Impact of COVID19 in spondyloarthritis (SPA) patients in a Tertiary Hospital

ABSTRACT

Background: This tertiary hospital is the referall centre of 360.000 inhabitants, population with a Covid seroprevalence of 8,4% at final 2020. Since march, we have had a special concern for rheumatologic patients with systemic diseases and under inmunosupressive agents, including disease modifying antirheumatic drugs (DMARDs) and biological therapy (BT). This is why a special protocol for this population was set. It included performance of serology (CLIA test) for patients under BT and PCR and CLIA testing prior to new treatments. PCR testing was also generally performed if symptomatology consistent with Covid;before hospitalisation;to tight contacts of infected people;and before procedures. Objectives: To evaluate the impact of COVID-19 in our SpA patients in terms of severity of viral infection and its effect on SpA. Methods: Data of 665 SpA patients and confirmed Covid infection seen in our center from March 15th to December 15th was crossed. 3 miscoded patients with rheumatoid arthritis and 2 with non definite CLIA positivity were excluded. Finally 49 patients' clinical records were reviewed. Data regarding epidemiologic features, SpA characteristics, comorbidities, therapy received, clinical activity before and after Covid, and severity of the infection was collected. IBM SPSS v23 was used for statistical analysis. Results: Among 49 SpA patients, 59% were male, mean aged 56,63 years (range 23-79). 62,2% presented at least 1 comorbidity. 65% were psoriatic arthritis. They mostly had longstanding disease (median 10,5 years -range-1-35). Previously 63% had received DMARDs, mainly methotrexate, and 32 % BT. When Covid was diagnosed 37,2% were under DMARDs and 53% under BT (69,2% TNF inhibitors, 26,9% anti-Il 17, 3,9% ustekinumab). At this point, disease activity was controlled in 82% of patients (39% in remission, and 43% in low disease activity state). Only 18% showed moderate activity. Within the 49 patients, 34 were diagnosed by PCR and 15 by CLIA tests. 9 required hospitalisation, of whom 4 developed more severe disease (3 received glucocorticoid pulses and 2 tocilizumab). A woman with PsA under secukinumab presented pneumonia and PE. None required mechanical ventilation. There were no exitus. Due to Covid infection 9 patients (50%) stopped DMARDs treatment, (5 of them hospitalised). 9 patients withdrew BT after Covid diagnosis;60% of the BT-hospitalised, and 28.5% of the BT-non-hospitalised. 1 suffered a flow with severe disease activity after withdrawal of Il-17 inhibitor. Conclusion: Prevalence of SARS cov 2 infection in SpA patients was not greater than in general population. Most were asymptomatic or suffered mild disease. Only 9 were hospitalised. Factors related to hospitalisation seem similar to those of general population, even if statistical significance was not found due to the small sample. BT does not seem to relate to hospitalisation in SpA and we had no deaths to date in them.