Prevalence of dry mouth in COVID-19 patients with and without Sicca syndrome in a large hospital center

Abstract Background Given that IBD patients were excluded from COVID-19 vaccine trials, there is a lack of vaccine efficacy data in this population. In this study, we evaluated longitudinal serological responses to SARS-CoV-2 infection as well as to COVID-19 vaccination in IBD patients. Methods We collected clinical data and sera from IBD patients enrolled in an observational SARS-CoV-2 sero-surveillance study at our large hospital center in New York City during routine infusions and clinic visits. To distinguish between infection and vaccination, sera was collected prior to vaccination where possible, and all sera was tested for both antibodies to SARS-CoV-2-specific RBD, the target of current available vaccines in the U.S., and nucleocapsid proteins. Results Our results reveal waning antibody titres in 13 of 16 (81%) patients infected with SARS-CoV-2 over a course of 6-7 months. Of 48 vaccinated patients, 16 patients completed vaccine schedules with two doses, and all 16 (100%) achieved seroconversion above the threshold required for convalescent plasma donation. Conclusion While antibody responses to infection in IBD patients have questionable stability, completion of the COVID-19 vaccine series in IBD patients results in robust serological responses. To our knowledge is the first data confirming adequate serological responses to COVID-19 vaccination in IBD patients with and without biologic medications. Studies are needed to assess adequacy of dosing schedules, medication effects, measurement of cell-mediated responses, durability of immune responses, and clinical efficacy of COVID-19 vaccines in IBD patients.

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EP33 Pronounced dys-autonomic symptoms announcing a primary Sjögren’s syndrome

Rheumatology ◽

10.1093/rheumatology/keaa109.032 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Francesco Masini ◽

Klodian Gjeloshi ◽

Fiammetta Danzo ◽

Emanuele Pinotti ◽

Lucio Monaco ◽

...

Keyword(s):

Blood Pressure ◽

Orthostatic Hypotension ◽

Autonomic Neuropathy ◽

Sinus Bradycardia ◽

Primary Sjögren’S Syndrome ◽

Sicca Syndrome ◽

Dry Mouth ◽

Primary Sjogren’S Syndrome ◽

Autonomic Symptoms ◽

History Of

Abstract Background Sjogren syndrome (SS) is an autoimmune disease which involves the nervous system in about 20% of SS cases, whilst in 25-92% neurological symptoms may precede the onset of sicca syndrome. Methods A 65-year-old male came to our observation due to a 7-month history of near-syncope episodes, constipation, hypohidrosis, fatigue and asthenia. Past history revealed hypothyroidism due to Hashimoto's thyroiditis, under treatment with levothyroxine. Physical examination showed: temperature 36.5 °C, blood pressure 90/60 mmHg and respiration rate 20 breaths per minute. The ECG revealed sinus bradycardia with 55 beats per minute (bpm) and right bundle-branch block (RBBB). Laboratory exams showed: lymphocytopenia (WBC 9008/μL, with 90% granulocytes and 3% lymphocytes); CRP (0.3 mg/dL), ESR (20mm/hr). In order to investigate endocrine disorders, hormone tests were also performed, showing: euthyroidism (FT3 2.0 pg/mL, FT4 12.6 pg/mL, TSH 1.685 µUI/mL, Ab anti-thyroglobulin 1630.0 UI/mL, Ab anti-thyreoperoxidase 592.5 UI/mL), hypogonadotropic hypogonadism (LH 1.6 mIU/mL, FSH 2.7 mIU/mL, prolactin 15.9 ng/mL, testosterone 133 ng/dL) and normal adrenocortical function (serum cortisol 8 am 17.5 µg/dL, aldosterone 6.8 pg/dL, ACTH 8.5 pg/mL). Brain-MRI showed anterior pituitary hypoplasia. Results In order to assess a potential autonomic neuropathy, deep breathing test (E/I 1.02) , lying to standing test (R/R’ 0.95) and orthostatic hypotension tests (at 120 seconds systolic reduction was >20 mmHg and diastolic reduction >10 mmHg) were performed, all resulting pathological. ECG Holter monitoring revealed sinus bradycardia, with a mean heart rate of 55 bpm and RBBB. Holter blood pressure 24-hour monitoring showed a diurnal hypotensive profile. The echocardiogram revealed a mild mitral and tricuspid insufficiency. A paraneoplastic syndrome was also excluded by total body-CT with mean of contrast and tumor markers, which resulted normal. On a further assessment, the patient reported a 3-month history of worsening dry mouth and persistent dehydrated tongue. Signs of anisocoria in response to light stimulation, were observed as well. Tests for autoimmune diseases showed ANA (1:320 speckled pattern), Ro/SS-a (>240U/l) and La/SS-b (162 U/ml) antibodies. Though symptoms such as dry eyes were not reported, “Shirmer test” revealed an insufficient tear production in both eyes (RE 5 mm, LE 3 mm). The patient was discharged with the diagnosis of autonomic neuropathy most likely due to primary Sjögren’s syndrome and started therapy with Prednisone 25 mg/die and Hydroxychloroquine 200 m/bid o.d. After one month, he reported a significant improvement in symptoms such as asthenia, fatigue and dry mouth. Orthostatic hypotension symptoms were also significantly decreased and no further near-syncopal events occurred. Conclusion This case underlines the clinically importance of dys-autonomic symptoms, antecedent to the onset of sicca syndrome, and highlights the favorable response to immune-modulating therapy in the treatment of autonomic dysfunction arising from SS. Disclosures F. Masini None. K. Gjeloshi None. F. Danzo None. E. Pinotti None. L. Monaco None. G. Cuomo None.

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