symptoms after COVID-19 in recent studies is controversial because of differences in design. Aim: to assess the prevalence and severity of symptoms in the long-term period after COVID-19. Materials and methods: patients hospitalized with COVID-19 in the period 13.04.2020-10.06.2020 were interviewed by phone: 195 (58,2 %) convalescents at 143 (131-154) days after disease onset and 183 (54,6 %) of them at 340 (325-351) days. Results: The subjective assessment of health status with 100-point scale before and after the COVID-19 was 95 (80-100) and 80 (70-96) points, p <0,001, at first interview;90 (80-100) and 80 (60-90) points, p <0,001, at second one. Various complaints were detected in 63 % of respondents at the first interview and in 75 % at the second, the number of identified symptoms was 2 (0-6) and 4 (1-8) respectively. The most frequent complaints were weakness/fatigue (31.3 and 47.5 % of respondents), joint pain (31.3 and 47.5 %) and dyspnoe/shortness of breath (31.3 and 43.2 %). The growth of these indicators can be associated with a change in the interview methodology. The severity of the symptoms at second interview was low: fatigue — 3 (0-6) points, shortness of breath — 0 (0-3) points;joint pain, weakness and dyspnoe — 0 (0-5) points each. Conclusion: a decrease of health status can sustain for a long time after COVID-19. Symptoms persist in a significant proportion of convalescents, but their severity in the end of follow-up is quite low.

6.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009632

ABSTRACT

Background: Immunotherapy is becoming a common therapy in cancer patients. Cancer patients on systemic therapy are a vulnerable population, making them highly susceptible to illness from any infection. The purpose of this study was to collect and analyze data reported by patients regarding the side effects of COVID-19 vaccines (Pfizer-BioNTech and Moderna) in cancer patients with solid tumors receiving immunotherapy. Due to the lack of studies and inclusion of cancer patients in the clinical trials for the vaccine, it is pivotal to investigate of the effects of the SARS-2-CoV vaccine on patients receiving immunotherapy to begin to bridge the current gap in knowledge. Methods: We performed a twophased retrospective analysis of adult patients (age ≥18 years) who received either Moderna or Pfizer-BioNTech COVID-19 vaccinations and were currently on immunotherapy (December 15th, 2020, through July 31st, 2021). Phase 1 included a tertiary health system (n = 15,910) in Northeast Georgia. Phase 2 involved cross-tabulation with the VAERS CDC database to compare results at a national level (n = 374,667). The primary endpoints were severity of side effects, timing of side effects and the relationship between the vaccines. The method to evaluate outcome was the Pearson-Chi-Squared test. Results: Results showed that patients on immunotherapy were more likely to have at least one side effect in the tertiary health system (OR 6.727 [95% CI, 2.748 -16.465] compared to least two side effects in the national dataset (X2 = 7.032, p < 0.05). This difference was driven by the Moderna vaccine recipients, demonstrating a higher likelihood of experiencing two or more side effects (X2 = 6.159, p < 0.05). Those receiving the Pfizer-BioNTech vaccine did not demonstrate statistically significant side effects. The most common reaction noted was weakness in both datasets, which was more likely to occur after the Moderna vaccine. Gender analysis showed no difference in side effects in those receiving immunotherapy. In terms of timing of side effects, patients on immunotherapy (M = 10.66, SD = 25.1) had a delayed side effect onset of 10 days vs. four days. (M = 4.72, SD = 15.5, p < 0.05). Conclusions: Both local and national datasets demonstrate cancer patients receiving immunotherapy compared to those that were on immunotherapy, were more likely to experience mild vaccine side effects, specifically weakness being the most common. There was no statistically significant increase in more serious adverse reactions. Additionally, side effect onset was delayed in patients on immunotherapy. These findings provide a foundation for understanding mRNA vaccines in patients on immunotherapy, with future research needs involving larger sample sizes.

7.
Annals of the Rheumatic Diseases ; 81:1868-1869, 2022.
Article in English | EMBASE | ID: covidwho-2009214

ABSTRACT

Background: The COVID-19 pandemic accelerated the use telemedicine for rheumatologic patients. Patient reported outcomes (PRO) can provide prioritization criteria for the form of face-to-face care in situations of social restriction, and optimization of early care by identifying high-risk patients. Objectives: Our aim was to demonstrate the main associated factors for a fall or fracture reported by rheumatoid arthritis (RA) patients in an electronic MDHAQ (Multidimensional Health Assessment Questionnaire) during this period. Methods: Patients with RA according to 2010 ACR/EULAR and access to digital platforms were enrolled in the study, from January to august 2021. A weblink was sent to MDHAQ in electronic platform. The study was approved by the ethics committee of Hospital de Clínicas de Porto Alegre-Brazil and all patients agreed with a Term of Informed Consent. Results: A total of 129 RA patients completed the electronic MDHAQ, mean age was 60 years (S.D. 14) and 83% were female. The mean DAS28, SDAI and HAQ were 3.8 (S.D. 1.6), 14.2 (S.D. 11.0) and 1. 2 (S.D. 0.7). Of those 129 patients, 14 reported a fall or fracture in the last 6 months of response and only 16 patients were physically active. Relevant symptoms known as factors associated with risk of fall and its prevalence in this study were: pain (82%), followed by articular pain (68%), fatigue (43%), muscle weakness (37%) and weight gain (22%). Among patients who reported a fall or fracture, 83% had a RADAI ≥ 16 and mean FAST3 (Fibromyalgia Assessment Screening Test) index of 19 (IC95 % 17-21). FAST3 based on MDHAQ and independent RADAI showed positively association with a reported fall or fracture for these patients, with a p value of 0.023 and 0.025, respectively. Other factors, such as high disease activity based on DAS28 or MDHAQ, obesity and age were not statistically signifcant with the reported episode. Conclusion: Maintaining PRO is aligned with patient-centered care, allowing relevant data source and identifcation of high-risk patients-in our study: patients in pain, sedentary and in major risk of fracture. Also, use of combined in like FAST3 or independent articular pain scores such as RADAI, might be helpful to identify those high-risk patients in need for orientation for reinforcement of physical activity, prioritization for in person visits and early clinical adjustments.

8.
Annals of the Rheumatic Diseases ; 81:1497-1498, 2022.
Article in English | EMBASE | ID: covidwho-2009179

ABSTRACT

Background: The anti-SARS2 vaccination is considered the best way to reduce the frequency and the subsequent effects of COVID19 pandemic. To this aim, the most used in western countries are mRNA vaccines BNT16162b2 (Pfzer-Bi-oNT) and mRNA-1273 (Moderna). With both these vaccines the risk/benefts balance is largely favorable and severe adverse effects are almost rare. In keeping, although transient myalgia and arthralgia are frequently seen, myositis have been until now rarely reported. Objectives: To report two cases of myositis occurring in two patients after BNT16162b2 vaccine administration evaluated at the Center for Rheumatic Diseases in Venice, Italy. Methods: In these patients clinical examination, blood and instrumental investigations for myositis and, in addition HLA typing, were performed. Patients were followed for at least six months after the onset of symptoms. Results: The frst patient, a 54-year-old male, complained of high-grade fever 4 days after the I dose of BNT16162b2 (Pfzer-BioNT) followed, by mild fatigue, muscle soreness and increasing weakness. He was sent to the emergency department of the local Hospital. The physical examination confrmed the muscle weakness. Blood investigation revealed an increase of AST: 509 U/L (NV< 37), ALT:189 U/L (NV <78), LDH 609, CPK 11394 U/L (NV<, 309), Myoglobin 3571 ng/ml (VN <96), CRP 1. 6 mg/dl. Prednisone (PN) was started (50 mg orally day) and tapered to 5 mg in two weeks. At high doses, the symptoms slightly improved, but when < 10 mg, all the symptoms reappeared. Thus, he was hospitalized again. The new examination confrmed the increase of all indices of myositis;antinuclear antibodies and myositis antibodies were absent and PN was restarted at 10 mg/day without beneft;echo-cardiography and TC scan were negative. He was then sent to our observation. We increased the dose of PN at 1 mg/PN/kg and we required HLA typing. Two weeks later symptoms disappared almost completely and then we tapered PN 5 mg/day weekly. At present the patients is completely well and muscle indices negative since two months. HLA typing revealed the presence of B∗35 and DRB1∗15. The second case was a 29-year-old female presented with a history of complaints appeared two days after the vaccination with BNT16162b2 administration (Pfzer-BioNT) characterized by three days of high-degree fever, followed by sever weakness, especially in the arms. The family doctor decide to hear our advise. At the initial presentation arm strenght was very decrease and the patient was accompanied. We required a serie of investigations which revealed: CPK 8950 U/L (NV 250), CRP 3.5 mg/dl increased;antinuclear and anti-myositis antibodies absent;cardiac (Ultrasound) and thoracic (CT) investigation and electro-myography negative. HLA typing revealed the presence of haplotypes B∗35 and DRB1∗15. PN (50 mg orally day) was started;two weeks later she improved and both muscle indices and CRP negative. Thus, we reduce the dosage at 25 mg/day with tapering 5 mg weekly. She was completely remitted at end of PN cycle. At present, three month later she is well. Conclusion: The rare occurrence of some particular side effects is not predictable. Our cases of severe myositis which in both cases completely remitted in some months are associated with haplotypes HLA-B∗35 and DRB1∗15. These are both binding sites linked to high-affinity interactions to S-protein T-cell epitope which account for high potentials to trigger immunogenic responses to the S protein of SARS-CoV-2 (1). Furthermore classically, HLA-B35 is associated with reactive arthritis and self-limiting, unclassifed rheumatism (2).

9.
Annals of the Rheumatic Diseases ; 81:1071, 2022.
Article in English | EMBASE | ID: covidwho-2009077

ABSTRACT

Background: Intermittent hypoxia conditioning reduces the levels of infam-matory parameters and cytokines (C-reactive protein, TNF-α, IL-4, IL-6, IL-8), increases the tolerance to acute hypoxia, the functional capacity and improves parameters of respiratory and cardiovascular systems [1-4]. Objectives: To evaluate the efficiency of the interval hypoxic-hyperoxic training (Reoxy therapy) in the rehabilitation of patients with osteoarthritis (OA) and post-COVID syndrome. Methods: 36 patients with OA (78% females, age of 43 to 68 years, generalized OA, OA of the knee or hip joints) where included in the randomized placebo-controlled study. Coronavirus infection COVID-19 were diagnosed from 12 to 26 weeks before the study. The main symptoms of post-COVID syndrome were dry cough, smell loss, breathlessness, weakness, fatigue, sleep disorders, cognitive symptoms, memory problems, anxiety, depression, headache, dizziness, joint and muscle pain. All patients were randomized into 3 groups. 13 study group patients received 10 Reoxy therapy procedures, 9 placebo group patients-10 placebo procedures of Reoxy therapy, 14 control group patients-only standard rehabilitation. The patients of all groups underwent 2-week standard rehabilitation program: 10 procedures of electrostatic massage for muscles and periar-ticular tissues, 10 sessions of general magnetic therapy, 10 group sessions of physical exercises with elements of breathing exercises. All patients received NSAIDs and SYSADOA at standard dosages. Intra-articular corticosteroids was not used. The study group patients were breathing hypoxic (FiO2 13-15%) and hyperoxic (FiO2 up to 40%) gas mixture through the mask in the interval mode with biofeedback using device «ReOxy» (Ai Mediq S.A., Luxembourg). 10-min hypoxic test (FiO2 12-13%) was performed before the frst and fourth procedures. The duration of 1-4 procedures was 30 min, 5-10 procedures-40 min. The placebo procedures were performed using the mask with the atmospheric air hole. Joint pain and general health on 100-mm VAS, Lequesne and WOMAC indexes, Spielberger-Khanin anxiety test, Beck depression inventory and breath-lessness on Modifed Borg scale were evaluated at baseline and at 2 weeks. Results: After 2 weeks in the study group pain on VAS decreased by 49,6% (p<0,05), Lequesne index-by 39,3% (p<0,05), WOMAC-by 1,4 times (p<0,01), anxiety level on Spielberger-Khanin test-by 40,9% (p<0,05), depression level on Beck depression inventory-by 64,1% (p<0,01), general health on VAS improved by 69,3% (p<0,01). The level of breathlessness on Modifed Borg scale in the study group initially was 2,5±0,9 score (moderate-slight breathlessness). After rehabilitation in the study group the level of breathlessness decreased to 0,3±0,4 score (extremely slight-no breathlessness). In the study group there were statistically signifcant differences from the placebo group (p<0,05) and the control group (p<0,05) in all parameters. Conclusion: 2-week complex rehabilitation program, including interval hypox-ic-hyperoxic training (Reoxy therapy), reduces pain, breathlessness, depression and anxiety, improves functional status and general health in patients with OA and post-COVID syndrome.

10.
Annals of the Rheumatic Diseases ; 81:960, 2022.
Article in English | EMBASE | ID: covidwho-2009055

ABSTRACT

Background: Anti-phospholipid syndrome (APS) is an autoimmune disorder characterized by presence of anti-phospholipid antibodies (aPL) comprising lupus anticoagulant, anti-β2-glycoprotein I and/or anti-cardiolipin antibodies together with recurrent thrombosis and/or obstetric morbidity. In the course of COVID-19, thromboembolism may ocur due to endothelial dysfunction directly related to the viral factor and systemic infammatory response. Concerns about COVID-19 vaccines began to arise after unexpected thromboembolic events were launched with the launch of vaccine campaigns around the world to prevent the disease. Objectives: The purpose of the study is to contribute to the literature on this subject by evaluating the development of any side effects or activation of the disease after the COVID-19 vaccine in our APS patients. Methods: This study was designed as a cross-sectional, retrospective cohort study. The patients who meet the Sapporo Criteria for APS which are followed up in Ankara City Hospital Rheumatology Clinic, 18 years and over and vaccinated with any of the COVID-19 vaccines, were included into the study. The files of the patients were examined in order to evaluate the side effects and APS disease activation (thrombosis, embolism or pregnancy complications) in the 3-month period after the last dose of the COVID-19 vaccines (CoronaVac and BNT162b2). Also, information of the patients was collected via telephone or reviewed at regular follow-up visits. Results: A total of 35 patients were included into the study (Table 1). In our patients, we did not observe any new thrombotic events or pregnancy complications during the 3-months observation period after COVID-19 vaccinations. The most common side effects after vaccinations were as follows;myalgia (30%), weakness (16.7%) and fever (10%) (Table 2). No patient became pregnant or gave birth during the follow-up. Conclusion: According to our results, no thrombotic events or pregnancy complications were observed after CoronaVac and BNT162b2 vaccines in APS patients. Apart from this, minor side effects related to COVID-19 vaccines were clinically acceptable level.

11.
Annals of the Rheumatic Diseases ; 81:1687, 2022.
Article in English | EMBASE | ID: covidwho-2009054

ABSTRACT

Background: One of the problems with the COVID-19 epidemic is infodemic. Insufficient and inaccurate information can be confusing and hinder treatment. In Japan, tabloid TV show might be an easily accessible source of information, but its reliability is low and it has a harmful effect on patients' mental status and lifestyle. There are no reports to examine what is the source of COVID-19 news for patients with rheumatoid arthritis and how these information affect patients' daily lives and disease activity. By using NinJa, Japanese largest database of rheumatoid arthritis, it may be possible to examine them in detail. Objectives: To investigate the impact of the COVID-19 news sources on rheumatoid arthritis patients' lifestyle and their disease activity using NinJa 2020 cohort study. Methods: At the timing of collection of patients' data of NinJa2020, questionnaire about their lifestyle and news source of COVID-19 was given. Questionnaire includes questions about frequency of scheduled visit, going out and exercise, weakness and news source. Results: 6677 patients out of 15553 patients answered questionnaire. Most patients did not change the interval of scheduled visit. The frequency of hospital visits was 'unchanged' in 85.8%, 'longer' in 13.6%, and 'shortened' in 0.6%. The chances of going out were 'unchanged' at 14.4%, 'signifcantly decreased' at 57.5%, 'slightly decreased' at 27.8%, and 'increased' at 0.3%. 42.6% answered that the amount of exercise did not change, 30.2% answered that it decreased considerably, 26.1% answered that it decreased a little, and 1.1% answered that it increased. Regarding muscular strength and physical strength, 46.0% answered 'no change', 19.9% answered 'signifcantly dropped', 33.5% answered 'slightly dropped', and 0.6% answered 'increased'. The media used as information sources are 'newspaper (86.4%)', 'tabloid show (54.5%)', 'family, acquaintances and friends (43.7%)', and 'official web of Ministry of Health, Labor and Welfare and academic societies (9.4. %)'. Respondents often referred to multiple media and 30.6% of them listed three sources (Figure 1). There was a positive correlation between the decrease in frequency of going out and the number of information sources, and a negative correlation between age and the number of information sources. We also found a negative correlation with age for muscle weakness. No correlation was found between the number of information sources and SDAI, CDAI, HAQ-DI, EQ-5D, HADS (A), HADS (D). Conclusion: The more sources of information, the less chance of going out. About 80% of the patients refrained from going out, the opportunity for exercise decreased in more than 50% of the patients, and the decrease in physical ft-ness was also noticed in nearly 50% of the patients. Newspapers, tabloid shows, and acquaintances were the most common sources of medical information, and relatively few patients used official sources. He provision of accurate information about COVID-19 was important to avoid infodemic. From this questionnaire, more practical information delivery system was required in Japan.

12.
Annals of the Rheumatic Diseases ; 81:1861, 2022.
Article in English | EMBASE | ID: covidwho-2009050

ABSTRACT

Background: A 50 years old woman, a medical doctor, came to our department with symmetrical proximal muscular weakness, several months after Covid-19 infection and three weeks after a second dose of Covid-19 mRNA vaccine. The patient had no prior or family history of autoimmune diseases and take no medicines. In the past she undergone an operation for double-kidney with frequent urinary infections. Objective fndings have shown symmetrical proximal muscular weakness and classic sings of dermatomyositis-Gottron's papules, shawl and holster signs, periungual vasculitis. Objectives: We present a case of a 50 old woman with clinical and laboratory proven dermatomyositis, starting three weeks after a second dose of a Covid1-19 mRNA vaccine without other reasons. Methods: The laboratory tests showed elevated CPK, lactate dehydroge-nase, aspartate aminotransferase and alanine aminotransferase, high ANA-1:1280 and myositis specifc autoantibodies-anti-NXP2 and anti-Mi-2-beta. The electromyography showed myopathic changes and the muscle MRI-symmetrical edema of mm.obturator and mm.adductor brevis. We exclude diseases that may mimic infammatory myopathies. We made a cancer screening-whole body MRI, colonoscopy, gastroscopy, mammography and gynecological exam, immunoblot for detection of paraneoplastic syndrome-associated neuronal antibodies, with no detection of cancer. Muscle biopsy of m.vastus lateralis showed attenuating muscle infammation with advancing muscle atrophy and fbrosis. Results: The diagnose dermatomyositis was made according Bohan and Peter criteria and we start a high dose (1mg/kg/day) glucocorticoid therapy with good initial clinical and laboratory effect. Two months after starting a therapy muscle weakness worsened together with difficulty of swallowing. We excluded steroid myopathy after second EMG and lack of improvement when tapering the GS dose. Methotrexate 20 mg/weekly was added as a steroid sparing drug with good response, but was stopped because fare of pyelonephritis. Accordning to the opinion of dermatologist hydroxychloroquine was started for a couple of weeks, because of active skin manifestations. Muscle weakness worsened on the background of treatment, which was stopped. We started a therapy with intravenous immunoglobulins and considered therapy with cyclophosphamide or azathio-prine after urinary infection. Because the patient was infected for a second time with covid-19, although vaccine, we continued only with glucocorticoids and anti-osteoporotic therapy. Conclusion: The etiology and pathogenesis of infammatory myopathies are not fully clarifed so far. We speculate that the infection with Covid-19 as well as mRNA vaccine trigger infammatory myopathy and compromise the patient's immunity for poor treatment response with glucocorticoids and immunosuppres-sives. On the other hand advanced muscle atrophy and fbrosis within a short period show that suspected triggering factors could be a reason for difficult to treat such type of dermatomyiositis.

13.
Annals of the Rheumatic Diseases ; 81:1683, 2022.
Article in English | EMBASE | ID: covidwho-2009025

ABSTRACT

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.

14.
Annals of the Rheumatic Diseases ; 81:1681-1682, 2022.
Article in English | EMBASE | ID: covidwho-2009015

ABSTRACT

Background: Patients with spondyloarthritis (SpA) probably have a high incidence of COVID-19. Vaccination remains one of the most effective methods of preventing infectious diseases. However, data on the safety of vaccines against COVID-19 in patients with SpA are few and relate to foreign vaccines that are not licensed in Russia. Objectives: To study the safety of COVID-19 vaccines in patients with SpA in real clinical practice. Methods: The study included 47 SpA patients (25-ankylosing spondylitis, 13-psoriatic arthritis, 9-undifferentiated SpA, 19 women, 28 men, age 42.3±11.6 years, duration of the disease 11.8±9.2 years)-the main group and 97 people without any immuno-infammatory rheumatic diseases (67 women, 30 men, age 43.7±13.1 years)-the control group. 20 patients received disease-modifying antirheumatic drugs (12-methotrexate, 8-sulfasalazine), 10-biological drugs (8-TNF-α inhibitors, 2-IL-17 inhibitors), 6-glucocorticoids, 1-tofacitinib, 12-only nonsteroidal anti-infammatory drugs, 8-did not receive therapy. In the main group, 40 patients were vaccinated with Gam-COVID-Vac (Sputnik V), 3-Covi-Vac and Sputnik Light, 1-EpiVacCorona (both components of the vaccine were received by 44 patients). In the control group 69 were vaccinated with Sputnik V, 15-CoviVac, 5-Sputnik Light and BNT162b2, 2-EpiVacCorona, 1-mRNA-1273. (91 participants received both components of the vaccine). All participants were interviewed by a research doctor with a unifed questionnaire, additional information was obtained from medical documentation. Results: The data obtained are refilected in the Table 1. Local adverse events (AEs) occurred relatively less frequently in patients with SpA than in the control group. After the introduction of the first component of the vaccine, there was a significant increase in the frequency of pain without restriction of movement and edema/hyperemia in the control group (p<0.001 and p=0.049, respectively), while after the introduction of the second component, a significant difference was registered only for the first indicated symptom (p<0.001). The most frequent systemic AEs were weakness, fever, arthralgia or myalgia, headache, and chills, which were significantly less common (p=0.008) in the main group after immunization with the first component. The proportion of SpA patients without any reactions was significantly higher after the introduction of the first component of the vaccine (59.6% and 29.9%, p<0.001), while after immunity with the second component there were no differences (59.1% and 44.0%, p>0.05). After complete immunization, the percentage of patients without any AEs was significantly higher in the main group than in the control (50.0% and 17.6%, p<0.001). There was no exacerbation of SpA or development of new autoimmune phenomena in the main group after full vaccination. Conclusion: According to preliminary data, the tolerability of vaccines against COVID-19 in patients with SpA is satisfactory. Further studies with an increased sample are needed to study the safety, immunogenicity and clinical efficacy of immunization against COVID-19 in patients of this cohort.

15.
Annals of the Rheumatic Diseases ; 81:1860, 2022.
Article in English | EMBASE | ID: covidwho-2008984

ABSTRACT

Background: The world is currently rocking to and fro in the midst of the COVID-19 viral storm and vaccinations have played a pivotal role in calming this.Although COVID-19 vaccines have been thoroughly assessed and studied before being rolled out to the general population, there have been reports of post vaccination complications in limited number of subjects strongly associated with COVID-19 vaccinations[1]. Objectives: To report a case of severe ANCA associated vasculitis after COVID-19 vaccination. Methods: A case report and discussion. Results: In view of this, we report the case of a 77 year old caucasian male who developed severe ANCA associated vasculitis (AAV) after two doses of Astra-Zeneca vaccine and one booster dose of Pfzer COVID-19 booster. He presented with acute onset infammatory arthritis with mononeuritis multiplex with bilateral foot drop and left radial and ulnar nerve forearm weakness in typical asymmetrical pattern two weeks after the Pfzer vaccination. He had a raised MPO-ANCA titre of 66 IU/ml, C-reactive protein of 131mg/L and reactive thrombocytosis of 458 X 10 9/L. Nerve conduction study confrmed mononeuritis multiplex in the bilateral peroneal nerves and left radial and ulnar nerve. A total body CT had excluded malignancy and paraneoplastic associations and Gullian-Barre diagnosis was also excluded. The patient was treated with 3 days of intravenous methylprednisolone 1g daily then given intravenous Rituximab 1g, two weeks apart. He is currently undergoing rehabilitation in view of the vasculitic neuropathy from his diagnosis. Conclusion: Diagnosis of AAV is often delayed or missed by other medical specialties due to its varied presentation. AAV should be suspected in a patient with paraesthesia/weakness in keeping with mononeuritis multiplex or other peripheral neuropathy in the absence of an alternative explanation (e.g. diabetes,B12 defciency) and in particular with a wrist or foot drop.Exposure to certain drugs and substances of abuse such as cocaine, hydralazine and propylthiouracil has been implicated with AAV.While short-term side effects of COVID-19 vaccine resemble those of other vaccines, long-term side effects remain unknown[2]. Rare side effects continue to surface as millions of people receive COVID-19 vaccines around the world.

16.
Annals of the Rheumatic Diseases ; 81:1617, 2022.
Article in English | EMBASE | ID: covidwho-2008968

ABSTRACT

Objectives: To evaluate the dynamics of pain on the VAS scale, functional activity according to the WOMAC index and quality of life according to the EQ-5D questionnaire in elderly and senile patients with knee joint osteoarthritis (OA) after COVID-19. Methods: A total of 32 elderly and senile male patients with an established diagnosis of knee joint OA (according to the criteria of ACR, 1986) of stage II-III according to Kellgren-Lawrence, with pain ≥40 mm on a visual analog scale (VAS), who needed to take nonsteroidal anti-infammatory drugs (NSAIDs), were included in the study. The median age of the patients included in this study was 72.6 (66.0;79.3) years. All patients have been ill with COVID-19 for the last 6 months. Pain dynamics was assessed on the VAS scale, functional activity-on the WOMAC index, quality of life-on the EQ-5D questionnaire. Results: When analyzing the clinical picture, it was found that the majority of patients-22 people (68.8%)-had moderate COVID-19, 4 people (12.5%)-in mild form, 6 patients (18.7%)-in severe. The average duration of hospitalization was 14.0 (9.0;17.0) days. The majority of patients were discharged with recovery-30 people (93.75%), 2 people died (6.25%). The most frequent manifestations of postcovid syndrome in elderly and senile patients with OA: weakness-in 18 (56.2%) patients, arthralgia-in 17 (53.1%) and memory loss-in 14 (43.8%). There was a signifcant increase in the pain index on the VAS scale and the total WOMAC index after COVID-19. Pain on the VAS scale before COVID-19 was 45.9 (34.8;72.4), after the disease-60.9 (51.4;68.5) (p<0.001);the total WOMAC index was 46.3 (38.5;51.2) and 63.1 (48.9;76.2), respectively (p=0.007). There were no differences in the need for NSAIDs before and after the disease. When flling out the EQ-5D questionnaire, all the interviewed patients indicated health problems to one degree or another. When calculating the quantitative index after COVID-19, there was a deterioration in the health index, but the changes were unreliable. The 'health thermometer' also changed in a similar way. Conclusion: COVID-19 in elderly and senile patients with OA occurred in a variant of moderate severity in 22 (68.8%), severe-in 6 (18.7%), mild-in 4 (12.5%). The most frequent manifestations of postcovid syndrome in elderly and senile patients with OA: weakness, arthralgia and memory loss. Negative dynamics of indicators of functional activity according to the WOMAC index and pain on the scale VAS after COVID-19 was registered.

17.
Annals of the Rheumatic Diseases ; 81:1079, 2022.
Article in English | EMBASE | ID: covidwho-2008903

ABSTRACT

Objectives: to study the clinical and laboratory features of septal panniculitis in the form of erythema nodosum (EN) in a cohort of patients with COVID-19 referred to a rheumatological center. Methods: In 2020-2021 we examined 21 patients (18 women and 3 men, average age 43.2±11.4 years) with EN and polyarthralgia/arthritis. Depending on the time of EN and articular syndrome associated with COVID-19 development, patients were divided into three groups: 1) up to 4 weeks-acute COVID (symptoms potentially associated with infection);2) from 4 to 12 weeks-ongoing symptomatic COVID and 3) more than 12 weeks-post-COVID syndrome (persistent symptoms not associated with an alternative diagnosis). All patients underwent a comprehensive clinical, laboratory and instrumental examination, including ultrasound of the joints and chest computed tomography (CT), as well as pathomorphological examination of skin and subcutaneous adipose tissue from the node area (in 9 cases). Results: Based on the history data, COVID-19 in the study cohort had mild (in 3 patients), moderate (12) and severe (6) severity. Two patients (21 and 23 years old) with a mild severity of the disease on the 2nd-3rd day of the development of the respiratory symptom for the frst time noted red painful (45 mm on a visual analogue scale) nodes on the legs and polyarthralgia. In 9 patients (52.3%), similar skin changes were detected 24.5 ± 7. 6 days after stopping active COVID-19, i.e. during the period of ongoing symptomatic COVID. In 8 patients (38%), including 6 with moderate severity of the disease, nodules appeared after 85.6 ± 12.3 days, which corresponded to post-COVID syndrome. At the time of examination, 100 and 71.4% of patients complained of skin rashes and joint pain, respectively. Shortness of breath, weakness, cough, sweating and myalgia disturbed 67% of patients. An increase in body temperature to subfebrile was observed in 43% of cases, mainly with ongoing symptomatic COVID. In the overwhelming majority of cases (86%), UE was located on the anterior and lateral surfaces of the legs, less often on the posterior and medial surfaces. It is noteworthy that the lesion of more than 50% of the surface of the lower and upper extremities was associated with the number of nodes (p <0.02), CRP level (p <0.03) and post-COVID syndrome (p <0.2). Sixteen patients (76.1%) had signs of arthralgia, mainly ankle (81%) and knee (56%) joints. In a laboratory study, the median ESR was 39 [14;62] mm/h, the level of CRP was 17 [2;79] mg/l. The results of the polymerase chain reaction for SARS-CoV-2 were negative in 90.4 % of patients. In 90.4 % of cases, IgG antibodies were detected and in 52.3%-IgM to the SARS-CoV-2 virus. At CT of the chest, ≤25% of lung lesions were detected in 51% of patients, from 25 to 50%-in 33% and from 50% to 75%-in 9.5 % of cases. Pathomorphological examination of the nodes showed signs of septal panniculitis. Conclusion: When EN associated with SARS-CoV-2 appears it is important to timely suspect a post-infectious manifestation, based on the clinical picture of the disease and to determine the scope of further examination and adequate treatment.

18.
Annals of the Rheumatic Diseases ; 81:1669-1670, 2022.
Article in English | EMBASE | ID: covidwho-2008884

ABSTRACT

Background: Almost two years after the start of the pandemic, it has become clear that the severity of COVID-19 is not limited to the manifestations of the acute phase of SARS-CoV-2 infection. The so-called post-covid syndrome (PCS) can occur even in patients who have experienced mild or moderate COVID-19 and includes long-term symptoms that may be associated with residual infammation, organ damage, non-specifc effects of hospitalization or prolonged ventilation, social isolation, or comorbid diseases. In October 2021, the WHO defned PCS as a condition that occurs in individuals with a history of probable or confrmed infection with the SARS-CoV-2 virus, usually within 3 months of the onset of COVID-19, and is characterized by the presence of symptoms for at least 2 months, as well as the impossibility of explaining them with an alternative diagnosis. Objectives: To conduct a comparative assessment of clinical and demographic indicators in groups of patients with rheumatoid arthritis who underwent COVID-19, with and without PCS. Methods: The material of the questionnaires flled in by patients of the V.A. Nasonova Research Institute of Rheumatology, who underwent COVID-19, ver-ifed by RT-PCR for SARS-CoV-2 RNA. The information was supplemented with data from discharge records after inpatient treatment for COVID-19. Statistica program (version 12) was used for statistical processing. The results of correlation analysis were considered signifcant at p<0.05. Results: The study included 23 adult patients (over 18 years of age) with a reliable diagnosis of rheumatoid arthritis (ACR/EULAR). Of these, 11 (47.8%) patients noted the development of PCS (Group 1), and 12 patients underwent COVID-19 without consequences (Group 2). Both groups were represented predominantly by women (90.9% and 91.7%, respectively). The average age in both groups did not differ sig-nifcantly and amounted to 56.73±14.79 years in group 1, and 48.17±19.59 years in group 2. The median number of comorbid diseases was 2 [1;4] in group 1 and 0.5 [0;2.5] in group 2. PCS was presented by the following symptoms: weakness, increased fatigue-in 6 patients, problems with attention, concentration-in 7, memory impairment-in 6, sleep disturbances-in 7, increased pain in the joints-in 7, shortness of breath during exercise-in 6, fuctuations in blood pressure-in 5, tachycardia-in 4. On average (median), each patient noted 10 [6.5;12] symptoms of PCS at a time. When assessing the number of symptoms in the infectious phase, in group 1, patients reported 20 [16;23], and in group 2, 10 [7;12] symptoms of COVID-19. At the time of development of COVID-19, the severity of RA symptoms, assessed by VAS, was 5.64±3.26 in group 1 and 4.75±2.99 in group 2. In group 1, 5 (45.5%) patients needed hospitalization, 3 of them needed oxygen support. In group 2, 4 (33.3%) patients were hospitalized, two of them needed oxygen support. 3 patients in group 1 suffered COVID-19 again on average 9.33±2.52 months after the frst illness. One of them has been vaccinated. All patients in this group were treated as outpatients, while the frst case of COVID-19 required one hospitalization and oxygen support. Statistical assessment of signifcant differences (p<0.05) between groups in terms of sex, age, number of comorbid diseases, number of COVID-19 symptoms in the infectious phase, severity of RA symptoms, and hospitalization rate was not revealed. Conclusion: Even though when assessing the socio-demographic characteristics, no statistically significant differences were found between the study groups, the average age, the number of comorbid diseases, and the severity of RA symptoms at the time of COVID-19 were higher in the group of patients with RA and PCS. Patients with PCS reported higher rates of hospitalizations and more severe COVID-19. There were also repeated cases of COVID-19 in this group. It is necessary to continue the study on a larger cohort.

19.
Annals of the Rheumatic Diseases ; 81:1858, 2022.
Article in English | EMBASE | ID: covidwho-2008876

ABSTRACT

Background: Numerous immune-mediated diseases fare or new disease onset after SARS-CoV2-vaccination have been reported. There were case reports showed the immune-mediated disease fare post vaccination but study on new disease occurs post Covid-19 vaccination is still lacking. Objectives: To describe two SLE cases that diagnosed post Covid-19 vaccination. Methods: Case report Results: 14 years old girl, post Covid-19 vaccination 1st dose 3 weeks ago presented with 2 day history of giddiness, breathlessness, vomiting and diarrhea prior to admission. She also complained of frothy urine for the past 1 week associated with lower limbs swelling and facial puffiness. Clinical examination noted she had sparse hair, oral ulcers and discoid lupus at the ear concha. She also noted to have periorbital puffiness with pedal edema. Lung auscultation noted bi-basal crepitations. Blood investigation noted ANA positive (1:640, speckled) with low complement 3 (0.1g/L). Her full blood count showed leucopenia (3100 UL) with low lymphocyte count of 810UL. UFEME noted protein of 3 + and red blood cell of 2+ with normal renal profile. Her serum albumin was 22g/L. Chest x ray showed clear lung field with no cardiomegaly. Her 24-hour urine protein showed proteinuria of 2.345g/dl and her renal biopsy showed mesangial proliferative lupus nephritis class iI. She was given intravenous methyl-prednisolone 500mg OD for 3 days and discharged with tapering dose of prednisolone, hydroxychloroquine, calcium supplements, perindopril and frusemide. Another case was a 17 year-old female, post covid-19 vaccination 10 weeks, presented with 3 weeks history of bilateral lower limbs weakness with difficulty in getting up from chair. She also had fever on and off with cough for 1 week. There was no alopecia, oral ulcer, facial rash or photosensitivity. No joints pain. Clinical examination noted presence of proximal myopathy with stable vital signs. Other systemic examinations were unremarkable. Blood investigation noted ANA positive (1: 640, homogenous and speckled) with low complements level (C3 0.19g/L and C4 0.049 g/L).Her creatine kinase was 2367U/L and EMG showed evidence of irritable myopathic process which is consistent with inflammatory myositis. Her TFT was normal. Myositis panel showed anti-Ku and anti-Ro 52 were positive. She was treated as SLE with myositis and intravenous methylprednisolone was given. She discharge well with tapering dose of prednisolone and azathioprine. Her creatine kinase showed improvement with immunosuppression therapy and she was advised on intensive physiotherapy. Conclusion: The onset of these two SLE cases were occurred within the 2 month of post covid-19 vaccination. Whether Covid-19 vaccination direct contribute to the occurrence of SLE remained inconclusive. More studies are required to show its correlation between onset of SLE and Covid-19 vaccination.

20.
Annals of the Rheumatic Diseases ; 81:1667, 2022.
Article in English | EMBASE | ID: covidwho-2008852

ABSTRACT

Background: It has been more than a year and a half since the WHO announced a pandemic of a new coronavirus infection caused by SARS-CoV-2. The virus belongs to the respiratory group, but it it can damage various organs and tissues of the body. COVID-19 infection is characterized by pathological activation of immunity, violated synthesis of pro-infammatory, immunoregulatory, anti-infammatory cytokines, such as interleukins-1 and-6, tumor necrosis factor α and others. These features contribute to the development of rheumatic diseases and syndromes in people who have had COVID-19. Cellular and humoral immune responses are also of primary importance in the pathogenesis of infammatory myopathies. Objectives: Description of a case of severe dermatomyositis after COVID-19. Methods: The 34-year-old female patient complained of pain and weakness in the proximal muscles of the upper and lower extremities, difficulty swallowing solid and liquid food, rash on the face, neck, chest and arms. In August 2020 she had a mild case of COVID-19. A month later, faky erythematous papules like Gottron's sign appeared on the extensor surfaces of the metacarpophalangeal joints and proximal interphalangeal joints of the hands. Six months later, sore throats, hoarseness of voice, belching of air, choking on solid food and episodes of subfebrility joined. Refux esophagitis, duodenitis was detected by fbrogastroduodenoscopy. After 9 months, there were muscle pains and muscle weakness, erythema on the face, neck and chest, the patient lost 11 kg. She was hospitalized in the rheumatology department with suspected dermatomyositis. Results: On objective examination: proximal myopathy, erythematous rashes on the face, neck, chest, Gottron's erythema on the hands. In the analyses: clinical analysis of blood and urine without pathology, ANA 1:1280, creatinkinase 5370 IU/l, with an increase in dynamics up to 9260 IU/l, CRP 0.03 mg/dl, LDH 1023 IU/l, rheumatoid factor and anti-ds DNA were negative. Nasal regurgitation was detected during radiography of the pharynx with contrast. Instrumental examination revealed no signs of a tumor process. Fibrogastroduodenoscopy-superfcial refux-esophagitis, duodenitis, Chest CT-interstitial pneumonitis, abdominal ultrasound without pathology, ECG-sinus rhythm, normal EOS position, accelerated A-V conduction, echocardiography-minor separation of pericardial leaves (up to 5 mm), colonoscopy-dolichosigma. The patient was diagnosed with idiopathic dermatomyositis of high activity. Because of progressive myopathy and increasing dysphagia, pulse therapy with methylpredniso-lone500 mg for 3 days and rituximab 1000 mg was performed. She also received metipred 48 mg per day orally, methotrexate 15 mg per week subcutaneously and folic acid 5 mg per week. Against the background of therapy, positive dynamics was noted: swallowing normalized, the severity of myopathy decreased, after 10 days CKdecreased to 2049 IU/l. After 6 months during the control examination: there are no skin rashes, muscle strength is restored, CK 300 IU/l. The dose of methylprednisolone is reduced to 10 mg per day, the patient continues injections of methotrexate 15 mg per week. Conclusion: COVID-19 may be a trigger for the development of infammatory myopathy. In this clinical case there are features of the course and therapy of infammatory myopathies in patients after coronavirus infection.

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