Role of targeted therapies in rheumatic patients on COVID-19 outcomes: results from the COVIDSER study

ObjectivesTo analyse the effect of targeted therapies, either biological (b) disease-modifying antirheumatic drugs (DMARDs), targeted synthetic (ts) DMARDs and other factors (demographics, comorbidities or COVID-19 symptoms) on the risk of COVID-19 related hospitalisation in patients with inflammatory rheumatic diseases.MethodsThe COVIDSER study is an observational cohort including 7782 patients with inflammatory rheumatic diseases. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Antirheumatic medication taken immediately prior to infection, demographic characteristics, rheumatic disease diagnosis, comorbidities and COVID-19 symptoms were analysed.ResultsA total of 426 cases of symptomatic COVID-19 from 1 March 2020 to 13 April 2021 were included in the analyses: 106 (24.9%) were hospitalised and 19 (4.4%) died. In multivariate-adjusted models, bDMARDs and tsDMARDs in combination were not associated with hospitalisation compared with conventional synthetic DMARDs (OR 0.55, 95% CI 0.24 to 1.25 of b/tsDMARDs, p=0.15). Tumour necrosis factor inhibitors (TNF-i) were associated with a reduced likelihood of hospitalisation (OR 0.32, 95% CI 0.12 to 0.82, p=0.018), whereas rituximab showed a tendency to an increased risk of hospitalisation (OR 4.85, 95% CI 0.86 to 27.2). Glucocorticoid use was not associated with hospitalisation (OR 1.69, 95% CI 0.81 to 3.55). A mix of sociodemographic factors, comorbidities and COVID-19 symptoms contribute to patients’ hospitalisation.ConclusionsThe use of targeted therapies as a group is not associated with COVID-19 severity, except for rituximab, which shows a trend towards an increased risk of hospitalisation, while TNF-i was associated with decreased odds of hospitalisation in patients with rheumatic disease. Other factors like age, male gender, comorbidities and COVID-19 symptoms do play a role.

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AB0699 RETROSPECTIVE ANALYSIS OF 52 SARS-COV2 POSITIVE PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASE: A SINGLE CENTER EXPERIENCE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3672 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1382.1-1382

Author(s):

Y. Karabulut

Keyword(s):

Rheumatic Disease ◽

Rheumatic Diseases ◽

Organ Involvement ◽

Inflammatory Rheumatic Diseases ◽

Tnf Inhibitor ◽

Single Center ◽

Difficult Situation ◽

Inflammatory Rheumatic Disease ◽

Increased Risk ◽

Synthetic Dmards

Background:It is a generally accepted opinion that autoimmune and inflammatory rheumatic diseases or drugs used in the treatment of these conditions increase the risk of infection. During the pandemic period, the follow-up and treatment of patients who were diagnosed with rheumatic disease and used corticosteroid, immunosuppressive, biological or synthetic DMARDs and disease management during sars-cov2 infection still remain a problem.Objectives:In this study, it was aimed to share the demographic data of 52 patients with inflammatory rheumatic disease diagnosed with SARS-COV2 who were followed up and treated in the Rheumatology Department of Private Doruk Hospital during the SARS-COV2 pandemic. Additionally, it is aimed to examine the primary rheumatological diseases of the patients, their biological and conventional DMARD treatments, their comorbidities and the course of SARS-COV2.Methods:Fifty-two patients who were diagnosed with SARS-COV2 by PCR method while being followed up and treated in the rheumatology center between May 2020 and November 2020 and get COVID treatment in the same center were included in the study. All patients diagnosed with SARS-COV2 and required hospitalization were hospitalized in the same center and followed up and treated. The files and electronic records of the patients were retrospectively recorded by the rheumatologist who followed the patients.Results:In this retrospective study conducted from a single center, 52 patients whose diagnosis of SARS-COV2 was confirmed by PCR were included. Distribution of primary rheumatic diseases of the patients; 19 rheumatoid arthritis (RA), 14 Ankylosing spondylitis (AS), 4 Psoriatic Arthritis (PsA), 4 Systemic lupus erythematosus (SLE), 5 Behcet’s Disease (BD), 4 Familial Mediterranean Fever (FMF), 2 Sjögren’s syndrome. 76.8% of the patients were female, 22.2% male, their mean age was 47 ± 18. Biological drug use rate of 37 patients in RA, AS and PsA groups was 83.7% (monotherapy or combination 31/37).Moreover, 16.2% (6/37) of the patients were using synthetic DMARD combination (MTX+SLZ +HCQ) and 40.5% (15/37) of the patients were using a combination of biological and synthetic DMARDs. While 73% (38/52) of 52 patients had a mild course, 27% (14/52) had severe SARS-COV2 requiring hospitalization. 14 patients who had severe SARS-COV2 infection and required hospitalization, 10 were followed up with the diagnosis of RA, 2 with AS and 2 with SLE. Hospitalization of patients using monotherapy biological drugs (TNF inhibitor, Tocilizumab, IL 17-A) due to severe SARS-COV2 was found to be lower than the group using combined synthetic DMARDs with steroids (MTX+SSZ+HCQ) (p <0.05). The corticosteroid dose of the RA patients was in the range of 5-10 mg/day. The rate of having severe SARS-COV2 was found to be higher in the combination group using biological or synthetic DMARD and low dose corticosteroids compared to group using monotherapy biologicals (p <0.05). The rate of having severe SARS-COV2 was found to be significantly higher in the group using 10/mg or more at the time of diagnosis (p <0.05). Two patients with SLE multiple organ involvement had severe SARS-COV2 while using rituximab, and hospitalization was required. In terms of comorbidities, hypertension was the most common comorbidity with 64.2% (9/14) in the group with severe SARS-COV2, followed by obesity with 21.4% (3/14).Conclusion:In patients with inflammatory rheumatic disease, SARS-COV-2 infection and the drugs used for the treatment of primary disease are still considered to be a difficult situation in terms of prognosis. In our study with limited cases, data suggesting that there is no increased risk of SARS-COV2 requiring hospitalization in patients using TNF inhibitors, tocilizumab and IL17-A blockers. It was thought that there might be a drug-induced increased risk due to the severe SARS-COV2 infection that developed in our two patients who used rituximab, but the disease-related risk increase was not ignored because the patients were SLE patients with active multi-organ involvement.Disclosure of Interests:None declared

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Does COVID-19 cause an increased risk of hospitalization or death in patients with inflammatory rheumatic diseases treated with biological DMARDs or targeted synthetic DMARDs?

Rheumatology Advances in Practice ◽

10.1093/rap/rkaa061 ◽

2020 ◽

Vol 4 (2) ◽

Cited By ~ 1

Author(s):

May Lwin ◽

Christopher Holroyd ◽

Dinny Wallis ◽

Brian Davidson ◽

Lyndsey Goulston ◽

...

Keyword(s):

Rheumatic Diseases ◽

Inflammatory Rheumatic Diseases ◽

Biological Dmards ◽

Increased Risk ◽

Synthetic Dmards

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Should Patient with Autoimmune Inflammatory Rheumatic Diseases (AIIRD) be vaccinated with COVID-19 Vaccines?

Indonesian Journal of Rheumatology ◽

10.37275/ijr.v13i1.167 ◽

2021 ◽

Vol 13 (1) ◽

pp. 492-503

Author(s):

Cesarius Singgih Wahono ◽

Perdana Aditya ◽

Faisal Parlindungan ◽

RM. Suryo Anggoro KW ◽

Anna Ariane ◽

...

Keyword(s):

Side Effects ◽

Rheumatic Disease ◽

Rheumatic Diseases ◽

Live Vaccine ◽

Inflammatory Rheumatic Diseases ◽

Inflammatory Rheumatic Disease ◽

Important Measure ◽

Increased Risk

Vaccination is a very important measure for the prevention of various infections worldwide including the recent COVID-19 disease. However, until now the COVID-19 vaccine with various platforms has not been clinically tested on autoimmune inflammatory rheumatic disease (AIIRD) patients, due to caution against possible side effects and unknown efficacy. Several recent studies proved that there is increased risk of SARS-CoV-2 infection in AIIRD patients and moreover, those patients also have worse COVID-19 outcomes. Thus, patients with AIIRD should be prioritized for vaccination because they have an increased burden of infections, including COVID-19. Many studies showed that inactivated/non-live vaccine is safe for AIIRD patients and do not cause disease exacerbations. We conclude that benefits of vaccination greatly outweigh the risks of infection and therefore, COVID-19 vaccines can also be administered safely in stable AIIRD patients.

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

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3719 ◽

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

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The Effect of Obesity and Other Factors towards On the Increased Risk of Rheumatism in Indonesia (Analysis of IFLS 2014)

Jurnal Ilmu Kesehatan Masyarakat ◽

10.26553/jikm.2021.12.1.77-87 ◽

2021 ◽

Vol 12 (1) ◽

pp. 77-87

Author(s):

Nuraini Nuraini ◽

Amrina Rosyada

Keyword(s):

Rheumatic Disease ◽

Rheumatic Diseases ◽

Cross Sectional Study ◽

Sample Survey ◽

Healthy Lifestyles ◽

Sectional Study ◽

Cross Sectional ◽

Increased Risk ◽

Gender Education ◽

Complex Sample

The number of people with rheumatism worldwide has reached 355 million, and this is estimated by 2025, suggesting that more than 25% will experience paralysis. This study aims to determine obesity and other factors related to the increased risk of rheumatic diseases in Indonesia, the method used was data analysis using a complex sample survey. It used 2014 IFLS data and a cross sectional study design, as well as a multistage random sampling with a total of 29,106 respondents, and the results showed that the prevalence of rheumatic disease in Indonesia was 5.2% in 2014. The most dominant and unmodifiable variable that influenced incidence was gender (PR=1.686; 95% CI=1.488-1.910). Meanwhile, obesity is the most dominant and modifying variable that influences the incidence of rheumatic disease (PR=1.630; 95% CI=1.433-1.855). Factors that are simultaneously related to the increased risk of rheumatic diseases include age, gender, education, physical activity, protein consumption, obesity, and accident history. Considering the results, patients need to eat healthy and low purine foods, as well as implementing other healthy lifestyles such as appropriate, adequate, and regular physical activities in order to reduce the risk of rheumatism.

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Comorbidities of rheumatic disease

10.1093/med/9780199642489.003.0032 ◽

2013 ◽

Cited By ~ 1

Author(s):

Tuulikki Sokka ◽

Kari Puolakka ◽

Carl Turesson

Keyword(s):

Rheumatic Disease ◽

Rheumatic Diseases ◽

Health Professionals ◽

Physical Inactivity ◽

Organ Damage ◽

Inflammatory Rheumatic Diseases ◽

Rheumatology Clinic ◽

Cholesterol Levels ◽

Lifestyle Choices ◽

The Impact

All other diseases that coexist with a disease of interest are called comorbidities. Comorbidities in inflammatory rheumatic diseases may be associated with persistent inflammatory activity or disease-related organ damage, or may be related to medications. Lifestyle choices such as smoking or physical inactivity contribute to comorbidity. Patients with rheumatic diseases meet health professionals regularly and are more often tested for osteoporosis or cholesterol levels than individuals without rheumatic disease, which may contribute to a higher prevalence of some comorbidities. Comorbidities can also be unrelated to rheumatic diseases or their treatments. In this chapter, we discuss the impact of comorbidities to the patient. We emphasize the importance to review and manage comorbidities in usual daily rheumatology clinic, to improve outcomes of patients with rheumatic diseases.

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Features of inflammatory rheumatic diseases treatment in older people

Russian Journal of Geriatric Medicine ◽

10.37586/2686-8636-3-2021-319-331 ◽

2021 ◽

pp. 327-339

Author(s):

A. D. Meshkov ◽

V. S. Ostapenko

Keyword(s):

Older People ◽

Rheumatic Diseases ◽

Treatment Options ◽

Interdisciplinary Approach ◽

Immunosuppressive Drugs ◽

Inflammatory Rheumatic Diseases ◽

Synthetic Drugs ◽

Iatrogenic Complications ◽

Increased Risk ◽

The One

Currently the number of older people with chronic rheumatic diseases is increasing. Distinctive features of this population are the increased risk of cardiovascular and infectious diseases, tumours, as well as iatrogenic complications, while this group of patients is rather heterogeneous. On the one hand, modern biological and targeted synthetic drugs, provide new, previously inaccessible, treatment options; on the other hand, their use is associated with risk of side effects. In this review specifics of prescribing immunosuppressive drugs in older patients with rheumatoid arthritis and spondyloarthritis has been analyzed. An effective and safe approach to the use of these drugs in older people can be based on a comprehensive interdisciplinary approach, taking into account geriatric characteristics of the patients.

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Comorbidities of rheumatic disease

10.1093/med/9780199642489.003.0032_update_001 ◽

2015 ◽

Author(s):

Tuulikki Sokka ◽

Kari Puolakka ◽

Carl Turesson

Keyword(s):

Rheumatic Disease ◽

Rheumatic Diseases ◽

Health Professionals ◽

Physical Inactivity ◽

Organ Damage ◽

Inflammatory Rheumatic Diseases ◽

Rheumatology Clinic ◽

Cholesterol Levels ◽

Lifestyle Choices ◽

The Impact

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Increased risk for severe COVID-19 in patients with inflammatory rheumatic diseases treated with rituximab

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-218075 ◽

2020 ◽

pp. annrheumdis-2020-218075 ◽

Cited By ~ 19

Author(s):

Hendrik Schulze-Koops ◽

Klaus Krueger ◽

Inka Vallbracht ◽

Rebecca Hasseli ◽

Alla Skapenko

Keyword(s):

Rheumatic Diseases ◽

Inflammatory Rheumatic Diseases ◽

Increased Risk

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Comorbidities of rheumatic disease

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0032_update_002 ◽

2013 ◽

pp. 243-250

Author(s):

Tuulikki Sokka ◽

Kari Puolakka ◽

Carl Turesson

Keyword(s):

Rheumatic Disease ◽

Rheumatic Diseases ◽

Health Professionals ◽

Organ Damage ◽

Inflammatory Rheumatic Diseases ◽

Rheumatology Clinic ◽

Cholesterol Levels ◽

Lifestyle Choices ◽

The Impact ◽

Index Disease

All other diseases that coexist with a disease of interest are called comorbidities. Comorbidities in inflammatory rheumatic diseases may be associated with persistent inflammatory activity or disease-related organ damage, or may be related to medications. Lifestyle choices such as smoking or physical inactivity contribute to comorbidity. Patients with rheumatic diseases meet health professionals regularly and are more often tested for osteoporosis or cholesterol levels than individuals without rheumatic disease, which may contribute to a higher prevalence of some comorbidities. Comorbidities can also be unrelated to rheumatic diseases or their treatments. The concept of ‘multimorbidity’ is being used increasingly, shifting the focus from the index disease to two or more chronic diseases that exist in the same individual. In this chapter, we discuss the impact of multi/comorbidities. We emphasize the importance to review and manage comorbidities in usual daily rheumatology clinic, to improve outcomes of patients with rheumatic diseases.

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