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Tang KT. Comparative outcome of patients with systemic autoimmune rheumatic disease affected by COVID-19 infection-An Asian perspective. Int J Rheum Dis 2024; 27:e15359. [PMID: 39352022 DOI: 10.1111/1756-185x.15359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 08/09/2024] [Accepted: 09/22/2024] [Indexed: 10/03/2024]
Affiliation(s)
- Kuo-Tung Tang
- Division of Allergy, Immunology, and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Ph.D. Program in Translational Medicine and RongHsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
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2
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Gayathri C, Monica K, Lakshmi PA, Mathini S, Kumar NP, Ram, Kumar VS. Systemic lupus erythematosus nephritis and COVID-19 disease. Clin Rheumatol 2023; 42:2335-2340. [PMID: 37195372 PMCID: PMC10189213 DOI: 10.1007/s10067-023-06634-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/18/2023]
Abstract
Of the more than 20 studies published on SLE patients with COVID-19, none of the studies focused on lupus nephritis. We report the outcomes of renal biopsy-proven systemic lupus erythematosus (SLE) nephritis patients after COVID-19 disease. Our institute has been declared as a state COVID-19 hospital in the last week of March 2020. From then till now, we have admitted and managed COVID-19 patients from several districts of Andhra Pradesh and neighbouring states. We collected the data of patients with SLE nephritis contemporaneously from admission to the outcomes on a computerised proforma. We had identified sixteen patients with SLE nephritis who were admitted with COVID-19 disease. Of them, fourteen were females and two were males. The mean age was 29.3 years. Out of sixteen patients, seven required a mechanical ventilator and dialysis and eventually succumbed. One more patient died due to disseminated tuberculosis. Our results suggested that with an approximately 50% mortality rate, the COVID-19 disease had a calamitous effect on SLE nephritis patients. Key Points • We identified the significant risk factors for mortality: younger age, higher serum creatinine at presentation, higher CT severity score and lower serum albumin. • After the analysis done for this article, we decided to reduce the medications for SLE nephritis to prednisolone 10 mg/day when COVID-19 disease is contracted.
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Affiliation(s)
- C Gayathri
- Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - K Monica
- Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | | | - S Mathini
- Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | | | - Ram
- Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
| | - V Siva Kumar
- Sri Venkateswara Institute of Medical Sciences, Tirupati, India
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Ughi N, Bernasconi DP, Gagliardi C, Del Gaudio F, Dicuonzo A, Maloberti A, Giannattasio C, Rossetti C, Valsecchi MG, Epis OM. Trends in severe outcomes in SARS-CoV-2-positive hospitalized patients with rheumatic diseases: a monocentric observational and case-control study in northern Italy. Reumatismo 2023; 75. [PMID: 37462130 DOI: 10.4081/reumatismo.2023.1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/18/2023] [Indexed: 07/20/2023] Open
Abstract
Rheumatic disease patients are at greater risk of infection due to their disease, comorbidities, and immunosuppressive therapy. COVID-19 outcomes in this patient setting appeared to be similar to those of the general population. However, data on this topic were mainly related to small studies on a limited number of patients. Consequently, to date, this field remains poorly explored, particularly in the pre-vaccine era. This monocentric study aimed to describe the intrahospital mortality in rheumatic patients with SARS-CoV-2 consecutively hospitalized from 21 February to 31 December 2020, before anti-SARS-CoV-2 vaccine administration spread, compared with non-rheumatic patients. Of 2491 included patients, 65 [3%, median (interquartile range) age 75 (64.76-82.239 years, 65% women] were suffering from rheumatic diseases. A total of 20 deaths were reported [case fatality rate 31%, 95% confidence interval (CI): 19-42] compared with 433 deaths (19%, 95% CI: 17-20) in patients without rheumatic diseases (p=0.024). However, the rheumatic disease was not associated with a significant increase in univariate mortality hazards (hazard ratio 1.374, 95% CI: 0.876-2.154), and after adjustment (hazard ratio 1.199, 95% CI: 0.759-1.894) by age, sex and Charlson comorbidity index. The incidence of intensive care unit admission, death, and discharge in the case-control study was comparable between rheumatic and non-rheumatic patients. The presence of rheumatic diseases in SARS-CoV-2-hospitalized patients did not represent an independent risk factor for severe disease or mortality.
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Affiliation(s)
- N Ughi
- Division of Rheumatology, Multispecialist Medical Department, Niguarda Hospital, Milan.
| | - D P Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center-B4, School of Medicine and Surgery, Milano-Bicocca University, Milan.
| | - C Gagliardi
- Division of Rheumatology, Multispecialist Medical Department, Niguarda Hospital, Milan.
| | - F Del Gaudio
- Functional Department for Higher Education, Research, and Development, Niguarda Hospital, Milan.
| | - A Dicuonzo
- Functional Department for Higher Education, Research, and Development, Niguarda Hospital, Milan.
| | - A Maloberti
- Division of Cardiology 4, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan; School of Medicine and Surgery, Milano-Bicocca University, Milan .
| | - C Giannattasio
- Division of Cardiology 4, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan; School of Medicine and Surgery, Milano-Bicocca University, Milan .
| | - C Rossetti
- Functional Department for Higher Education, Research, and Development, Niguarda Hospital, Milan.
| | - M G Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center-B4, School of Medicine and Surgery, Milano-Bicocca University, Milan.
| | - O M Epis
- Division of Rheumatology, Multispecialist Medical Department, Niguarda Hospital, Milan.
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4
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Ward NKZ, Pal S, Ruddy K, Savvas S. Attitudes and beliefs towards COVID-19 and COVID-19 vaccination among rheumatology patients in a Los Angeles County safety net clinic. BMC Rheumatol 2023; 7:13. [PMID: 37259135 DOI: 10.1186/s41927-023-00338-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/09/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The novel Coronavirus disease (COVID-19) pandemic has represented an evolving global threat with high morbidity and mortality. Patients with autoimmune rheumatic diseases and on immune-suppressing medications may be at increased risk to more severe disease, hospitalization, and death. Vaccines are essential to combat the COVID-19 pandemic and curb the spread of infection. Rheumatology patients may be more fearful to receive the vaccine compared to the general population. The Los Angeles County rheumatology patients are primarily Hispanic and represent a unique and possibly particularly vulnerable cohort warranting further exploration into barriers to receive the COVID-19 vaccine. We aimed to explore the willingness of COVID-19 vaccine acceptance among patients with rheumatic disease. METHODS We conducted a cross-sectional survey to assess the perceptions and barriers to COVID-19 vaccine acceptance in our Los Angeles County rheumatology clinics between July 2021 to September 2021 and received responses from 116 patients. RESULTS The majority of respondents were female (83.9%), 41-60 years of age (59.8%), Hispanic (89.2%), with high school or lower level of education (68.7%), and had Rheumatoid Arthritis (56.9%). We found most (88.4%) patients received at least one dose of the COVID-19 vaccine. We identified no differences in vaccine acceptance related to age, education, race, and ethnicity. Most respondents agreed that their health condition puts them at high risk of COVID-19 complications. In addition, individuals reported that they valued being engaged by their rheumatologists in discussions of the risk and benefits of the vaccine prior to receiving it. CONCLUSION We found that the majority of patients were already vaccinated or willing to be vaccinated, at higher levels than general United States population and that a conversation initiated by a rheumatologist can have positive effect on patients' health behaviors related to COVID-19.
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Affiliation(s)
- Nicole K Zagelbaum Ward
- Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County, Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA.
| | - Suman Pal
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, 87106, USA
| | - Katherine Ruddy
- Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County, Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Stavros Savvas
- Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County, Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
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5
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Abdulnaby NK, Gamal SM, Alkemary A, Abdo M, Sabry IM, Belita MI, Mohamed SS. COVID-19 outcomes in patients with and without autoimmune rheumatic diseases: A multicenter comparative study. Int J Rheum Dis 2023; 26:870-877. [PMID: 36929695 DOI: 10.1111/1756-185x.14662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/10/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND AND OBJECTIVE People with rheumatic diseases are particularly concerned with the coronavirus disease 2019 (COVID-19) pandemic. Our work aimed to study the impact of pre-existing autoimmune rheumatic disease (AIRD) and its immunosuppressive drugs on COVID-19 severity and outcome. PATIENTS AND METHODS This is a multicenter case-control study performed between September 2020 and February 2021 on 130 adults with COVID-19, including 66 patients with AIRD and 64 without AIRD, who served as a control group. RESULTS Regarding COVID-19 clinical manifestations; diarrhea, fatigue, and headache were found with significantly higher frequency in the AIRD group while a higher frequency of cough was found in the control group. Comparing COVID-19 complications, only septic shock was significantly higher in the AIRD group (P = 0.013). Both groups were treated with similar COVID-19 drugs except for tocilizumab and anticoagulants, which were statistically significantly more frequently used in the control group (P < 0.001 for both). No statistically significant difference was found between the groups in the outcome or severity of COVID-19. There was no impact of previous immunosuppressive drugs before COVID-19 on the severity of the disease except for a longer duration of recovery in patients on steroids (P < 0.001). Patients with hypertension had severe COVID-19 compared with those without (odds ratio 2.8, 95% confidence interval 1.2-6.9; P = 0.020). CONCLUSION AIRD may not affect COVID-19 severity and outcome. Similarly, immunosuppressive medications had no effect; except that patients on systemic steroids had longer duration for recovery. Comorbid conditions, such as hypertension, may be associated with more severe COVID-19 disease course.
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Affiliation(s)
- Nasser K Abdulnaby
- Chest Diseases and Tuberculosis Department Faculty of Medicine Cairo University, Cairo, Egypt
| | - Sherif M Gamal
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alkhateeb Alkemary
- Internal Medicine and Nephrology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa Abdo
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Irene M Sabry
- Chest Diseases and Tuberculosis Department Faculty of Medicine Cairo University, Cairo, Egypt
| | - Mohamed I Belita
- Department of Anesthesia and Surgical ICU, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sally S Mohamed
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Ramirez GA, Moroni L, Della-Torre E, Gerosa M, Beretta L, Bozzolo EP, Dagna L. Systemic lupus erythematosus and COVID-19: what we know so far. Ann Rheum Dis 2023; 82:e73. [PMID: 32859611 DOI: 10.1136/annrheumdis-2020-218601] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Giuseppe A Ramirez
- Università Vita Salute San Raffaele, Milano, Italy .,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Luca Moroni
- Università Vita Salute San Raffaele, Milano, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Emanuel Della-Torre
- Università Vita Salute San Raffaele, Milano, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Maria Gerosa
- Unit of Clinical Rheumatology, Azienda Socio Sanitaria Territoriale Gaetano Pini, Milano, Italy.,Department of Clinical Science of Community Health and Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milano, Italy
| | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy.,University of Milan, Milano, Lombardia, Italy
| | - Enrica P Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Lorenzo Dagna
- Università Vita Salute San Raffaele, Milano, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
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Systemic Autoimmune Diseases in Patients Hospitalized with COVID-19 in Spain: A Nation-Wide Registry Study. Viruses 2022; 14:v14081631. [PMID: 35893696 PMCID: PMC9394472 DOI: 10.3390/v14081631] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 12/15/2022] Open
Abstract
We aimed to evaluate the clinical outcome of Systemic Autoimmune Diseases (SADs) patients hospitalized with COVID-19 in Spain, before the introduction of SARS-CoV-2 vaccines. A nationwide, retrospective and observational analysis of the patients admitted during 2020, based on the ICD10 codes in the National Registry of Hospital Discharges, was performed. Among 117,694 patients, only 892 (0.8%) presented any type of SAD before COVID-19-related admission: Sjogren’s Syndrome constituted 25%, Systemic Vasculitides 21%, Systemic Lupus Erythematosus 19%, Sarcoidosis 17%, Systemic Sclerosis 11%, Mixed and Undifferentiated Connective Tissue Disease 4%, Behçet’s Disease 4% and Inflammatory Myopathies 2%. The in-hospital mortality rate was higher in SAD individuals (20% vs. 16%, p < 0.001). After adjustment by baseline conditions, SADs were not associated with a higher mortality risk (OR = 0.93, 95% CI 0.78−1.11). Mortality in the SADs patients was determined by age (OR = 1.05, 95% CI 1.04−1.07), heart failure (OR = 1.67, 95% CI 1.10−2.49), chronic kidney disease (OR = 1.29, 95% CI 1.05−1.59) and liver disease (OR = 1.97, 95% CI 1.13−3.44). In conclusion, the higher COVID-19 mortality rate seen in SADs patients hospitalized in Spain in 2020 was related to the higher burden of comorbidities, secondary to direct organ damage and sequelae of their condition. Whilst further studies should evaluate the impact of baseline immunosuppression on COVID-19 outcomes in this population, efforts should be focused on the optimal management of SAD to minimize the impact of the organ damage that has been shown to determine COVID-19 prognosis.
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8
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Degarege A, Naveed Z, Kabayundo J, Brett-Major D. Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis. Pathogens 2022; 11:563. [PMID: 35631084 PMCID: PMC9147100 DOI: 10.3390/pathogens11050563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA; (Z.N.); (J.K.); (D.B.-M.)
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9
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Dadashi M, Dadashi A, Sameni F, Sayadi S, Goudarzi M, Nasiri MJ, Yaslianifard S, Ghazi M, Arjmand R, Hajikhani B. SARS-CoV-2 and HIV co-infection; clinical features, diagnosis, and treatment strategies: A systematic review and meta-analysis. GENE REPORTS 2022; 27:101624. [PMID: 35607389 PMCID: PMC9117161 DOI: 10.1016/j.genrep.2022.101624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 12/15/2022]
Abstract
Background and aim Coronavirus disease 2019 (COVID-19) in people living with human immunodeficiency virus (HIV) who has a compromised immune system can be associated with more significant risks for severe complications. To date, no comprehensive study has been performed to evaluate HIV in patients with COVID-19. In the present study, we assessed the status of patients co-infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and HIV as a systematic review and meta-analysis. Methods A systematic literature search strategy was conducted via reviewing original research articles published in Medline, Web of Science, and Embase databases in 2019 and 2020. Statistical analysis was performed using STATA software, version 14.0 (Stata Corporation, College Station, Texas, USA), to report the prevalence of HIV among patients with COVID-19. Case reports/case series were also evaluated as a systematic review. Results Sixty-three studies (53 case reports/case series and ten prevalence studies) were included in our study. A meta-analysis of prevalence studies showed that HIV infection among patients with COVID-19 was reported in 6 countries (Uganda, China, Iran, USA, Italy, and Spain) with an overall frequency of 1.2% [(95% CI) 0.8–1.7] among 14,424 COVID-19 patients. According to the case reports and case series, 111 patients with HIV have been reported among 113 patients with COVID-19 from 19 countries. Most of the cases were in the USA, China, Italy, and Spain. Conclusion The small number of SARS-CoV-2-HIV co-infected patients reported in the literature makes it difficult to draw precise conclusions. However, since people with HIV are more likely to develop more severe complications of COVID-19, targeted policies to address this raised risk in the current pandemic should be considered. Our findings highlight the importance of identifying underlying diseases, co-infections, co-morbidities, laboratory findings, and beneficial treatment strategies for HIV patients during the COVID-19 pandemic.
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Ramachandran L, Dontaraju VS, Troyer J, Sahota J. New onset systemic lupus erythematosus after COVID-19 infection: a case report. AME Case Rep 2022; 6:14. [PMID: 35475008 PMCID: PMC9010314 DOI: 10.21037/acr-21-55] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/20/2021] [Indexed: 09/29/2023]
Abstract
COVID-19 is a respiratory viral illness that can have life threatening complications. While the short-term sequela of COVID-19, including cytokine storm, is relatively well known, the long-term complications of COVID-19 infection on the immune system is still unknown. There have been some reported cases of autoimmune disease development after COVID-19 infection. We present a patient with a history of COVID-19 infection one month prior who presented with non-specific symptoms including fatigue, malaise, bilateral lower extremity swelling and shortness of breath. His laboratory evaluation and physical exam showed him to be in acute renal failure. Further workup and kidney biopsy results confirmed systemic lupus erythematosus (SLE). Our patient needed treatment with plasmapheresis and immunosuppressants, and subsequently had significant improvement in his symptoms. We discuss the current 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) diagnostic criteria for SLE and describe plausible mechanisms of COVID-19 induced lupus such as B-cell activation by the virus. We also explore the role of interferons in the potential development of autoimmune diseases after COVID-19 infection and highlight the need for further research in the area.
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Affiliation(s)
| | | | - James Troyer
- Department of Internal Medicine, Mercyhealth Javon Bea Hospital, Rockford, IL, USA
| | - Jagpal Sahota
- Department of Internal Medicine, Mercyhealth Javon Bea Hospital, Rockford, IL, USA
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11
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Wu H, Dai R, Wu X, Li Q, Lu H, Yang J, Mao W, Hei P, Liang J, Ji C. Efficacy and Safety of Chinese Medicine for COVID-19: A Systematic Review and Meta-Analysis. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2022; 50:333-349. [PMID: 35114908 DOI: 10.1142/s0192415x22500136] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This systematic review and meta-analysis aimed to evaluate the efficacy and safety of traditional Chinese medicine for COVID-19 treatment with a focus on the benefits of symptomatic relief and time-related indexes. Seven electronic databases (PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, Chongqing VIP, Wanfang Data, and Chinese Clinical Trial Registry) were systematically searched from their beginning to April 2021. Only randomized controlled trials (RCTs) comparing patients using Western therapy (WT) alone and those using additional Chinese medicine (WT [Formula: see text] CM) were included. Primary outcomes included overall efficacy, lung recovery, and time to viral assay conversion. Secondary outcomes included time and rate of individual symptom recovery, laboratory indicators, and adverse events. Overall, 15 RCTs, including 1469 participants, were included in this review. WT [Formula: see text] CM significantly improved overall efficacy (risk ratio, RR [Formula: see text] 1.21; 95% CI: 1.12 to 1.30; [Formula: see text] [Formula: see text] 0.01) and lung recovery (RR [Formula: see text] 1.30; 95% CI:1.19 to 1.42; [Formula: see text] [Formula: see text] 0.01) and shortened the time to viral assay conversion (weighted mean differences, WMD [Formula: see text]1.38; 95% CI: -1.98 to -0.78; [Formula: see text] [Formula: see text] 0.01) and duration of chest distress (WMD [Formula: see text] 2.41; 95% CI: -2.99 to -1.83; [Formula: see text] [Formula: see text] 0.01) compared to WT alone. There was no difference in safety between the WT [Formula: see text] CM and WT groups (RR [Formula: see text] 0.94; 95% CI: 0.64 to 1.39; [Formula: see text] 0.76). In conclusion, the synthesized evidence from 15 RCTs showed that additional Chinese medication may improve treatment efficacy, relieve symptoms, promote lung recovery, and reduce the inflammatory response against COVID-19, while not increasing the risk of adverse events compared with conventional Western medication alone.
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Affiliation(s)
- Hanting Wu
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, P. R. China
| | - Rongchen Dai
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, P. R. China
| | - Xiaqiu Wu
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, P. R. China
| | - Qiushuang Li
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, P. R. China
| | - Hanti Lu
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, P. R. China
| | - Junchao Yang
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, P. R. China
| | - Wei Mao
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, P. R. China
| | - Peijie Hei
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, P. R. China
| | - Juan Liang
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, P. R. China
| | - Conghua Ji
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, P. R. China.,The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, P. R. China
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Tan EH, Sena AG, Prats-Uribe A, You SC, Ahmed WUR, Kostka K, Reich C, Duvall SL, Lynch KE, Matheny ME, Duarte-Salles T, Bertolin SF, Hripcsak G, Natarajan K, Falconer T, Spotnitz M, Ostropolets A, Blacketer C, Alshammari TM, Alghoul H, Alser O, Lane JCE, Dawoud DM, Shah K, Yang Y, Zhang L, Areia C, Golozar A, Recalde M, Casajust P, Jonnagaddala J, Subbian V, Vizcaya D, Lai LYH, Nyberg F, Morales DR, Posada JD, Shah NH, Gong M, Vivekanantham A, Abend A, Minty EP, Suchard M, Rijnbeek P, Ryan PB, Prieto-Alhambra D. COVID-19 in patients with autoimmune diseases: characteristics and outcomes in a multinational network of cohorts across three countries. Rheumatology (Oxford) 2021; 60:SI37-SI50. [PMID: 33725121 PMCID: PMC7989171 DOI: 10.1093/rheumatology/keab250] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/07/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Patients with autoimmune diseases were advised to shield to avoid coronavirus disease 2019 (COVID-19), but information on their prognosis is lacking. We characterized 30-day outcomes and mortality after hospitalization with COVID-19 among patients with prevalent autoimmune diseases, and compared outcomes after hospital admissions among similar patients with seasonal influenza. METHODS A multinational network cohort study was conducted using electronic health records data from Columbia University Irving Medical Center [USA, Optum (USA), Department of Veterans Affairs (USA), Information System for Research in Primary Care-Hospitalization Linked Data (Spain) and claims data from IQVIA Open Claims (USA) and Health Insurance and Review Assessment (South Korea). All patients with prevalent autoimmune diseases, diagnosed and/or hospitalized between January and June 2020 with COVID-19, and similar patients hospitalized with influenza in 2017-18 were included. Outcomes were death and complications within 30 days of hospitalization. RESULTS We studied 133 589 patients diagnosed and 48 418 hospitalized with COVID-19 with prevalent autoimmune diseases. Most patients were female, aged ≥50 years with previous comorbidities. The prevalence of hypertension (45.5-93.2%), chronic kidney disease (14.0-52.7%) and heart disease (29.0-83.8%) was higher in hospitalized vs diagnosed patients with COVID-19. Compared with 70 660 hospitalized with influenza, those admitted with COVID-19 had more respiratory complications including pneumonia and acute respiratory distress syndrome, and higher 30-day mortality (2.2-4.3% vs 6.32-24.6%). CONCLUSION Compared with influenza, COVID-19 is a more severe disease, leading to more complications and higher mortality.
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Affiliation(s)
- Eng Hooi Tan
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, OX3 7LD, UK
| | - Anthony G Sena
- Janssen Research and Development, Titusville, NJ USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Albert Prats-Uribe
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, OX3 7LD, UK
| | - Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Waheed-Ul-Rahman Ahmed
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, OX3, 7LD, UK
- College of Medicine and Health, University of Exeter, St Luke’s, 2LU, USA
| | | | | | - Scott L Duvall
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kristine E Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Michael E Matheny
- Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Sergio Fernandez Bertolin
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY, USA
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Matthew Spotnitz
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Clair Blacketer
- Janssen Research and Development, Titusville, NJ USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Thamir M Alshammari
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Heba Alghoul
- Faculty of Medicine, Islamic University of Gaza, Palestine
| | - Osaid Alser
- Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA
| | - Jennifer C E Lane
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, OX3 7LD, UK
| | | | - Karishma Shah
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, OX3, 7LD, UK
| | - Yue Yang
- Digital China Health Technologies Co., LTD, Beijing 100085, China
| | - Lin Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3015, Australia
| | - Carlos Areia
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK
| | - Asieh Golozar
- Regeneron Pharmaceuticals, NY, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,, Baltimore, MD, USA
| | - Martina Recalde
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Paula Casajust
- Real-World Evidence, Trial Form Support, Barcelona, Spain
| | | | - Vignesh Subbian
- College of Engineering, The University of Arizona Tucson, Arizona, USA
| | - David Vizcaya
- Bayer Pharmaceuticals, Sant Joan Despi, Barcelona, Spain
| | - Lana Y H Lai
- School of Medical Sciences, University of Manchester, UK
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniel R Morales
- Division of Population Health Sciences, University of Dundee, Dundee, Scotland, UK
| | - Jose D Posada
- Stanford Center for Biomedical Informatics Research, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Nigam H Shah
- Stanford Center for Biomedical Informatics Research, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Mengchun Gong
- Health Management Institute, Southern Medical University, Guangzhou, China
| | - Arani Vivekanantham
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, OX3, 7LD, UK
| | - Aaron Abend
- Autoimmune Registry Inc., Guilford, CT 06437, USA
| | - Evan P Minty
- O’Brien School for Public Health, Faculty of Medicine, University of Calgary, Calgary, Alberta, T2N, 1N4, Canada
| | - Marc Suchard
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Peter Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Patrick B Ryan
- Janssen Research and Development, Titusville, NJ USA
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, OX3 7LD, UK
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13
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Brito-Zerón P, Melchor S, Seror R, Priori R, Solans R, Kostov B, Baldini C, Carubbi F, Callejas JL, Guisado-Vasco P, Hernández-Molina G, Pasoto SG, Valim V, Sisó-Almirall A, Mariette X, Carreira P, Ramos-Casals M. SARS-CoV-2 infection in patients with primary Sjögren syndrome: characterization and outcomes of 51 patients. Rheumatology (Oxford) 2021; 60:2946-2957. [PMID: 33316070 PMCID: PMC7798705 DOI: 10.1093/rheumatology/keaa748] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/12/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To analyse the prognosis and outcomes of SARS-CoV-2 infection in patients with primary SS. METHODS We searched for patients with primary SS presenting with SARS-CoV-2 infection (defined following and according to the European Centre for Disease Prevention and Control guidelines) among those included in the Big Data Sjögren Registry, an international, multicentre registry of patients diagnosed according to the 2002/2016 classification criteria. RESULTS A total of 51 patients were included in the study (46 women, mean age at diagnosis of infection of 60 years). According to the number of patients with primary SS evaluated in the Registry (n = 8211), the estimated frequency of SARS-CoV-2 infection was 0.62% (95% CI 0.44, 0.80). All but two presented with symptoms suggestive of COVID-19, including fever (82%), cough (57%), dyspnoea (39%), fatigue/myalgias (27%) and diarrhoea (24%), and the most frequent abnormalities included raised lactate dehydrogenase (LDH) (88%), CRP (81%) and D-dimer (82%) values, and lymphopenia (70%). Infection was managed at home in 26 (51%) cases and 25 (49%) required hospitalization (five required admission to ICU, four died). Compared with patients managed at home, those requiring hospitalization had higher odds of having lymphopenia as laboratory abnormality (adjusted OR 21.22, 95% CI 2.39, 524.09). Patients with comorbidities had an older age (adjusted OR 1.05, 95% CI 1.00, 1.11) and showed a risk for hospital admission six times higher than those without (adjusted OR 6.01, 95% CI 1.72, 23.51) in the multivariate analysis. CONCLUSION Baseline comorbidities were a key risk factor for a more complicated COVID-19 in patients with primary SS, with higher rates of hospitalization and poor outcomes in comparison with patients without comorbidities.
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Affiliation(s)
- Pilar Brito-Zerón
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain
| | - Sheila Melchor
- Servicio de Reumatologia, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Raphaèle Seror
- Department of Rheumatology, National Reference Center for Sjögren Syndrome and Rare Autoimmune Diseases, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, AP-HP, Le Kremlin Bicêtre, France
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
| | - Roser Solans
- Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Belchin Kostov
- Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary healthcare transversal research group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | | | - Francesco Carubbi
- COVID-19 Medical Unit, San Salvatore Hospital, Department of Medicine, ASL1 Avezzano-Sulmona-L’Aquila, L’Aquila, Italy
| | | | - Pablo Guisado-Vasco
- Department of Internal Medicine, Hospital Universitario Quironsalud, Madrid, Spain
| | - Gabriela Hernández-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valeria Valim
- Department of Medicine, Federal University of Espírito Santo, Vitória, Brazil
| | - Antoni Sisó-Almirall
- Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary healthcare transversal research group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Xavier Mariette
- Centre for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, Université Paris-Saclay, INSERM, Paris, France
| | - Patricia Carreira
- Servicio de Reumatologia, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Manuel Ramos-Casals
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain
- Department of Medicine, Universitat de Barcelona, Barcelona, Spain
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
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14
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Tam LS, Tanaka Y, Handa R, Li Z, Lorenzo JP, Louthrenoo W, Hill C, Pile K, Robinson PC, Dans LF, Hsu LY, Lee SM, Cho J, Hasan ATMT, Salim B, Samreen S, Shaharir SS, Wong P, Chau J, Danda D, Haq SA. Updated APLAR consensus statements on care for patients with rheumatic diseases during the COVID-19 pandemic. Int J Rheum Dis 2021; 24:733-745. [PMID: 33945214 PMCID: PMC8206920 DOI: 10.1111/1756-185x.14124] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022]
Abstract
AIM To update previous guidance of the Asia Pacific League of Associations for Rheumatology (APLAR) on the management of patients with rheumatic and musculoskeletal diseases (RMD) during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Research questions were formulated focusing on diagnosis and treatment of adult patients with RMD within the context of the pandemic, including the management of RMD in patients who developed COVID-19. MEDLINE was searched for eligible studies to address the questions, and the APLAR COVID-19 task force convened 2 meetings through video conferencing to discuss its findings and integrate best available evidence with expert opinion. Consensus statements were finalized using the modified Delphi process. RESULTS Agreement was obtained around key aspects of screening for or diagnosis of COVID-19; management of patients with RMD without confirmed COVID-19; and management of patients with RMD with confirmed COVID-19. The task force achieved consensus on 25 statements covering the potential risk of acquiring COVID-19 in RMD patients, advice on RMD medication adjustment and continuation, the roles of telemedicine and vaccination, and the impact of the pandemic on quality of life and on treatment adherence. CONCLUSIONS Available evidence primarily from descriptive research supported new recommendations for aspects of RMD care not covered in the previous document, particularly with regard to risk factors for complicated COVID-19 in RMD patients, modifications to RMD treatment regimens in the context of the pandemic, and COVID-19 vaccination in patients with RMD.
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Affiliation(s)
- Lai-Shan Tam
- Division of Rheumatology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | - Zhanguo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Jose Paulo Lorenzo
- Section of Rheumatology, Department of Medicine, Makati Medical Center, Makati City, Philippines
| | - Worawit Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Catherine Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Kevin Pile
- Rheumatology Unit, Campbelltown Hospital, Western Sydney University, Sydney, NSW, Australia
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland School of Medicine, Brisbane, QLD, Australia
| | - Leonila F Dans
- Department of Pediatrics and Department of Clinical Epidemiology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jiacai Cho
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
| | - A T M Tanveer Hasan
- Department of Rheumatology, Enam Medical College & Hospital, Dhaka, Bangladesh
| | - Babur Salim
- Department of Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Saba Samreen
- Department of Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Syahrul Sazliyana Shaharir
- Division of Rheumatology, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Priscilla Wong
- Division of Rheumatology, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jeffrey Chau
- Hong Kong Psoriatic Arthritis Association, Hong Kong, Hong Kong
| | - Debashish Danda
- Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital, Vellore, India
| | - Syed Atiqul Haq
- Department of Rheumatology, BSM Medical University, Dhaka, Bangladesh
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15
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Conway R, Konig MF, Graef ER, Webb K, Yazdany J, Kim AHJ. Inflammatory arthritis in patients with COVID-19. Transl Res 2021; 232:49-59. [PMID: 33626415 PMCID: PMC7897406 DOI: 10.1016/j.trsl.2021.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 12/12/2022]
Abstract
Patients with inflammatory arthritis represent a possible high-risk group to COVID-19 due to their immunosuppressive regimen designed to maintain low disease activity. Thus, substantial effort has been put forth to understand the impact of COVID-19 on these patients. Patients with rheumatic diseases as a whole do not appear to be more susceptible to acquiring COVID-19. Furthermore, immunosuppression generally did not increase the likelihood of developing severe COVID-19, with the important exception of medium and high-dose glucocorticoid use. In addition, a small number of COVID-19 patients have developed new inflammatory arthritis; whether this represents an unmasking of previous subclinical disease or a bone fide virus-induced arthritis is unclear. Nevertheless, it appears that inflammatory arthritis patients currently on immunosuppression should continue their medication to prevent future flares and limit glucocorticoid usage. While this continues to be a rapidly evolving field, these data are reassuring to both patients with and providers treating inflammatory arthritides.
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Key Words
- ace-2, angiotensin converting enzyme-2
- acr, american college of rheumatology
- c1, complement component 1
- ci, confidence interval
- covid-19, coronavirus disease-2019
- dmard, disease-modifying antirheumatic drugs
- eular, european league against rheumatism
- gra, global rheumatology alliance
- hcq, hydroxychloroquine
- hiv, human immunodeficiency virus
- hla, human leukocyte antigen
- hr, hazard ratio
- mis-c, multisystem inflammatory syndrome in children
- mri, magnetic resonance imaging
- nhs, national health service
- or, odds ratio
- pcr, polymerase chain reaction
- ra, rheumatoid arthritis
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- sle, systemic lupus erythematosus
- slicc, systemic lupus erythematosus international collaborating clinics
- tnfi, tumor necrosis factor inhibitor
- tracr, trinity rheumatology and covid-19 registry
- uk, united kingdom
- us, united states
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Affiliation(s)
- Richard Conway
- Department of Rheumatology, St. James's Hospital, Dublin, Ireland
| | - Maximilian F Konig
- Division of Rheumatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Kate Webb
- Division of Paediatric Rheumatology, School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Crick African Network, Francis Crick Institute, London, UK
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, California.
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
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16
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Fernandez-Ruiz R, Paredes JL, Niewold TB. COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease. Transl Res 2021; 232:13-36. [PMID: 33352298 PMCID: PMC7749645 DOI: 10.1016/j.trsl.2020.12.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023]
Abstract
As the world navigates the coronavirus disease 2019 (COVID-19) pandemic, there is a growing need to assess its impact in patients with autoimmune rheumatic diseases, such as systemic lupus erythematosus (SLE). Patients with SLE are a unique population when considering the risk of contracting COVID-19 and infection outcomes. The use of systemic glucocorticoids and immunosuppressants, and underlying organ damage from SLE are potential susceptibility factors. Most patients with SLE have evidence of high type I interferon activity, which may theoretically act as an antiviral line of defense or contribute to the development of a deleterious hyperinflammatory response in COVID-19. Other immunopathogenic mechanisms of SLE may overlap with those described in COVID-19, thus, studies in SLE could provide some insight into immune responses occurring in severe cases of the viral infection. We reviewed the literature to date on COVID-19 in patients with SLE and provide an in-depth review of current research in the area, including immune pathway activation, epidemiology, clinical features, outcomes, and the psychosocial impact of the pandemic in those with autoimmune disease.
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Key Words
- act-1, adaptor protein nf-κ activator
- ace2, angiotensin-converting enzyme 2
- aza, azathioprine
- c5ar1, c5a receptor
- covid-19, coronavirus disease 2019
- c-19-gra, covid-19 global rheumatology alliance
- cyc, cyclophosphamide
- ebv, epstein-barr virus
- hcq, hydroxychloroquine
- icu, intensive care unit
- ifn, interferon
- irf, interferon regulatory factor
- isg, interferon-stimulated gene
- ifnar, interferon-α/β receptor
- il, interleukin
- jak, janus kinase
- lof, loss-of-function
- masp-2, manna-binding lectin associated serine protease-2
- mtor, mechanistic (mammalian) target of rapamycin
- mmf, mycophenolate mofetil
- myd88, myeloid differentiation primary response 88
- nac, n-acetylcisteine
- net, neutrophil extracellular trap
- nyc, new york city
- pdc, plasmacytoid dendritic cell
- pi3k, phosphatidylinositol 3-kinase
- treg, regulatory t cell
- rt-pcr, reverse transcription polymerase chain reaction
- ps6, ribosomal protein 6
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- stat, signal transducer and activator of transcription
- sdh, social determinants of health
- sgc, systemic glucocorticoids
- sle, systemic lupus erythematosus
- th17, t helper 17
- tbk1, tank-binding kinase 1
- tlr, toll-like receptor
- tnf, tumor necrosis factor
- traf, tumor necrosis factor receptor-associated factor
- trif, tirdomain-containing adapter-inducing interferon-β
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Affiliation(s)
- Ruth Fernandez-Ruiz
- Division of Rheumatology, NYU Grossman School of Medicine, New York, New York; Colton Center for Autoimmunity, New York University School of Medicine, New York, New York.
| | - Jacqueline L Paredes
- Colton Center for Autoimmunity, New York University School of Medicine, New York, New York
| | - Timothy B Niewold
- Colton Center for Autoimmunity, New York University School of Medicine, New York, New York
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17
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Ayala Gutiérrez MDM, Rubio-Rivas M, Romero Gómez C, Montero Sáez A, Pérez de Pedro I, Homs N, Ayuso García B, Cuenca Carvajal C, Arnalich Fernández F, Beato Pérez JL, Vargas Núñez JA, Letona Giménez L, Suárez Fernández C, Méndez Bailón M, Tuñón de Almeida C, González Moraleja J, de Guzmán García-Monge M, Helguera Amezua C, Fidalgo Montero MDP, Giner Galvañ V, Gil Sánchez R, Collado Sáenz J, Boixeda R, Ramos Rincón JM, Gómez Huelgas R. Autoimmune Diseases and COVID-19 as Risk Factors for Poor Outcomes: Data on 13,940 Hospitalized Patients from the Spanish Nationwide SEMI-COVID-19 Registry. J Clin Med 2021; 10:1844. [PMID: 33922777 PMCID: PMC8123043 DOI: 10.3390/jcm10091844] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 12/18/2022] Open
Abstract
(1) Objectives: To describe the clinical characteristics and clinical course of hospitalized patients with COVID-19 and autoimmune diseases (ADs) compared to the general population. (2) Methods: We used information available in the nationwide Spanish SEMI-COVID-19 Registry, which retrospectively compiles data from the first admission of adult patients with COVID-19. We selected all patients with ADs included in the registry and compared them to the remaining patients. The primary outcome was all-cause mortality during admission, readmission, and subsequent admissions, and secondary outcomes were a composite outcome including the need for intensive care unit (ICU) admission, invasive and non-invasive mechanical ventilation (MV), or death, as well as in-hospital complications. (3) Results: A total of 13,940 patients diagnosed with COVID-19 were included, of which 362 (2.6%) had an AD. Patients with ADs were older, more likely to be female, and had greater comorbidity. On the multivariate logistic regression analysis, which involved the inverse propensity score weighting method, AD as a whole was not associated with an increased risk of any of the outcome variables. Habitual treatment with corticosteroids (CSs), age, Barthel Index score, and comorbidity were associated with poor outcomes. Biological disease-modifying anti-rheumatic drugs (bDMARDs) were associated with a decrease in mortality in patients with AD. (4) Conclusions: The analysis of the SEMI-COVID-19 Registry shows that ADs do not lead to a different prognosis, measured by mortality, complications, or the composite outcome. Considered individually, it seems that some diseases entail a different prognosis than that of the general population. Immunosuppressive/immunoregulatory treatments (IST) prior to admission had variable effects.
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Affiliation(s)
- María del Mar Ayala Gutiérrez
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), 29010 Málaga, Spain; (C.R.G.); (I.P.d.P.); (R.G.H.)
| | - Manuel Rubio-Rivas
- Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (M.R.-R.); (A.M.S.); (N.H.)
| | - Carlos Romero Gómez
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), 29010 Málaga, Spain; (C.R.G.); (I.P.d.P.); (R.G.H.)
| | - Abelardo Montero Sáez
- Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (M.R.-R.); (A.M.S.); (N.H.)
| | - Iván Pérez de Pedro
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), 29010 Málaga, Spain; (C.R.G.); (I.P.d.P.); (R.G.H.)
| | - Narcís Homs
- Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (M.R.-R.); (A.M.S.); (N.H.)
| | - Blanca Ayuso García
- Internal Medicine Department, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Carmen Cuenca Carvajal
- Internal Medicine Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | | | - José Luis Beato Pérez
- Internal Medicine Department, Albacete University Hospital Complex, 02006 Albacete, Spain;
| | | | | | | | - Manuel Méndez Bailón
- Internal Medicine Department, San Carlos Clinical Hospital, 28040 Madrid, Spain;
| | | | | | | | | | | | - Vicente Giner Galvañ
- Internal Medicine Department, San Juan de Alicante University Hospital, 03550 San Juan de Alicante, Spain;
| | - Ricardo Gil Sánchez
- Internal Medicine Department, La Fe University Hospital, 46026 Valencia, Spain;
| | | | - Ramon Boixeda
- Internal Medicine Department, Mataró Hospital, 08304e Mataró, Spain;
| | | | - Ricardo Gómez Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), 29010 Málaga, Spain; (C.R.G.); (I.P.d.P.); (R.G.H.)
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18
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van Ouwerkerk L, van der Meulen-de Jong AE, Ninaber MK, Teng YKO, Huizinga TW, Allaart CF. Prospective study into COVID-19-like symptoms in patients with and without immune-mediated inflammatory diseases or immunomodulating drugs. Ann Rheum Dis 2021; 80:1364-1365. [PMID: 33849918 DOI: 10.1136/annrheumdis-2021-219958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Lotte van Ouwerkerk
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Maarten K Ninaber
- Department of Pulmonology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Y K Onno Teng
- Department of Nephrology, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
| | - Tom Wj Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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19
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Xu C, Yi Z, Cai R, Chen R, Thong BYH, Mu R. Clinical outcomes of COVID-19 in patients with rheumatic diseases: A systematic review and meta-analysis of global data. Autoimmun Rev 2021; 20:102778. [PMID: 33609804 PMCID: PMC7889462 DOI: 10.1016/j.autrev.2021.102778] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/20/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The impact of rheumatic diseases on COVID-19 infection remains poorly investigated. Here we performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 in patients with rheumatic diseases. METHODS We systematically searched PubMed, Embase, Cochrane Library, Scopus and preprint database up to 29th August 2020, for publications with confirmed COVID-19 infection in patients with rheumatic diseases. The primary outcomes were the rates of hospitalization, oxygen support, intensive care unit (ICU) admission and death. A meta-analysis of effect sizes using the random-effects models was performed, and meta-regression analyses were performed to explore heterogeneity. The data from the COVID-19 Global Rheumatology Alliance physician registry (the COVID-19 GRA) was used as a reference. RESULTS A total of 31 articles involving 1138 patients were included in this systematic review and meta-analysis. The publications were from Europe, Asia and North America, but none from other continents. The overall rates of hospitalization, oxygen support, ICU admission and fatality among COVID-19 infected patients with rheumatic diseases were 0.58 (95% confidence interval (CI) 0.48-0.67), 0.33 (95% CI 0.21-0.47), 0.09 (95% CI 0.05-0.15) and 0.07 (95% CI 0.03-0.11), respectively. The rate of oxygen support in Europe (0.48, 95% CI 0.4-0.57) was higher than that in other continents. Among all hospitalized patients, the rates of oxygen support, ICU admission and fatality were 0.61 (95% CI 0.48-0.73), 0.13 (95% CI 0.07-0.21) and 0.13 (95% CI 0.09-0.18), respectively. The fatality rate was highest in Europe (0.19, 95% CI 0.15-0.24). The fatality rate was higher both in this meta-analysis and the COVID-19 GRA (7.0% and 6.7%, respectively) than that (3.4%) in WHO database, although the age, gender and comorbidity were not matched. CONCLUSION Patients with rheumatic diseases remain vulnerable with substantial rates of severe outcomes and a geographic variation. More studies were urgently needed to elucidate the risk factors of severe outcomes in this population.
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Affiliation(s)
- Chuanhui Xu
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
| | - Zixi Yi
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - Ruyi Cai
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - Ru Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Rong Mu
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China.
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20
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Xu C, Yi Z, Cai R, Chen R, Thong BYH, Mu R. Clinical outcomes of COVID-19 in patients with rheumatic diseases: A systematic review and meta-analysis of global data. Autoimmun Rev 2021; 20:102778. [PMID: 33609804 DOI: 10.1016/j.autrev.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/20/2020] [Indexed: 05/20/2023]
Abstract
OBJECTIVES The impact of rheumatic diseases on COVID-19 infection remains poorly investigated. Here we performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 in patients with rheumatic diseases. METHODS We systematically searched PubMed, Embase, Cochrane Library, Scopus and preprint database up to 29th August 2020, for publications with confirmed COVID-19 infection in patients with rheumatic diseases. The primary outcomes were the rates of hospitalization, oxygen support, intensive care unit (ICU) admission and death. A meta-analysis of effect sizes using the random-effects models was performed, and meta-regression analyses were performed to explore heterogeneity. The data from the COVID-19 Global Rheumatology Alliance physician registry (the COVID-19 GRA) was used as a reference. RESULTS A total of 31 articles involving 1138 patients were included in this systematic review and meta-analysis. The publications were from Europe, Asia and North America, but none from other continents. The overall rates of hospitalization, oxygen support, ICU admission and fatality among COVID-19 infected patients with rheumatic diseases were 0.58 (95% confidence interval (CI) 0.48-0.67), 0.33 (95% CI 0.21-0.47), 0.09 (95% CI 0.05-0.15) and 0.07 (95% CI 0.03-0.11), respectively. The rate of oxygen support in Europe (0.48, 95% CI 0.4-0.57) was higher than that in other continents. Among all hospitalized patients, the rates of oxygen support, ICU admission and fatality were 0.61 (95% CI 0.48-0.73), 0.13 (95% CI 0.07-0.21) and 0.13 (95% CI 0.09-0.18), respectively. The fatality rate was highest in Europe (0.19, 95% CI 0.15-0.24). The fatality rate was higher both in this meta-analysis and the COVID-19 GRA (7.0% and 6.7%, respectively) than that (3.4%) in WHO database, although the age, gender and comorbidity were not matched. CONCLUSION Patients with rheumatic diseases remain vulnerable with substantial rates of severe outcomes and a geographic variation. More studies were urgently needed to elucidate the risk factors of severe outcomes in this population.
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Affiliation(s)
- Chuanhui Xu
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
| | - Zixi Yi
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - Ruyi Cai
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - Ru Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Rong Mu
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China.
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21
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Raza HA, Tariq J, Agarwal V, Gupta L. COVID-19, hydroxychloroquine and sudden cardiac death: implications for clinical practice in patients with rheumatic diseases. Rheumatol Int 2021; 41:257-273. [PMID: 33386447 PMCID: PMC7775739 DOI: 10.1007/s00296-020-04759-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/21/2020] [Indexed: 12/15/2022]
Abstract
Sudden cardiac death is commonly seen due to arrhythmias, which is a common cardiac manifestation seen in COVID-19 patients, especially those with underlying cardiovascular disease (CVD). Administration of hydroxychloroquine (HCQ) as a potential treatment option during SARS-CoV-2, initially gained popularity, but later, its safe usage became questionable due to its cardiovascular safety, largely stemming from instances of cardiac arrhythmias in COVID-19. Moreover, in the setting of rheumatic diseases, in which patients are usually on HCQ for their primary disease, there is a need to scale the merits and demerits of HCQ usage for the treatment of COVID-19. In this narrative review, we aim to address the association between usage of HCQ and sudden cardiac death in COVID-19 patients. MEDLINE, EMBASE, ClinicalTrials.gov and SCOPUS databases were used to review articles in English ranging from case reports, case series, letter to editors, systematic reviews, narrative reviews, observational studies and randomized control trials. HCQ is a potential cause of sudden cardiac death in COVID-19 patients. As opposed to the reduction in CVD with HCQ in treatment of systemic lupus erythematous, rheumatoid arthritis, and other rheumatic diseases, safe usage of HCQ in COVID-19 patients is unclear; whereby, it is observed to result in QTc prolongation and Torsades de pointes even in patients with no underlying cardiovascular comorbidity. This is occasionally associated with sudden cardiac death or cardiac arrest; hence, its clinical efficacy needs further investigation by large-scale clinical trials.
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Affiliation(s)
- Hussain Ahmed Raza
- Medical College, The Aga Khan University, National Stadium Road, Karachi, 74800 Pakistan
| | - Javeria Tariq
- Medical College, The Aga Khan University, National Stadium Road, Karachi, 74800 Pakistan
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014 India
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014 India
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22
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Hanson KE, Caliendo AM, Arias CA, Hayden MK, Englund JA, Lee MJ, Loeb M, Patel R, El Alayli A, Altayar O, Patel P, Falck-Ytter Y, Lavergne V, Morgan RL, Murad MH, Sultan S, Bhimraj A, Mustafa RA. The Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Molecular Diagnostic Testing. Clin Infect Dis 2021:ciab048. [PMID: 33480973 PMCID: PMC7929045 DOI: 10.1093/cid/ciab048] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Accurate molecular diagnostic tests are necessary for confirming a diagnosis of coronavirus disease 2019 (COVID-19). Direct detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acids in respiratory tract specimens informs patient, healthcare institution and public health level decision-making. The numbers of available SARS-CoV-2 nucleic acid detection tests are rapidly increasing, as is the COVID-19 diagnostic literature. Thus, the Infectious Diseases Society of America (IDSA) recognized a significant need for frequently updated systematic reviews of the literature to inform evidence-based best practice guidance. OBJECTIVE The IDSA's goal was to develop an evidence-based diagnostic guideline to assist clinicians, clinical laboratorians, patients and policymakers in decisions related to the optimal use of SARS-CoV-2 nucleic acid amplification tests. In addition, we provide a conceptual framework for understanding molecular diagnostic test performance, discuss the nuance of test result interpretation in a variety of practice settings and highlight important unmet research needs in the COVID-19 diagnostic testing space. METHODS IDSA convened a multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review to identify and prioritize clinical questions and outcomes related to the use of SARS-CoV-2 molecular diagnostics. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. RESULTS The panel agreed on 17 diagnostic recommendations. CONCLUSIONS Universal access to accurate SARS-CoV-2 nucleic acid testing is critical for patient care, hospital infection prevention and the public response to the COVID-19 pandemic. Information on the clinical performance of available tests is rapidly emerging, but the quality of evidence of the current literature is considered moderate to very low. Recognizing these limitations, the IDSA panel weighed available diagnostic evidence and recommends nucleic acid testing for all symptomatic individuals suspected of having COVID-19. In addition, testing is recommended for asymptomatic individuals with known or suspected contact with a COVID-19 case. Testing asymptomatic individuals without known exposure is suggested when the results will impact isolation/quarantine/personal protective equipment (PPE) usage decisions, dictate eligibility for surgery, or inform solid organ or hematopoietic stem cell transplantation timing. Ultimately, prioritization of testing will depend on institutional-specific resources and the needs of different patient populations.
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Affiliation(s)
- Kimberly E Hanson
- Department of Internal Medicine and Pathology, University of Utah, Salt Lake City, Utah
| | - Angela M Caliendo
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cesar A Arias
- Division of Infectious Diseases, Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health McGovern Medical School, Center for Infectious Diseases, University of Texas Health School of Public Health, Houston, TX
| | - Mary K Hayden
- Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois; Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle, Washington
| | - Mark J Lee
- Department of Pathology and Clinical Microbiology Laboratory, Duke University School of Medicine, Durham, North Carolina
| | - Mark Loeb
- Divinsion of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario
| | - Robin Patel
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota
| | - Abdallah El Alayli
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Osama Altayar
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Payal Patel
- Department of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, Georgia
| | - Yngve Falck-Ytter
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Valery Lavergne
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota
| | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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23
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Tariq S, Van Eeden C, Tervaert JWC, Osman MS. COVID-19, rheumatic diseases and immune dysregulation-a perspective. Clin Rheumatol 2021; 40:433-442. [PMID: 33411143 PMCID: PMC7788381 DOI: 10.1007/s10067-020-05529-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/30/2020] [Accepted: 11/26/2020] [Indexed: 12/26/2022]
Abstract
The COVID-19 pandemic has resulted in widespread hospitalisations and deaths around the world. As patients with rheumatic diseases generally have increased risk of infections and complications, understandably, there is significant concern of the impact of SARS-CoV-2 on these patients. However, there is a paucity of data in rheumatic patients. We review mechanisms through which SARS-CoV-2 results in infection, including ACE2 receptor, and complications (including immune dysregulation, thrombosis and complement activation). We assess these pathways in patients with rheumatic disease and those on immune modulating therapy. Although data thus far does not appear to show worse outcomes in rheumatic patients as a whole, given alterations in the underlying immune pathways in certain diseases (such as systemic lupus erythematosus), we posit that the risk is not equal in all rheumatic patients. We also discuss the benefit of underlying disease control with respect to COVID-19 risk reduction and potential increased risk of disease flares following viral infection from an immune standpoint.
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Affiliation(s)
- Shahna Tariq
- Division of Rheumatology, Department of Medicine, University of Alberta, 8-130 Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada
| | - Charmaine Van Eeden
- Division of Rheumatology, Department of Medicine, University of Alberta, 8-130 Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada
| | - Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, University of Alberta, 8-130 Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada
| | - Mohammed S Osman
- Division of Rheumatology, Department of Medicine, University of Alberta, 8-130 Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada.
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24
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Cañas CA. The triggering of post-COVID-19 autoimmunity phenomena could be associated with both transient immunosuppression and an inappropriate form of immune reconstitution in susceptible individuals. Med Hypotheses 2020; 145:110345. [PMID: 33080459 PMCID: PMC7556280 DOI: 10.1016/j.mehy.2020.110345] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/14/2020] [Accepted: 10/10/2020] [Indexed: 01/08/2023]
Abstract
With the progression of the COVID-19 pandemic, there have been different reports about the development of autoimmune diseases once the infection is controlled. After entering the respiratory epithelial cells, SARS-CoV-2-the virus that causes the disease-triggers a severe inflammatory state in some patients known as "cytokine storm" and the development of thrombotic phenomena-both conditions being associated with high mortality. Patients additionally present severe lymphopenia and, in some cases, complement consumption and autoantibody development. There is a normalization of lymphocytes once the infection is controlled. After this, autoimmune conditions of unknown etiology may occur. A hypothesis for the development of post-COVID-19 autoimmunity is proposed based on the consequences of both a transient immunosuppression (both of innate and acquired immunity) in which self-tolerance is lost and an inappropriate form of immune reconstitution that amplifies the process.
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Affiliation(s)
- Carlos A Cañas
- Unit of Rheumatology, Fundación Valle del Lili, Cra.98 No.18-49, Cali 760032, Colombia.
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25
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Tan EH, Sena AG, Prats-Uribe A, You SC, Ahmed WUR, Kostka K, Reich C, Duvall SL, Lynch KE, Matheny ME, Duarte-Salles T, Bertolin SF, Hripcsak G, Natarajan K, Falconer T, Spotnitz M, Ostropolets A, Blacketer C, Alshammari TM, Alghoul H, Alser O, Lane JC, Dawoud DM, Shah K, Yang Y, Zhang L, Areia C, Golozar A, Relcade M, Casajust P, Jonnagaddala J, Subbian V, Vizcaya D, Lai LYH, Nyberg F, Morales DR, Posada JD, Shah NH, Gong M, Vivekanantham A, Abend A, Minty EP, Suchard M, Rijnbeek P, Ryan PB, Prieto-Alhambra D. Characteristics, outcomes, and mortality amongst 133,589 patients with prevalent autoimmune diseases diagnosed with, and 48,418 hospitalised for COVID-19: a multinational distributed network cohort analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.11.24.20236802. [PMID: 33269355 PMCID: PMC7709171 DOI: 10.1101/2020.11.24.20236802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Patients with autoimmune diseases were advised to shield to avoid COVID-19, but information on their prognosis is lacking. We characterised 30-day outcomes and mortality after hospitalisation with COVID-19 among patients with prevalent autoimmune diseases, and compared outcomes after hospital admissions among similar patients with seasonal influenza. DESIGN Multinational network cohort study. SETTING Electronic health records data from Columbia University Irving Medical Center (CUIMC) (NYC, United States [US]), Optum [US], Department of Veterans Affairs (VA) (US), Information System for Research in Primary Care-Hospitalisation Linked Data (SIDIAP-H) (Spain), and claims data from IQVIA Open Claims (US) and Health Insurance and Review Assessment (HIRA) (South Korea). PARTICIPANTS All patients with prevalent autoimmune diseases, diagnosed and/or hospitalised between January and June 2020 with COVID-19, and similar patients hospitalised with influenza in 2017-2018 were included. MAIN OUTCOME MEASURES 30-day complications during hospitalisation and death. RESULTS We studied 133,589 patients diagnosed and 48,418 hospitalised with COVID-19 with prevalent autoimmune diseases. The majority of participants were female (60.5% to 65.9%) and aged ≥50 years. The most prevalent autoimmune conditions were psoriasis (3.5 to 32.5%), rheumatoid arthritis (3.9 to 18.9%), and vasculitis (3.3 to 17.6%). Amongst hospitalised patients, Type 1 diabetes was the most common autoimmune condition (4.8% to 7.5%) in US databases, rheumatoid arthritis in HIRA (18.9%), and psoriasis in SIDIAP-H (26.4%).Compared to 70,660 hospitalised with influenza, those admitted with COVID-19 had more respiratory complications including pneumonia and acute respiratory distress syndrome, and higher 30-day mortality (2.2% to 4.3% versus 6.3% to 24.6%). CONCLUSIONS Patients with autoimmune diseases had high rates of respiratory complications and 30-day mortality following a hospitalization with COVID-19. Compared to influenza, COVID-19 is a more severe disease, leading to more complications and higher mortality. Future studies should investigate predictors of poor outcomes in COVID-19 patients with autoimmune diseases. WHAT IS ALREADY KNOWN ABOUT THIS TOPIC Patients with autoimmune conditions may be at increased risk of COVID-19 infection andcomplications.There is a paucity of evidence characterising the outcomes of hospitalised COVID-19 patients with prevalent autoimmune conditions. WHAT THIS STUDY ADDS Most people with autoimmune diseases who required hospitalisation for COVID-19 were women, aged 50 years or older, and had substantial previous comorbidities.Patients who were hospitalised with COVID-19 and had prevalent autoimmune diseases had higher prevalence of hypertension, chronic kidney disease, heart disease, and Type 2 diabetes as compared to those with prevalent autoimmune diseases who were diagnosed with COVID-19.A variable proportion of 6% to 25% across data sources died within one month of hospitalisation with COVID-19 and prevalent autoimmune diseases.For people with autoimmune diseases, COVID-19 hospitalisation was associated with worse outcomes and 30-day mortality compared to admission with influenza in the 2017-2018 season.
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Affiliation(s)
- Eng Hooi Tan
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, OX3 7LD, UK
| | - Anthony G. Sena
- Janssen Research and Development, Titusville, NJ USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Albert Prats-Uribe
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, OX3 7LD, UK
| | - Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Waheed-Ul-Rahman Ahmed
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
- College of Medicine and Health, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | | | | | - Scott L. Duvall
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kristine E. Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Michael E. Matheny
- Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Sergio Fernandez Bertolin
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, US
- New York-Presbyterian Hospital, New York, NY, US
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University, New York, NY, US
- New York-Presbyterian Hospital, New York, NY, US
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York, NY, US
| | - Matthew Spotnitz
- Department of Biomedical Informatics, Columbia University, New York, NY, US
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University, New York, NY, US
| | - Clair Blacketer
- Janssen Research and Development, Titusville, NJ USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Heba Alghoul
- Faculty of Medicine, Islamic University of Gaza, Palestine
| | - Osaid Alser
- Massachusetts General Hospital, Harvard Medical School, Boston, 02114, Massachusetts, USA
| | - Jennifer C.E. Lane
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, OX3 7LD, UK
| | | | - Karishma Shah
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
| | | | - Lin Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3015, Australia
| | - Carlos Areia
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK
| | - Asieh Golozar
- Regeneron Pharmaceuticals, NY US
- Departament of Epidemiology, Johns Hopkins School of Public, Baltimore MD
| | - Martina Relcade
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autonoma de Barcelona, Spain
| | - Paula Casajust
- Real-World Evidence, Trial Form Support, Barcelona, Spain
| | | | - Vignesh Subbian
- College of Engineering, The University of Arizona Tucson, Arizona, USA
| | | | - Lana YH Lai
- School of Medical Sciences, University of Manchester, UK
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Jose D. Posada
- Stanford Center for Biomedical Informatics Research, Department of Medicine, School of Medicine, Stanford University
| | - Nigam H. Shah
- Stanford Center for Biomedical Informatics Research, Department of Medicine, School of Medicine, Stanford University
| | - Mengchun Gong
- Health Management Institute, Southern Medical University
| | - Arani Vivekanantham
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Aaron Abend
- Autoimmune Registry Inc., 125 West Lane, Guilford, CT 06437
| | - Evan P Minty
- O’Brien School for Public Health, Faculty of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Marc Suchard
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, CA USA
| | - Peter Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Patrick B Ryan
- Janssen Research and Development, Titusville, NJ USA
- Department of Biomedical Informatics, Columbia University, New York, NY, US
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, OX3 7LD, UK
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Boyadzhieva VV, Stoilov NR, Stoilov RM. Coronavirus disease 2019 (COVID-19) during pregnancy in patients with rheumatic diseases. Rheumatol Int 2020; 40:1753-1762. [PMID: 32930863 PMCID: PMC7490482 DOI: 10.1007/s00296-020-04698-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023]
Abstract
The novel coronavirus outbreak induces many concerns about the management of pregnancy, as well as rheumatic and musculoskeletal diseases. The very rapid spread of the infection throughout all inhabited continents leads to a fast-growing number of infected with SARS-CoV-2 and requires answers and special recommendations to the most vulnerable group of people: pregnant woman and patients on immunomodulatory or immunosuppressive treatment. A systematic literature search was performed in Embase, MEDLINE, and Scopus database for studies describing COVID-19 infection in pregnant women diagnosed with rheumatic and musculoskeletal diseases. From the 1,115 initially identified articles, we selected 29 publications in the English language, from which 18 were eligible according to the inclusion criteria. Limited number of cases and further researches are required to evaluate the risk of transmission of SARS-CoV-2 from mother to her infant as well as clinical features of infection in pregnant women. The conclusions of different authors, despite the small number of cases, suggest that there is no vertical transmission in women diagnosed with COVID-19 pneumonia. Although the World Health Organization recently reported that pregnant patients do not have a higher risk of infection than the rest of the population, Royal College of Obstetricians & Gynecologists and The Royal College of Midwives for COVID-19 infection in pregnancy published Guidelines for pregnant women with suspected SARS-CoV-2 infection.Considerations about patients with rheumatic diseases on the immunosuppressive treatment required European League Against Rheumatism, American College of Rheumatology, British Society for Rheumatology, and Australian Rheumatology Association to publish recommendations for patients with rheumatic diseases and COVID-19. These algorithms are very important to the medical society, but many concerns, absence of experience, and many questions are still unanswered and need time to be resolved and proceed successfully in this global pandemic situation.
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Affiliation(s)
- Vladimira Vasileva Boyadzhieva
- Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical University of Sofia, 13 Urvich str, 1612, Sofia, Bulgaria.
| | - Nikolay Rumenov Stoilov
- Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical University of Sofia, 13 Urvich str, 1612, Sofia, Bulgaria
| | - Rumen Malinov Stoilov
- Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical University of Sofia, 13 Urvich str, 1612, Sofia, Bulgaria
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