scholarly journals Clinical characteristics of Chilean patients with rheumatic diseases and COVID-19: data from the Covid-19 Global Rheumatology Alliance physician-reported registry

2021 ◽  
Author(s):  
Oriela Martínez ◽  
Francisca Valenzuela ◽  
Sebastián Ibáñez
Keyword(s):  
Rheumatoid Arthritis ◽  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Clinical Characteristics ◽  
Invasive Mechanical Ventilation ◽  
List Type ◽  
Non Invasive ◽  
Rheumatic Patients

AbstractObjectiveThe coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), has registered more than 234 million confirmed cases and more than 4.7 million deaths throughout the world until October 2, 2021. During the last few months, a significant number of reports of COVID-19 in patients with rheumatic diseases have been published. In this study the objective is to report the clinical characteristics of Chilean patients with rheumatic diseases and COVID-19 reported in the “Global Rheumatology Alliance” (GRA) physician registration platform.MethodsChilean patients with rheumatic diseases and COVID-19 were included in the Covid-19 GRA physician-reported registry.Results54 patients were included. The most common primary rheumatic disease was rheumatoid arthritis (RA) with 28 cases (51.9%). 30 patients (55.6%) used corticosteroids, of which 20 (66.7%) used a dose of 10 mg or less. 33 patients (61.1%) only used conventional DMARDs, 4 (7.4%) only biological, and 6 (11.1%) the combination. A total of 35 patients (64.8%) had to be hospitalized. 2 patients (3.7%) died. 26 patients of the 35 hospitalized (74.2%) required some type of ventilatory support, of which 5 (19.2%) required non-invasive and 8 (30.8%) invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO).DiscussionMost of included Chilean rheumatic patients were hospitalized, with a low mortality rate but with a high percentage of patients requiring at least non-invasive mechanical ventilation.Key Points-The most common primary rheumatic disease was rheumatoid arthritis (RA) followed by lupus (LES)-Most of the included Chilean rheumatic patients were hospitalized, with a high percentage of patients requiring at least non-invasive mechanical ventilation, but with a low mortality rate.-Worsening of arthralgias or activation of the rheumatic disease was not reported.

scholarly journals Spectrum and Clinical Characteristics of Symptomatic and Asymptomatic Coronavirus Disease 2019 (COVID-19) With and Without Pneumonia

2021 ◽  
Vol 8 ◽  
Author(s):  
Huihui Zeng ◽  
Yiming Ma ◽  
Zhiguo Zhou ◽  
Wenlong Liu ◽  
Peng Huang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Viral Load ◽  
Clinical Characteristics ◽  
Invasive Mechanical Ventilation ◽  
The Other ◽  
Limited Information ◽  
Viral Shedding ◽  
Non Invasive ◽  
Radiologic Findings ◽  
Global Pandemic

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has become a global pandemic. Based on symptoms, COVID-19 cases can be classified as symptomatic or asymptomatic. However, there is limited information about the differences between COVID-19 patients with and without pneumonia. Our study aimed to further discuss the spectrum and clinical characteristics of symptomatic and asymptomatic COVID-19 patients with and without pneumonia.Methods: In China, all COVID-19 cases are hospitalized in designated hospitals until two continuous negative oropharyngeal swabs obtained, which allows the professional monitoring of symptoms and clinical characteristics. We stratified all COVID-19 cases in our database and evaluated clinical characteristics in different COVID-19 subgroups (symptomatic with pneumonia, symptomatic without pneumonia, asymptomatic with pneumonia, and asymptomatic without pneumonia).Results: According to symptoms and laboratory and radiologic findings, COVID-19 cases were defined as symptomatic with pneumonia, symptomatic without pneumonia, asymptomatic with pneumonia, or asymptomatic without pneumonia. There were differences in the clinical characteristics and prognosis among the four groups. Both non-invasive mechanical ventilation (18, 4.2%) and invasive mechanical ventilation (11, 2.6%) were applied in only the symptomatic with pneumonia group. Likewise, extracorporeal membrane oxygenation and continuous renal replacement therapy were applied in only the symptomatic with pneumonia group. There were no differences in viral load, the durations of viral shedding, and hospitalization among the four groups.Conclusion: We have defined a comprehensive spectrum of COVID-19 with and without pneumonia. The symptomatic with pneumonia group consumed more medical resources than the other groups, and extra caution and monitoring should be applied in this group. The asymptomatic COVID-19 group had a similar viral load and viral shedding duration as the symptomatic COVID-19 group.

scholarly journals AB0694 COVID-19 İNFECTION IN PATIENTS WITH RHEUMATIC DISEASES: TWO CENTERS EXPERIENCE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1380.1-1380
Author(s):  
A. Şahin ◽  
M. A. Gedikli ◽  
M. E. Derin ◽  
B. Karakaş ◽  
B. Karataş ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Rheumatic Disease ◽  
Autoimmune Diseases ◽  
Rheumatic Diseases ◽  
Clinical Characteristics ◽  
Normal Population ◽  
Meta Analysis ◽  
Demographic Data ◽  
Severe Disease ◽  
University Hospital

Background:Coronavirus disease 2019 (COVID-19) is a new viral infection characterized by dry cough, fever, shortness of breath, fatigue and lymphopenia. It may be complicated by interstitial pneumonia leading to severe acute respiratory distress syndrome(1). The COVID-19 outbreak has increased concerns in those with rheumatological diseases(2).Objectives:To present the clinical course of COVID-19 infection in patients with rheumatological disease and comorbid conditions of patients and drug use.Methods:70 COVID-19 patients with autoimmune and autoinflammatory rheumatic diseases over the age of 18 who were followed up in the internal diseases-rheumatology department of Sivas Cumhuriyet University Hospital and Sivas Numune Hospital between April 2020 and January 2021 were included in this study. An application was made to the ethics committee of Sivas Cumhuriyet University Hospital and approval was obtained. Demographic data, comorbidities, smoking, treatments for their diseases, symptoms and hospitalization status of the patients were evaluated.Results:The median age of the women patients was 48 years (min: 20-max: 73), 41 years in men (min: 21-max: 78). 15 patients (21.4%) were male, 55 patients (78.6%) were female. The most common rheumatic disease was rheumatoid arthritis (RA, 21, 30%) followed by ankylosing spondylitis (19, 27.1%), familial Mediterranean fever (13, 18.6%), Behçet’s disease (12, 17.1%). 22 (31.4%) patients hydroxychloroquine sulfate, 14 (20%) leflunomide, 7 (10%) patients methotrexate, 6 (8.6%) patients sulfasalazine, 10 (14.3%) patients azathioprine/mycophenolate mofetil, 22 (31.4%) patients were using colchicine. As a biological medicine; 20 (28.6%) patients were using infliximab, 5 (7.1%) patients were using adalimumab, 6 (8.6%) patients were using rituximab, and 4 (5.7%) patients were using tocilizumab. Other are summarized in Table 1. The most common comorbidities were hypertension (25.7%) and diabetes mellitus (DM 17.1%). While 56 patients (80%) had symptoms of COVID-19, 14 patients (20%) were asymptomatic. The most common symptoms was fever (32, 45.7%) followed by cough (29, 41.4%), dyspnea (28, 40%), myalgia (25, 35.7%), loss of taste and smell (18, 25.7%). 21 pneumonia cases were diagnosed. 22 (31.4%) patients were hospitalized. Mortality rate was 2/70, 2.9%. Two RA patients who just treated with rituximab and tocilizumab were died. 10 cases were using >10 mg/day prednisolone, 2 died, 8 cases were hospitalized and had severe disease. They had hypertension and DM. Characteristics of the patients are summarized in Table 2.Conclusion:The course of COVID-19 in rheumatic diseases is not clearly. Meta-analysis has shown that the frequency of COVID-19 is increased in autoimmune diseases. However, this increase was mostly associated with the use of> 10mg/day prednisolone. It has been stated that the use of biological drugs and Dmard causes the SARS-CoV 2 process with a milder course and therefore their use is safe (3). Similar results have been obtained in global registry registers (4). In our data, there was no increase in the mortality rate compared to the normal population. However, especially the use of rituximab may increase the rate of severe disease and mortality, so its use should be careful. There is a need for more comprehensive studies.References:[1]Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020.[2]N. Chen, M. Zhou, X. Dong,et al., Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study, Lancet 395 (10223) (2020) 507*513[3]Akiyama S,Hamdeh S, Micic D, et al, Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis,Ann Rheum Dis 2020 Oct 13;annrheumdis-2020-218946.[4]Gianfrancesco M, Hyrich KL, Al-Adely S,et al, Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis. 2020 Jul;79(7):859-866.Disclosure of Interests:None declared

scholarly journals Pneumococcal Burden in Hospitalized Adults in Bogotá, Colombia. 

2021 ◽  
Author(s):  
Paula Narvaez ◽  
Salome Gomez-Duque ◽  
Juan Alarcon ◽  
Paula Ramirez-Valbuena ◽  
Cristian Serrano-Mayorga ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Characteristics ◽  
Invasive Mechanical Ventilation ◽  
Geographic Location ◽  
Vaccine Uptake ◽  
Surveillance Program ◽  
Limited Data ◽  
Serotype Distribution ◽  
Non Invasive ◽  
Number Of Factors

Abstract Background: The incidence of invasive pneumococcal disease (IPD) varies depending on a number of factors, including vaccine uptake, in both children and adults, the geographic location, and local serotype prevalence. There are limited data about the burden of Streptococcus pneumoniae (Spn), serotype distribution, and clinical characteristics of adults hospitalized due to IPD in Colombia. Thus, this study will attempt to bridge this gap in the literature. Methods: This was an observational, retrospective, a citywide study conducted between 2012 and 2019 in Bogotá, Colombia. We analyzed reported positive cases of IPD from 55 hospitals in a governmental pneumococcal surveillance program. Pneumococcal strains were isolated in each hospital and typified in a centralized laboratory. The objectives of this study included assessment of Spn serotype distribution, clinical characteristics, mortality, ICU admission, and the need for mechanical ventilation. Results: A total of 310 patients with IPD were included, of whom 45.5% were female. The leading cause of IPD was pneumonia (60%, 186/310), followed by meningitis. The most frequent serotypes isolated were 19A (13.87%, 43/310) and 3 (11.94%, 37/310). The overall hospital mortality rate was 30.3% (94/310). Moreover, 52.6% (163/310 patients) were admitted to the ICU, 45.5% (141/310) required invasive mechanical ventilation and 5.1% (16/310) non-invasive mechanical ventilation. Conclusion: Pneumococcal pneumonia is the most prevalent cause of IPD, with serotypes 19A and 3 being the leading cause of IPD in Colombian adults. Mortality due to IPD in adults continues to be very high. 

Ambulatory care of non-invasive mechanical ventilation in COPD patients with global decompensated respiratory acidosis

Pneumologie ◽  
2017 ◽  
Vol 71 (S 01) ◽  
pp. S1-S125
Author(s):  
EJ Soto Hurtado ◽  
P Gutiérrez Castaño ◽  
JJ Torres ◽  
MD Jiménez Fernández ◽  
M Pérez Soriano ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Ambulatory Care ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Acidosis ◽  
Non Invasive ◽  
Copd Patients

scholarly journals P052 Leflunomide and severe COVID-19 outcome: a cautionary observation from the COVID-19 Scottish Registry of Autoimmune Rheumatic Diseases (SCAR-19)

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Maira Karabayas ◽  
James Brock ◽  
Gillian Fordyce ◽  
Neil Basu
Keyword(s):  
Rheumatic Diseases ◽  
Clinical Characteristics ◽  
National Registry ◽  
Favourable Outcome ◽  
Non Invasive ◽  
Autoimmune Rheumatic Diseases ◽  
Non Invasive Ventilation ◽  
Pcr Diagnosis ◽  
Related Symptom ◽  
Disease Modifying

Abstract Background/Aims  Leflunomide, a conventional disease modifying drug (csDMARD), is used in a variety of autoimmune rheumatic diseases (ARD) due to its immunomodulating, immunosuppressive and antiproliferative properties. This agent does however confer a greater infection risk and, due to its long half-life, drug washout procedures are often advised in the context of serious infections. Interestingly, Leflunomide is currently being tested as a potential therapy for COVID-19 in the general population. It is unknown whether leflunomide therapy is associated with a poor or favourable outcome among ARD patients infected with COVID-19. Methods  A Scottish-wide registry was rapidly developed in March 2020. Clinical characteristics and outcomes of infected cases were collated across all Scottish health boards. Eligible patients included any adult leflunomide treated ARD patients with a confirmed (clinically or PCR) diagnosis of COVID-19. Results  Of the 69 cases included in the registry, n = 4 were treated with leflunomide (75% female; mean age 61, SD 4.2). N = 2 were treated with combination baricitinib or hydroxychloroquine respectively, whilst n = 1 received recent corticosteroid therapy (intramuscular Kenalog). Comorbidities observed in this sub-cohort include diabetes mellitus n = 3, hypertension n = 2, cardiovascular disease n = 1, lung disease n = 1 and latent TB n = 1. At presentation, all patients (n = 4) experienced the established COVID-19 related symptom triad of dyspnoea, cough and fever and promptly developed acute respiratory syndrome. Diarrhoea was also recorded in n = 2 and constitutional upset n = 3. All patients suffered a serious COVID-19 disease outcome (defined as a requirement of invasive or non-invasive ventilation (n = 4) and/ or death (n = 2). P052 Table 1:Patient demographics, clinical characteristics and outcomesPatient 1Patient 2Patient 3Patient 4Age58635766SexFemaleFemaleMaleFemaleRheumatic diagnosisRheumatoid arthritisPsoriatic arthritisPsoriatic arthritisRheumatoid ArthritisComorbiditiesDiabetesHypertension Diabetes COPDNilIschaemic heart disease Hypertension Diabetes Latent TBClinical presentationDyspnoea Cough Fever Confusion Constitutional upsetDyspnoea Cough Fever Diarrhoea Constitutional upsetDyspnoea Cough Fever Constitutional upsetDyspnoea Cough Fever Diarrhoea Constitutional upsetAdditional csDMARD*NilNilNilHydroxychloroquinebDMARD**/ tsDMARD***BaricitinibNilNilNilSteroid therapyNilNilNilIM KenalogInvasive or non-invasive ventilationYesYesYesYesDeathNoNoYesYes* conventional disease modifying drug,**biologic disease modifying drug,***targeted synthetic disease modifying drug. Conclusion  Preliminary data from this Scotland-wide registry has identified only a small number of leflunomide treated ARD patients infected with COVID-19. However, it is concerning that all cases experienced a serious outcome. Given the relatively infrequent prescription of this drug, combining similar national registry data is necessary to ensure this observation is not spurious. If confirmed, leflunomide washout procedures should be encouraged among such patients when they first present with COVID-19. Disclosure  M. Karabayas: None. J. Brock: None. G. Fordyce: None. N. Basu: None.

scholarly journals SAT0589 RISK FOR PSYCHIATRIC HOSPITALIZATION FOLLOWING A RHEUMA-RELATED HOSPITALIZATION: RESULTS FROM A CZECH NATIONWIDE, COHORT STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1253.2-1254
Author(s):  
T. Formánek ◽  
K. Mladá ◽  
M. Husakova
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Ankylosing Spondylitis ◽  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Psychiatric Hospitalization ◽  
Population Based ◽  
Index Hospitalization ◽  
Increased Risk ◽  
History Of

Background:Cohort studies using nationwide health registers have shown an increased risk for affective and anxiety disorders in people with ankylosing spondylitis (AS) and rheumatoid arthritis (RA) (1-3). Moreover, a nationwide cohort study demonstrated an increased risk for mental disorders in people with rheumatic diseases (4).Objectives:We aimed to investigate the risk for psychiatric hospitalization following a hospitalization for rheumatic disease.Methods:Using data from the Czech nationwide register of all-cause hospitalizations, we obtained 4 971 individuals hospitalized (index hospitalization) between 2004 and 2012 for rheumatic diseases - RA, spondyloarthritis (including AS, psoriatic arthritis and undifferentiated spondyloarthritis), systemic lupus erythematosus and systemic sclerodermia, with no history of psychiatric and rheuma-related hospitalization in the previous 10 years from the index hospitalization. On these individuals, we randomly matched (on age, gender and year of index hospitalization) controls that were hospitalized in the same time period for a non-rheumatic disease and have no history of psychiatric and rheumatic hospitalization in the last 10 years from their index hospitalization, in the ratio of 1:5. We employed conditional logistic regression for assessing the risk for psychiatric hospitalization in the subsequent 3 years from the index hospitalization. To strengthen our results, we repeated the matching step 100 times and run the analysis on each resulting dataset separately, and pooled the results. The findings are expressed as odds ratios (OR) with 95% confidence intervals (95% CI).Results:We identified an elevated risk for psychiatric (OR = 1.34, 95% CI = 1; 1.78) and for affective disorders (OR = 2.19, 95% CI = 1.17; 4.1) in people hospitalized for rheumatic diseases. We did not find a statistically significant association with organic, psychotic and anxiety disorders.Conclusion:There is an increased risk for experiencing a psychiatric disorder in the period of 3 years after a rheuma-related hospitalization.References:[1]Shen C-C, Hu L-Y, Yang AC, Kuo BI-T, Chiang Y-Y, Tsai S-J. Risk of Psychiatric Disorders following Ankylosing Spondylitis: A Nationwide Population-based Retrospective Cohort Study. The Journal of Rheumatology. 2016;43(3).[2]Park J-S, Jang H-D, Hong J-Y, Park Y-S, Han K, Suh S-W, et al. Impact of ankylosing spondylitis on depression: a nationwide cohort study. Scientific Reports. 2019;9(1):6736.[3]Hsu C-C, Chen S-C, Liu C-J, Lu T, Shen C-C, Hu Y-W, et al. Rheumatoid Arthritis and the Risk of Bipolar Disorder: A Nationwide Population-Based Study. PLOS ONE. 2014;9(9).[4]Sundquist K, Li X, Hemminki K, Sundquist J. Subsequent Risk of Hospitalization for Neuropsychiatric Disorders in Patients With Rheumatic Diseases: A Nationwide Study From Sweden. Archives of General Psychiatry. 2008;65(5):501-7.Acknowledgments:Supported by the project (Ministry of Health Czech Republic) for conceptual development of research organization 00023728 (Institute of Rheumatology).Disclosure of Interests:Tomáš Formánek: None declared, Karolina Mladá: None declared, Marketa Husakova Speakers bureau: Novartis

scholarly journals FRI0443 CLINICAL CHARACTERISTICS AND RELATED FACTORS OF COMMON RHEUMATIC DISEASES COMPLICATED WITH TUBERCULOSIS INFECTION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 819.1-819
Author(s):  
L. Long ◽  
G. Tang ◽  
Y. Han ◽  
Q. Peng ◽  
J. Liu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Weight Loss ◽  
Risk Factor ◽  
High Risk ◽  
Rheumatic Diseases ◽  
Clinical Characteristics ◽  
Control Group ◽  
Average Dose ◽  
Systemic Lupus ◽  
Infection Group

Background:Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and syndrome(SS) are common rheumatic diseases with high incidence. Patients with those rheumatic diseases are at high risk of tuberculosis (TB) infection. However, manifestations can be atypical and easily confused with those of rheumatic disease itself. For those patients, diagnosis is usually much more difficult and further make treatment delayed. Sometimes it may lead to mistreatment. Therefore, it is important to recognize the clinical characteristics of those patients.Objectives:To explore the clinical characteristics and high risk factors of common systemic rheumatism complicated with tuberculosis infection.Methods:A total of 3,906 cases of RA, SLE, and SS common systemic rheumatism diagnosed in the People’s Hospital of Sichuan Province from January 2007 to January 2017 were collected with carefully exclusion with other infectious diseases and neoplastic disease. One hundred and five patients with TB were included as infection group, including 42 cases of RA, 41 cases of SLE, and 22 cases of SS. In the control group, 84 patients with RA, 82 patients with SLE, and 44 patients with SS were randomly selected from the corresponding rheumatoid non-infected patients hospitalized during the same period.Results:Fever was the most common symptom among 42 cases of RA, 41 cases of SLE, and 22 cases of SS with TB, accounting for 83.3%, 92.7%, and 68.2%, respectively. Cough, weight loss or fatigue was less common. For 41 cases of SLE and 22 cases of SS with TB, the proportion of pulmonary was 46.3%, 59.01%, respectively.In TB infection group, 27 cases of RA, 21 cases of SLE, and 13 cases of SS with TB had two or more chest CT findings, accounting for 59%, 57%, 62%, respectively. Lesions located in the posterior or posterior segment which TB usually affected were 9 cases(33.3%),9cases(42.9%),6cases(27.2%),respectively.The daily average dose of hormones within 1 year in TB infection group was higher than that in the control group (P<0.05). For SLE patients, lower counts of CD4+TL were found in TB infection group (P<0.05), while no such differences were found in RA and SS group.Conclusion:Patients with RA who have TB infection are mainly pulmonary TB. For SLE and SS patients, the chance of pulmonary tuberculosis and extra-pulmonary tuberculosis is similar.Symptoms of RA, SLE, SS with TB, such as fever, cough, weight loss, fatigue, are similar with the primary disease or other infection. Chest imaging is diversity. It is difficult to diagnose.Daily average dose of hormone within one year may be a common risk factor for RA, SLE and SS patients with TB. Decreased CD4+TL may also be a risk factor for SLE patients with TB.References:[1]Cantini F, Nannini C, Niccoli L, et al. Risk of Tuberculosis Reactivation in Patients with Rheumatoid Arthritis, Ankylosing Spondylitis, and Psoriatic Arthritis Receiving Non-Anti-TNF-Targeted Biologics[J]. Mediators of Inflammation, 2017, 2017(6):1-15.[2]Ruangnapa K, Dissaneewate P, Vachvanichsanong P. Tuberculosis in SLE patients: rare diagnosis, risky treatment.[J]. Clinical & Experimental Medicine, 2015, 15(3):429-432.[3]Manuela D F, Bruno L, Martina S, et al. Lung Infections in Systemic Rheumatic Disease: Focus on Opportunistic Infections[J]. International Journal of Molecular Sciences, 2017, 18(2):293-315.[4]Disseminated tuberculosis masquerading as a presentation of systemic lupus erythematosus.Li JC, Fong W, Wijaya L, Leung YY.Int J Rheum Dis. 2017 Oct 2. doi: 10.1111/1756-185X.13195.[5]Handa R, Upadhyaya S, Kapoor S, et al. Tuberculosis and biologics in rheumatology: India – A special situation[J]. International Journal of Rheumatic Diseases, 2017, 51(2):115.Disclosure of Interests:None declared

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