DMARD DISRUPTION, INCREASED DISEASE ACTIVITY, and PROLONGED SYMPTOM DURATION after ACUTE COVID-19 among PATIENTS with RHEUMATIC DISEASE: A PROSPECTIVE STUDY

ABSTRACT

Background: Systemic autoimmune rheumatic disease (SARD) patients may be at risk for disease fare and prolonged symptom duration after COVID-19, perhaps related to DMARD disruption and immune activation. Objectives: To describe DMARD disruption and identify differences in SARD activity among patients with and without prolonged COVID-19 symptom duration. Methods: We identifed all SARD patients with confrmed COVID-19 at the Mass General Brigham healthcare system in Boston, USA;prospective recruitment is ongoing. Surveys were used to collect demographics, clinical characteristics, DMARD disruption, COVID-19 course, and SARD disease activity before and after COVID-19. The survey included validated instruments measuring disease activity, pain, fatigue, functional status, and respiratory quality of life. Prolonged symptom duration was defned as COVID-19 symptoms lasting ≥28 days. We compared differences in patient-reported measures between those with and without prolonged symptoms. Results: We analyzed survey responses from 174 COVID-19 survivors with SARDs (mean age 52±16 years, 81% female, 80% White). The most common SARDs were RA (40%) and SLE (14%). Fifty-one percent of the 127 respondents on any DMARD reported a disruption to their regimen at COVID-19 onset (Figure 1). Among individual DMARDs, 56-77% were reported to have any change, except for hydroxychloroquine (23%) and rituximab (46%). SARD fare after COVID-19 was reported by 41% of respondents (Table 1). Patient global assessment of SARD activity was worse after COVID-19 (mean 7.6±2.3 before vs. 6.6±2.9 after COVID-19, p<0.001). Prolonged symptom duration was reported by 45% of participants. Those with prolonged symptoms had a higher initial COVID-19 symptom count (median 7 vs. 4, p<0.001) and were more likely to be hospitalized for COVID-19 (28% vs. 17%, p=0.001). Respondents experiencing prolonged symptom duration had higher disease activity on RAPID3 (p=0.007) as well as more pain (p<0.001) and fatigue (p=0.03) compared to those without prolonged symptoms. Conclusion: DMARD disruption, SARD fare, and prolonged symptoms were common in this prospective study of COVID-19 survivors with SARDs. Those with prolonged COVID-19 symptom duration, defned as ≥28 days, had higher SARD activity, more pain, and more fatigue compared to those without prolonged symptoms. These fndings suggest that post-acute sequelae of COVID-19 may have a large impact on underlying SARD activity and quality of life.