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BackgroundThe COVID-19 pandemic has brought uncertainties to rheumatology practice, mainly related to the possibility of triggering disease activity after infection in immune mediated rheumatic diseases (IMRD). To date, there are few data in the literature specifically evaluating this issue.ObjectivesEvaluate the disease activity in IMRD patients after 6 months of the infection, compared to pre infection status.MethodsReumaCoV Brasil is a longitudinal study performed at 35 study centers designed to follow-up IMRD patients for 6 months after clinical or laboratorial COVID-19 diagnosis (cases), comparing with patients with IMRD who had not had the infection at the time of inclusion (controls). Demographic data such as age, sex, comorbidities, clinical characteristics, treatment, evolution of COVID-19 and disease activity status were collected using a Research Eletronic Data Capture (REDCap) database on three consecutive visits (inclusion and 6 months). The analysis was carried out on the four diseases with the highest inclusion number in the study: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). In addition to specific disease activity assessment metrics, we used patient's global assessment of disease activity (PGA), ranging from 0 to 10, at all visits, with 0 being no activity and 10 being intense activity. All conclusions were drawn considering the significance level of 5%. This study was registered at the Brazilian Registry of Clinical Trials—REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.ResultsBetween May 2020 and January 2021, 2032 patients were included in the registry, and of these, 1322 patients (721 cases and 601 controls), completed 6 months of follow-up, being 550 SLE (42.0%), 497 RA (37.6%) and 176 SpA (13.3%) and 99 (7.4%) PsA. Most patients were female (82.0%);the median age was 46.7 (13.8). Disease activity at the time of enrollment, according to the PGA, was similar between cases and controls, except for patients with RA and AS, where it was higher in controls. After the follow up time, no worsening of activity was observed in any of the diseases evaluated in the case group (Table 1). Despite this, worsening of disease symptoms after COVID-19 was reported by 23.3%, 24.6%, 25.0% and 25.8% of patients with SLE, RA, AS and PsA respectively, not related with disease activity.ConclusionIn patients with IMRD, no worsening of disease activity was observed after COVID-19 in this cohort of Brazilian patients. Despite this, many patients noticed worsening of symptoms, possibly associated not with the triggering of the activity, but with the so-called long COVID syndrome.Table 1.Comparison of disease activity, according to PGA, comparing disease activity status at inclusion and after 6 months of follow up, in cases and controlsINCLUSIONAFTER 6 MONTHSCasesControlsp-valueCasesControlsp-valueSLE2 (0-4,5)2 (0-4)0,8102 (0-5)2 (0-4)0,172RA3 (1-5)4 (2-6)0.0013 (1-5)3 (1-5,5)0,731AS2 (0-5)4 (1-6)0,0022 (0-5)3,5 (1-6)0,044PsA2 (0-4)2 (0-5)0,8162 (0-5)2 (0-5)0,939*Median and interquatile range;Student t test;CI 95%AcknowledgementsReumaCoV Brasil researchers, Brazilian Society of Rheumatology and National Council for Ccientific and Technological Development.Disclosure of InterestsNone Declared.
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Objectives: COVID-19 is an acute respiratory infection caused by the new coronavirus that has spread around the world, becoming an international public health emergency. Studies have shown a high prevalence of psychiatric symptoms such as depression, anxiety and post-traumatic stress disorder in patients after the infection, a situation that can be evenmore pronounced in patients with chronic diseases such as Immune-mediated rheumatic diseases (IRMD). The aim of this study is to evaluate the psychological impact of the COVID-19 infection and pandemic on patients with IRMD as well as to describe the epidemiological profile of the selected population. Method(s): A longitudinal cohort observational study was carried out with a comparison group, based on the analysis of data from patients of Project Reumacov, organized by de Brazilian Society of Rheumatology, in Manaus/ Amazonas. Data regarding the psychological impact was obtained through the application of DASS-21 forms, which evaluated levels of depression, anxiety and stress. Possible answers were divided into four categories according to the frequency of the symptoms presented, such as Not applicable;Present for a short time;Present for a significant amount of time or Present most of the time. Result(s): In total, 283 patients were included in the study. The mean age was 44 years and the majority of the patients were female. The most frequent diagnosis was systemic lupus erythematosus, followed by rheumatoid arthritis. Of the patients included, 270 answered the DASS-21 questionnaire, being 152 in the Case group (patients with COVID-19) and 118 in the Control group (patients without COVID-19). There was a significant statistic correlation between high levels of depression, anxiety and stress and the presence of COVID-19 related symptoms. Conclusion(s): Our study demonstrated that high levels of stress, depression and anxiety were associated to the coronavirus infection. It is, however, difficult to determine whether this scenario is a result of a physiological response to the infection or a consequence of the social context of a pandemic. This knowledge may contribute to a better understanding of COVID-19 infection and its repercussions as well as to highlight the necessity of a multidisciplinary approach aimed at the mental health of patients with rheumatic diseases.
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Objectives: Patients with immune-mediated rheumatic diseases (IMRD) constitute an important subgroup of immunosuppressed patients at risk of developing severe infections. Since coronavirus 19 infection (COVID-19) is an international public health emergency, it is necessary to observe the relationship between this viral infection and the development or intensification of the clinical course of IMRD and the persistence of new associated symptoms. The aim of this study is to trace this population's epidemiological profile and evaluate the frequency of chronic fatigue syndrome in patients with IMRD and COVID-19 compared to uninfected patients. Method(s): This is a descriptive cross-sectional observational study with a comparison group. The sociodemographic, clinical, and FACIT-F Fatigue Scale data were from patients with IMRD of Project Reumacov, organized by the Brazilian Society of Rheumatology, locally inManaus/Amazonas. The statistical analysis was performed through the inferential method to demonstrate the prevalence. Result(s): 268 patients were evaluated, those who had contact with COVID-19 had fatigue according with the fatigue assessment scale compared to unexposed patients. There was a statistically significant correlation between fatigue post-COVID-19 infection in the patients studied. Conclusion(s): Clinically relevant fatigue was a prevalent and commonly reported symptom in the post-COVID-19 period in the evaluated population. These data should direct attention to the reported manifestations as they affect the functioning of individuals' socioeconomic and health well-being throughout the pandemic period and beyond.