Outcomes of covid-19 in patients with rheumatic diseases in a tertiary government hospital in the Philippines

ABSTRACT

Objective: To describe the outcomes of COVID-19 infection among hospitalized patients with rheumatic diseases referred to the Division of Rheumatology, University of the Philippines-Philippine General Hospital, from March to December 2020. Methods: Design: This is a retrospective study approved by the UP Manila Research Ethics Board as part of the Global Rheumatology Alliance physician-reported registry protocol. Background: Patients with autoimmune rheumatic diseases and immunosuppressed are at high risk of dying from COVID-19. The pandemic has also significantly affected the delivery of healthcare to these patients. Results: Out of 2,500 inpatients with COVID-19, 31 had rheumatic diseases. There was male predominance (n = 18) and the median age was 50 years. There was an average of 10 (+7.94) day-interval between onset of acute symptoms and hospitalization. Their comorbidities were vascular and metabolic (hypertension n = 11, diabetes n = 7, chronic kidney disease n = 7, ischemic heart disease n = 5, dyslipidemia, n = 2 and cerebrovascular disease n = 1). The most common rheumatic diagnoses were gout (n = 15) and systemic lupus erythematosus (SLE, n = 9). Most gout patients (n = 15) had uncontrolled disease (n = 7). Two patients had bacterial or tuberculous arthritis concomitant with COVID-19. Four patients (six in remission) had lupus flare, resulting in intrauterine fetal death for one patient. They were given intravenous high-dose glucocorticoids. One patient, with rheumatoid arthritis, was advised to discontinue disease-modifying anti-rheumatic drug (azathioprine) temporarily. Two had nosocomial COVID-19;the rest were community-acquired. Majority had moderate (n = 15) or milder infection (n = 8). Eight had severe to critical disease and seven of them died. Four deaths were from acute respiratory failure, two from thromboembolism (pulmonary and cerebral), and one from septic shock. Both patients with thrombotic events had confirmed or suspected SLE. The rest had gout (n = 3), RA (n = 1) and TB arthritis (n = 1). Conclusion: Most of our patients with COVID-19 and RMD had good recovery. The mortality rate (23%) was slightly higher than the PGH mortality rate for COVID-19 (17.5%).