The impact of COVID-19 infection in a cohort of patients with systemic sclerosis

ABSTRACT

Objectives: The aim was to determine the clinical evolution and the prognosis of COVID-19 in a cohort of patients with systemic sclerosis (SSc). Methods: During the pandemic we had continuous contact by digital media with a cohort of 197 patients with SSc. If they presented a condition that met the suspicious definition of COVID-19 disease, the polymerase chain reaction test for SARS-CoV-2 was performed and their evolution was followed every 24 hours until they were asymptomatic, or death occurred. Patients with COVID-19 were treated on a regular basis by the outpatient or in-hospital without interfering with their treatment. Results: Thirteen patients, 57 years of age (range 50 to 77), 9 diffuse cutaneous (dcSSc) and 4 limited cutaneous (lcSSc) become ill with COVID-19 during 9 months of follow-up. Immunosuppressors drugs used at the time of illness were 6 mycophenolate mofetil, 2 methotrexate, 4 low-dose of prednisone. Seven patients had interstitial lung disease (ILD). Main symptoms were chest pain, cough, dyspnea, dysgeusia and anosmia, 1 had mild symptoms without pneumonia, 11 had mild pneumonia and received outpatient treatment, 1 only one had severe pneumonia requiring hospital management. One used supplemental oxygen as part of her treatment for lung fibrosis but additionally 4 used it during her illness. Only one (7.7%) had severe pneumonia was hospitalized and died at 77 years of age. Three patients discontinued their immunosuppressants during the pandemic and among them was the patient who died. Image 1 Conclusion: COVID-19 disease in patients with SSc can be overcome in most cases, even when they have ILD and were using immunosuppressants at the time of contagion with the SARS-CoV-2 virus. The low aggressiveness of atypical pneumonia in these patients may be due to the existence of protective mechanisms that participate in the pathogenesis of SSc.