Epidemiological characteristics and outcomes of SARS-CoV-2 infection in patients with rheumatic diseases: first report from the Argentine SAR-COVID registry

In order to assess the impact of SARS-CoV-2 infection in patients with rheumatic diseases, the Argentine Society of Rheumatology has developed the National Registry of Patients with Rheumatic Diseases and COVID-19 (SAR-COVID). The aim of this study was to evaluate the sociodemographic and clinical characteristics of patients with rheumatic diseases and SARS-CoV-2 infection included in the SAR-COVID registry and to describe the complications and outcomes of COVID-19 in this population. Methods: SAR-COVID is a national, multicenter and observational registry, in which patients ≥18 years of age, with a diagnosis of a rheumatic disease who had SARS-CoV-2 infection are consecutively included. Sociodemographic data, comorbidities, underlying rheumatic disease and treatment, clinical characteristics, complications, laboratory and treatment of the SARS-CoV-2 infection were recorded. Results: a total of 525 patients were included, with a mean age of 51.3 years (SD 15.2). The most frequent rheumatic diseases were rheumatoid arthritis (40.4%), systemic lupus erythematous (14.9%) and spondyloarthritis (8.2%). At the time of the infection, 72.9% were receiving immunosuppressive or immunomodulatory treatment and 36.9% glucocorticoids. Most of the patients were diagnosed using RT-PCR (95%), at outpatient consultation (39.4%), at the emergency room (32.2%) or during hospitalization (14.7%). Symptoms were present in 96% of the patients, the most frequent being fever (56.2%), cough (46.7%) and headache (39.2%). During infection, 35.1% were hospitalized, 11.6% were admitted to the ICU and 6.9% died due to COVID-19. Most of them (75.1%) recovered completely. Conclusions: in this first report of the SAR-COVID registry we found a wide distribution of rheumatic diseases. Most of the patients had a good evolution of the infection, however 7% died as a result of it, comparable to other Latin American registries with similar populations.

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

Rheumatology ◽

10.1093/rheumatology/keab247.049 ◽

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.

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OP0097 LISTERIA MONOCYTOGENES. DESCRIPTION AND ANALYSIS OF CASES IN AN IMMUNODEPRESSED POPULATION BY RHEUMATIC DISEASES

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4282 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 53.2-54

Author(s):

M. Lisbona Muñoz ◽

P. León ◽

G. Lopez Antequera ◽

E. Rubio-Romero

Keyword(s):

Listeria Monocytogenes ◽

Rheumatic Disease ◽

Pregnant Women ◽

Rheumatic Diseases ◽

Case Series ◽

Similar Proportion ◽

Neurological Manifestations ◽

Biological Dmards ◽

Parametric Data ◽

The Impact

Background:Listeria monocytogenes is a gram-positive bacteria that cause the invasive disease listeriosis. Human clinical syndromes are infrequent, mostly appearing in immunosuppressed individuals, newborns, the elderly, pregnant women, and occasionally healthy patients.Objectives:We describe and analyze Listeria-related demographics and clinical features to determine the predisposing conditions for severe infections in an immunodepressed population by rheumatic diseases.Methods:Descriptive Observational Study. A retrospective analysis of 143 patients were performed affected by listeriosis, with positive isolation of Listeria monocytogenes from blood, treated in the H.U. Virgen del Rocío (Seville- Spain) between 2003-2019. Of them 9 were rheumatic patients. The type of clinical manifestation was analyzed, paying special attention to the characteristics associated with patients with neurological complications or unfavorable outcome (death and / or abortion in pregnant women), immunosuppression (associated with cancer or rheumatic disease) was assessed as independent variables, chronic diseases (Hypertension, Diabetes Mellitus, dyslipidemia, COPD, Renal Insufficiency and Ischemic Heart Disease) as well as other baseline characteristics of the patient. (age, sex, pregnancy) and their toxic habits (tobacco and alcohol).Results:The sample includes a similar proportion of men (70 cases) and women (73 cases), of all ages. Of the total patients, most (85%) required hospital admission, with a duration median (non-parametric data) of 11 days. 78% of the cases admitted showed a favorable evolution. However, 15.4% resulted in death and 5.6% in abortion. This percentage of abortions represented 29% of the total pregnant women admitted Of all the patients admitted, a third (33%) were immunocompromised, including patiets with cancer (79%) and rheumatic diseases (21%). Include lupus (33%), RA (22%), APs (11%), polymyalgia rheumatica (11%), panuveitis (11%) and ANCA vasculitis MPO specificity (11%). All of them required admission although the majority showed a favorable evolution, except one of the patient. which resulted in death, in which case in addition to lupus he presented with prostate cancer. Regarding the baseline treatment of these patients, 7 underwent treatment with synthetic DMARDs and three with biological DMARDs (1 Adalimumab, 1 Infliximab and 1 Rituximab) As a result of the listeria infection, most of them had fever or digestive symptoms and two of they experienced neurological manifestations (meningoencephalitis) None of these last two (with lupus and RA) had biological DMARDs.Conclusion:Listeriosis is an uncommon but potentially serious infection usually in older people, pregnant women and immunocompromised patients. In our sample, 33% of the patients were immunocompromised. Of the 9 patients. affected by listeria with rheumatic disease we find a death for meningoencephalitis. Given the impact of this infection in immunosuppressed patients should pay attention in our patients with fever and neurological manifestations.Reference:[1]Eleftherios Mylonakis et al. A Case Series and Review of 222 Cases. Medicine 2002; 81: 260-269.[2]Alcoba Lez M et al.Meningitis por Listeria monocytogenes en el adulto en España. Presentación de 10 casos y revisión de la literatura. Rev Clin Esp 2002; 202 (12): 638-643.[3]Eleftherios Mylonakis et al. Central Nervous Sistem Infection with Listeria monocytogenes. 33 Years’ Experience at a General Hospital and Review of 776 Episodes from tha Literature. Medicine 1998; 77: 313-336.Disclosure of Interests:None declared

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

10.1101/2021.12.07.21267429 ◽

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.

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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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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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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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Characteristics associated with Covid-19 in patients with Rheumatic Disease in Latin America: data from the Covid-19 Global Rheumatology Alliance physician-reported registry

Global Rheumatology ◽

10.46856/grp.10.e003 ◽

2020 ◽

Author(s):

Manuel F. Ugarte-Gil ◽

Claudia D. L. Marques ◽

Deshire Alpizar-Rodriguez ◽

Guillermo J. Pons-Estel ◽

Daniel Xibille-Friedmann ◽

...

Keyword(s):

Latin America ◽

Rheumatic Disease ◽

Latin American ◽

Rheumatic Diseases ◽

Lupus Erythematosus ◽

Ventilatory Support ◽

Invasive Ventilation ◽

Non Invasive ◽

The World ◽

Chi Squared

Objective: To compare the characteristics of patients with rheumatic diseases and COVID-19 reported from Latin American countries with those from the rest of the world. Methods: Patients from the COVID-19 Global Rheumatology Alliance Physician-Reported Registry were included. Details regarding demographics, rheumatic disease features, comorbidities, COVID-19 diagnosis and treatment, and outcomes were examined. Chi-squared and t-tests were used to compare associations between groups (Latin America vs. rest of the world). Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of hospitalization (yes/no) and ventilatory support (not hospitalized or supplementary oxygen only vs. non-invasive, invasive ventilation, or ECMO); Poisson models were used to estimate ORs and 95% CIs of mortality. Results: Seventy-four patients from Latin America and 583 patients from the rest of the world were included. The most frequent rheumatic diseases in both groups were rheumatoid arthritis (35% and 39%, respectively) and systemic lupus erythematosus (22% and 14% respectively). Mortality was similar between groups (12% Latin America vs 11% rest of the world, p=0.88. However, Latin American patients in the registry had a higher odds of requiring non-invasive or invasive ventilation, after adjustment [OR= 2.29, 95%CI (1.29, 4.07), p less than 0.01].. Conclusion: Latin American patients with rheumatic disease and COVID-19 reported to this global registry presented a higher need for ventilatory support, however experienced a similar mortality than patients from the rest of the world.

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Clinical Characteristics ofNocardiaInfection in Patients with Rheumatic Diseases

Clinical and Developmental Immunology ◽

10.1155/2013/818654 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

Mieko Yamagata ◽

Koichi Hirose ◽

Kei Ikeda ◽

Hiroshi Nakajima

Keyword(s):

Risk Factors ◽

Rheumatic Disease ◽

Rheumatic Diseases ◽

Medical Records ◽

Clinical Characteristics ◽

Mortality Rates ◽

Pulmonary Diseases ◽

High Dose ◽

Glucocorticoid Treatment ◽

Pulmonary Lesions

AlthoughNocardiosishas considerable recurrence and mortality rates, characteristics and risk factors ofNocardiainfection have not been assessed in patients with rheumatic diseases. Here, we examined the characteristics and risk factors ofNocardiainfection in rheumatic disease patients in our hospital. Ten rheumatic disease patients who developedNocardiainfection were identified by retrospectively reviewing the medical records. Possible predisposing factors forNocardiainfection were high-dose glucocorticoid treatment, concomitant use of immunosuppressants, preexisting pulmonary diseases, and diabetes mellitus. All patients had pulmonaryNocardiosis, and six of them had disseminatedNocardiosiswhen their pulmonary lesions were identified.

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EP09 COVID-19 and rheumatic disease clinical characteristics and outcomes of rheumatic disease patients hospitalised with COVID-19: a single centre experience

Rheumatology Advances in Practice ◽

10.1093/rap/rkaa052.008 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Myrto Cheila ◽

Ali Elrashid ◽

Nicola Erb ◽

Karen Douglas ◽

Christos Koutsianas

Keyword(s):

Case Report ◽

Rheumatic Disease ◽

Rheumatic Diseases ◽

Clinical Characteristics ◽

Fatal Outcome ◽

Previous History ◽

True Incidence ◽

Viral Spread ◽

Increased Risk ◽

History Of

Abstract Case report - Introduction There is limited evidence on the outcomes of COVID-19 in patients with rheumatic diseases. Since severe COVID-19 is characterised by hyperinflammation, the effects of a pre-existing inflammatory state and immunomodulatory treatments on the disease’s course are of great interest. Even though patients in this group are perceived of being at higher risk for severe disease, most of the relevant observational studies have had controversial results. We aimed to investigate the clinical characteristics and outcomes of patients with a history of rheumatic disease and COVID-19 related admission in our centre. Case report - Case description We conducted a retrospective observational study of COVID-19 RT-PCR positive admissions of patients coded as having rheumatic disease in the Dudley Group NHS Foundation Trust between April 1st and June 24th, 2020. Data were extracted from the patient clinical notes and electronic medical records and were captured and analysed on MS Excel. Among 613 COVID-19 related admissions, 19 (3.1%) patients were coded as having comorbid rheumatic disease. 8 cases were excluded from further analysis as, upon records review, they had osteoarthritis or a history of gout. Thus, the true incidence of comorbid rheumatic disease among COVID-19 related hospitalisations was even lower at 11/613 (1.8%). The mean age of the patients was 80.5 ± 8.06 years, 9/11 (81.8%) were female and 8/11 (73%) were Caucasian. In the vast majority the diagnosis was that of Rheumatoid Arthritis (9/11, 81.8%), while one patient had Polymyalgia Rheumatica and another Systemic Lupus Erythematosus. Only a quarter of the patients had moderate (2, 18%) or high (1, 9%) disease activity on their most recent outpatient visit. In terms of antirheumatic medication, 5 (45%) patients were on regular Prednisolone (20% <5mg, 80% 5-10mg), 8 (72%) were on cs DMARDs and only 1 (9%) on bDMARDs. A substantial proportion of the patient cohort also suffered with other comorbidities. 8/11 (72.7%) patients had arterial hypertension, 5 (45.4%) had a history of cardiovascular disease, 3 (27.3%) obesity (BMI 30+), 3 (27.3%) previous history of cancer, 2 (18.2%) COPD, 2 (18.2%) CKD, 1 (9%) Interstitial lung disease, 1 (9%) Diabetes, 1 (9%) Cerebrovascular disease and 1 (9%) immunodeficiency. During their admission, 7 (63.6%) patients required supplemental oxygen therapy. Unfortunately, 5/11 (45.5%) patients had a fatal outcome. Case report - Discussion In our cohort, the percentage of patients with rheumatic diseases among inpatients with confirmed COVID-19 infection was low (∼1.8%). Potential explanations for this observation could be a beneficial effect of concomitant antirheumatic treatment (steroids and/or DMARDs) in controlling hyperinflammation, but also rheumatic disease patients’ increased risk awareness and thus increased compliance with viral spread mitigation measures (‘shielding’) as per Government guidelines. We also note the low rate of biologic DMARD use with only 1 (9%) inpatient having received Rituximab for RA. Case report - Key learning points The incidence of rheumatic disease among COVID-19 related admissions in our centre was exceptionally low. Per recently published reports from worldwide registries, older age and multiple comorbidities appear to drive the risk for hospitalisation, need for oxygen supplementation and fatal outcome. Better understanding of the effect of DMARDs on COVID-19 severity requires further investigation, perhaps with SARS-CoV-2 antibody studies, but our observations appear to be reassuring.

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