CORONAVIRUS INFECTION in PATIENTS with SYSTEMIC LUPUS ERYTHEMATOSUS (CASE SERIES)

ABSTRACT

Background: SARS-CoV 2 infection (Covid-19) has a wide range of Clinical and laboratpry symptoms typical for rheumatic diseases, in particular systemic lupus erythematosus (SLE). Objectives: Analysis of the course of Covid-19 in patients with SLE and the influence of antirheumatic drugs on its outcomes. Methods: A retrospective analysis of 12 patients with SLE previously observed in the rheumatology department and had Covid-19 in 2020-2021. Average age of patients (83% women) is 41 years (24-59 years old), duration of SLE-11 years (3-25 years). 10 patients had low SLE activity, 1-moderate, 1-high. In anamnesis 8 patients had hematological disorders, 4-secondary antiphospholipid syndrome (APS) with thrombosis, 3-cerebrovasculitis, 5-lung damage, 3-lupus nephritis. All patients were treated with glucocorticosteroids (GCs) (the average dose 2 1/4 tablets per day), 10 (66,7%)-with hydroxychloroquine (HCQ), 4 (33,3%)-with immunosuppressants 2-mycophenolate mofetil, 1-methotrexate, 1-cyclophos-phamide. 3 (25%) patients received rituximab (RTM) 2-3 months before the onset of COVID-19. 9 (75%) patients received outpatient treatment, 5 of them had a mild infection (3-without lung damage, 2-with lung damage-CT 1), 4-had a moderate course, 3 (25%)-were admitted to the hospital,1-to the intensive care unit. Results: Patients were divided into 3 groups for SLE therapy. The frst group (6 patients) was treated with GCs (average dose of 1 1/2 tab.) and HCQ (200-400 mg). All of them had mild to moderate course of infection without complications. Exacerbation of SLE was noted in 3 (50%) patients 2 had capillarities, psycho-emotional lability, deterioration of laboratory parameters, 1 (with secondary APS) developed deep vein thrombosis of the legs and an exacerbation of lupus nephritis a month after. The second group (3 patients) received GCs (average dose 2 1/4 tab.) and immunosuppressants. In 2 patients the course of Covid-19 was mild, in 1-moderate. Exacerbation of SLE was noted in 2 patients 1 had headaches, high titers of ANA and anti-DNA, 2nd-a severe exacerbation (hematological disorders, lupus nephritis with impaired renal function). The third group (3 patients) received GCS (average dose 5 tab.) and rituximab. 2 patients received RTM for 2 years, the last infusion was carried out for 3 months before the onset of an infection. Their course of Covid-19 was moderate with CT-2 lung damage and mild respiratory failure. There were no exacerbations of SLE after recovery. The 3rd patient initially had a high activity of SLE with nephrotic syndrome, arterial hypertension, batterfy rash, arthritis, fever, which required high doses of GCs and 2 rituximab infusions of 500 and 1000 mg. A month later, a severe COVID-19 developed with 70% lung damage, severe respiratory failure (SpO2-80%), and cytokine storm syndrome. He was treated with GCS, anticoagulants, tocilizumab, immunoglobulin, followed by recovery. Mild and moderate course of COVID-19 was observed in 92% of patients with SLE, in 8%-severe. Exacerbation of SLE after infection occurred in 41% of cases with no lethal outcomes. Conclusion: Patients with low activity SLE on small doses of GCs and HCQ tolerate COVID-19 relatively easily. The high activity of SLE and the use of ritux-imab contribute to the severe course of COVID-19 with damage to the lungs and respiratory failure, so the use of anti-B-cell therapy during a pandemic is undesirable. The effect of immunosuppressants is controversal. Exacerbation of SLE after COVID-19 in 41% of all patients requires monitoring of laboratory parameters and observation by a rheumatologist for at least six months after recovery from infection.