CHARACTERISTICS and OUTCOMES of COVID-19 in PATIENTS with SYSTEMIC RHEUMATIC DISEASES: EXPERIENCE from A TERTIARY RHEUMATOLOGY CENTER in MALAYSIA

ABSTRACT

Background: South East Asia was one of the frst regions affected by the SARS-CoV-2 virus causing COVID-19 however data on the impact of COVID-19 infection in patients with systemic rheumatic diseases (SRD) in South East Asia remains scarce. Objectives: To evaluate basic demographics, clinical features and outcomes of COVID-19 infection in patients with SRD from a tertiary rheumatology centre in West Malaysia. Methods: A retrospective observational study of 77 patients with SRD diagnosed with COVID-19 between 1st December 2020 to the 31st of December 2021 was performed. Demographic details, type of SRD, number and type of disease-modifying antirheumatic drugs (DMARD), dose of glucocorticoid, comorbidities, SARS-CoV-2 vaccine (type and number of doses) hospitalisation, oxygen requirement, type of COVID-19 related complication and death were recorded. Results: A total of 55 (71%) patients were hospitalised and 9 (12%) died. Mean age at time of COVID-19 diagnosis was 51 ± 14. Amongst these patients, 32 (42%) were Chinese, 30 (39%) Malays and 15 (19%) Indians. Majority of these patients had infammatory arthritis (58%) which included rheumatoid arthritis and seronegative spondyloarthropathy. The most common DMARDs used was meth-otrexate (51%), hydroxychloroquine (46%), sulfasalazine (22%), lefunomide (13%), azathioprine and mycophenolate mofetil (5% each). Two patients were on Janus Kinase (JAK) inhibitors and 3 on biologic DMARDS (tumour necrosis factor inhibitor, IL-6 inhibitors and IL-17 inhibitors). There were 38 patients (49%) vaccinated with two doses of SARS-CoV-2 vaccine (Pfzer n=29, CoronoVac n=7 and AstraZeneca n=2) prior to admission and amongst those unvaccinated, 15 (20%) contracted COVID-19 before the vaccine was released in Malaysia. Among hospitalised patients, those more than 60 years and those with more than one comorbid had a higher chance of admission (n= 21, 88%;p=0.036 and n=28, 88%;p=0.001) and death (n=8, 33%;p<0.001 and n=7, 22%;p<0.001). Comorbidities associated with higher risk of hospitalisation was diabetes mel-litus (85%, p=0.06), hypertension (92%, p<0.001) and coronary artery disease (100%, p=0.03) and those associated with death was obesity (33%, p=0.01) and hypertension (22%, p=0.007). Use of conventional DMARD, JAK, biologics and glucocorticoid were not associated with hospitalisation or morbidity. However, we found that patients who developed acute respiratory distress syndrome secondary to COVID-19 were mostly on sulfasalazine compared to other DMARDS (35%, p=0.01). Conclusion: In our multiethnic cohort of patients with SRD we found that age and multiple comorbidities such as diabetes mellitus, hypertension, obesity and coronary artery disease were associated with hospitalisation and morbidity. Disease activity and glucocorticoid use which have been shown to be associated with morbidity [1] was not seen in our cohort. The association between sulfasala-zine and poor outcomes have been reported [2] however further studies are still needed to investigate the causal relationship between the two.