Prevalence and outcomes of COVID-19 infection among patients with autoimmune rheumatic disease -Single center experience

ABSTRACT

Background and Objective: This study describes the prevalence, characteristics, and outcomes of COVID-19 infection among patients with autoimmune rheumatic diseases (AIRD) seen in a tertiary hospital in Manila, Philippines. Method(s) This cross sectional study included patients diagnosed with AIRD seen over a 24-month period from March 2020 to February 2022 confirmed with COVID-19 infection. We collected data from patients' electronic records, clinic and hospital charts and analyzed underlying AIRD characteristics including disease activity, medications, severity, and outcomes including hospitalization and mortality. Result(s) Of the 565 patients with AIRD, 67 patients reported to be positive for COVID-19. The most common underlying AIRD was systemic lupus erythematosus (SLE) in 53 patients followed by rheumatoid arthritis and dermatomyositis. Cough, fever, dyspnea, diarrhea, anosmia, ageusia and sore throat were the common presenting symptoms. Three were asymptomatic, 52 had mild symptoms, 3 patients had moderate and 9 had severe COVID-19 infection. Nineteen patients (28%) were subjected to hospitalization and admission and 48 (72%) were confined at home or in an isolation facility. Use of methotrexate, mycophenolate mofetil, prednisone <10 mg/day and hydroxychloroquine did not affect the risk for moderate to severe COVID-19 infection, hospitalization and mortality. However, the use of azathioprine increases the risk for moderate to severe COVID-19 infection but not for hospitalization and mortality. Four (6%) patients died of severe COVID-19 pneumonia an elderly rheumatoid arthritis patient with co-morbidity of asthma, a lupus nephritis patient with end stage renal disease on hemodialysis, another lupus nephritis patient with malignancy who underwent radiotherapy and lastly, a patient with overlap dermatomyositis and SLE with restrictive lung disease due to severe dextroscoliosis. Conclusion(s) This single-center experience on AIRD patients with COVID-19 infection showed that patients with active disease, co-morbidities, especially lung diseases, and use of high dose glucocorticoid had higher risk for moderate to severe COVID-19 infection, hospitalization and mortality.