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Safar Alsofyani I, Samman BS, Alhubayshi SS, Ellahi AT, Alsaedi AB, Almansour M. Impact of COVID-19 Pandemic on Patients With Rheumatic Diseases in Medina, Saudi Arabia: An Observational Cross-Sectional Study. Cureus 2024; 16:e60128. [PMID: 38864060 PMCID: PMC11165667 DOI: 10.7759/cureus.60128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION The Coronavirus disease of 2019 (COVID-19) pandemic undoubtedly ranks among the most health-impacting pandemics throughout medical history. Although the COVID-19 global public health emergency has ended, lessons need to be learned to be more ready to face similar pandemics in the future. Few studies in Saudi Arabia discuss the impact of the COVID-19 pandemic on autoimmune rheumatic disease (AIRD) patients. Thus, this study was conducted to elaborate on the effects of the COVID-19 pandemic on AIRD patients and rheumatology practices in Saudi Arabia. Methods: This observational cross-sectional study was conducted among patients aged over 14 with AIRD using a pre-designed validated survey questionnaire. Data were collected from AIRD patients who were following up between November 2021 to April 2022 at the Rheumatology Clinic of King Fahad General Hospital in Madinah City, Saudi Arabia. This center was chosen as being the main hospital in the city following patients of AIRD. RESULTS A total of 324 patients were included in our study, with the majority (n=264, 81.5%) being females. The mean age was 44.42±14.4 years. Clinical data revealed that 115 (35.5%) of our patients experienced mild COVID-19 infection, 19 (5.9%) suffered from respiratory insufficiency, and seven (2.2%) required admission to the intensive care unit (ICU). Non-compliance to medication was recorded at 25.2%. There were 115 (35.5%) patients who had an AIRD flare that was significantly higher among those who were not adherent to the medications (p<0.001). Disease flare was also significantly seen among patients who were not on prednisone or were on low doses of prednisone (p<0.001). The majority (n=33, 97.1%) of the 34 infected patients who had an AIRD flare had their flare-up at the same time as their COVID-19 infection (p<0.001). COVID-19 vaccination rate was 87.7% (n=284). The most common reason for non-vaccination in 40 (12.3%) patients was the patients' concern about disease flare-ups by the vaccine or interference of the vaccine with their medication (n=16, 4.9%). CONCLUSION Our study showed a 35.5% (n=115) COVID-19 infection rate. The majority of our AIRD patients sustained minor infections that did not require hospitalization or ICU admission. The majority of the patients who underwent a severe COVID-19 infection course were not on prednisolone or were on low-dose prednisone. Due to COVID-19 restrictions and drug shortages, one in four patients (25.3%) stopped taking their medications and was significantly found to have a high prevalence of underlying AIRD flare. Despite the high vaccination rate, disease flare was the biggest concern for those who were not immunized. Although the COVID-19 pandemic has ended, doctors should be aware of risk factors associated with severe AIRD outcomes that should be balanced based on the infection severity, underlying disease flares, and patient-centered education about medication adherence and vaccination.
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Affiliation(s)
| | - Basim S Samman
- Internal Medicine, Ministry of National Guard - Health Affairs, Prince Mohammed Bin Abdulaziz Hospital, Medina, SAU
| | | | - Amjad T Ellahi
- Internal Medicine, King Fahad General Hospital, Medina, SAU
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Patel NJ, Wang X, Lin M, Kowalski EN, Cook CE, Vanni KMM, Guzzo K, Qian G, Bade KJ, Saavedra A, Venkat R, Srivatsan S, Williams ZK, Hanberg JS, Kawano Y, Schiff AE, Sparks JA, Wallace ZS. Factors Associated With an Electronic Health Record-Based Definition of Postacute Sequelae of COVID-19 in Patients With Systemic Autoimmune Rheumatic Disease. J Rheumatol 2024; 51:529-537. [PMID: 38428964 PMCID: PMC11065568 DOI: 10.3899/jrheum.2023-1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Many individuals with rheumatic disease are at higher risk for severe acute coronavirus disease 2019 (COVID-19). We aimed to evaluate risk factors for postacute sequelae of COVID-19 (PASC) using an electronic health record (EHR)-based definition. METHODS We identified patients with prevalent rheumatic diseases and COVID-19 within the Mass General Brigham healthcare system. PASC was defined by the International Classification of Diseases, 10th revision (ICD-10) codes, relevant labs, vital signs, and medications at least 30 days following the first COVID-19 infection. Patients were followed until the earliest of incident PASC, repeat COVID-19 infection, 1 year of follow-up, death, or February 19, 2023. We used multivariable Cox regression to estimate the association of baseline characteristics with PASC risk. RESULTS Among 2459 patients (76.37% female, mean age 57.4 years), the most common incident PASC manifestations were cough (14.56%), dyspnea (12.36%), constipation (11.39%), and fatigue (10.70%). Serious manifestations including acute coronary disease (4.43%), thromboembolism (3.09%), hypoxemia (3.09%), stroke (1.75%), and myocarditis (0.12%) were rare. The Delta wave (adjusted hazard ratio [aHR] 0.63, 95% CI 0.49-0.82) and Omicron era (aHR 0.50, 95% CI 0.41-0.62) were associated with lower risk of PASC than the early pandemic period (March 2020-June 2021). Age, obesity, comorbidity burden, race, and hospitalization for acute COVID-19 infection were associated with greater risk of PASC. Glucocorticoid (GC) use (aHR 1.19, 95% CI 1.05-1.34 compared to no use) was associated with greater risk of PASC. CONCLUSION Among patients with rheumatic diseases, following their first COVID-19 infection, we found a decreased risk of PASC over calendar time using an EHR-based definition. Aside from GCs, no specific immunomodulatory medications were associated with increased risk, and risk factors were otherwise similar to those seen in the general population.
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Affiliation(s)
- Naomi J Patel
- N.J. Patel, MD, MPH, Z.S. Wallace, MD, MSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Harvard Medical School, and Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital
| | - Xiaosong Wang
- X. Wang, MS, E.N. Kowalski, BS, K.M.M. Vanni, BA, G. Qian, BA&Sc, K.J. Bade, BS, A. Saavedra, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Miao Lin
- M. Lin, MS, C.E. Cook, MPH, K. Guzzo, BA, S. Srivatsan, BS, Z.K. Williams, BS, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital
| | - Emily N Kowalski
- X. Wang, MS, E.N. Kowalski, BS, K.M.M. Vanni, BA, G. Qian, BA&Sc, K.J. Bade, BS, A. Saavedra, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Claire E Cook
- M. Lin, MS, C.E. Cook, MPH, K. Guzzo, BA, S. Srivatsan, BS, Z.K. Williams, BS, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital
| | - Kathleen M M Vanni
- X. Wang, MS, E.N. Kowalski, BS, K.M.M. Vanni, BA, G. Qian, BA&Sc, K.J. Bade, BS, A. Saavedra, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Krishan Guzzo
- M. Lin, MS, C.E. Cook, MPH, K. Guzzo, BA, S. Srivatsan, BS, Z.K. Williams, BS, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital
| | - Grace Qian
- X. Wang, MS, E.N. Kowalski, BS, K.M.M. Vanni, BA, G. Qian, BA&Sc, K.J. Bade, BS, A. Saavedra, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Katarina J Bade
- X. Wang, MS, E.N. Kowalski, BS, K.M.M. Vanni, BA, G. Qian, BA&Sc, K.J. Bade, BS, A. Saavedra, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Alene Saavedra
- X. Wang, MS, E.N. Kowalski, BS, K.M.M. Vanni, BA, G. Qian, BA&Sc, K.J. Bade, BS, A. Saavedra, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | | | - Shruthi Srivatsan
- M. Lin, MS, C.E. Cook, MPH, K. Guzzo, BA, S. Srivatsan, BS, Z.K. Williams, BS, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital
| | - Zachary K Williams
- M. Lin, MS, C.E. Cook, MPH, K. Guzzo, BA, S. Srivatsan, BS, Z.K. Williams, BS, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital
| | - Jennifer S Hanberg
- J.S. Hanberg, MD, Y. Kawano, MD, J.A. Sparks, MD, MMSc, Harvard Medical School, and Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Yumeko Kawano
- J.S. Hanberg, MD, Y. Kawano, MD, J.A. Sparks, MD, MMSc, Harvard Medical School, and Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Abigail E Schiff
- A.E. Schiff, MD, PhD, Harvard Medical School, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jeffrey A Sparks
- J.S. Hanberg, MD, Y. Kawano, MD, J.A. Sparks, MD, MMSc, Harvard Medical School, and Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Zachary S Wallace
- N.J. Patel, MD, MPH, Z.S. Wallace, MD, MSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Harvard Medical School, and Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital;
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Abutiban F, Saleh K, Hayat S, Tarakmah H, Al-Herz A, Ghanem A. COVID-19 and reported mortality cases among rheumatic disease patients in Kuwait: Data from the Global Rheumatology Alliance registry. Int J Rheum Dis 2024; 27:e14771. [PMID: 37287425 DOI: 10.1111/1756-185x.14771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/10/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
Mycophenolate mofetil and rituximab have been shown to be considerably associated with poorer outcomes following SARS-CoV-2 infection. Such agents were associated with longer hospital stay as well as severe COVID-19 outcomes (infection-related complications, intensive care unit admission, and mortality). Using the data of the COVID-19 Global Rheumatology Alliance (GRA) registry of inflammatory rheumatic disease (IRD) patients in Kuwait, who had COVID-19 from March 2020 to March 2021, revealed 4 mortality cases (3 cases used CD-20 inhibitors as monotherapy and 1 case used mycophenolate mofetil/mycophenolic acid as monotherapy). This article describes the characteristics and course of disease among 4 patients with IRD who died following COVID-19 infection at Jaber Al Ahmed Hospital, Kuwait. The current series raises the intriguing prospect that IRD patients may have a varying risk of unfavorable clinical outcomes depending on the type of biological agents they were given. Rituximab and mycophenolate mofetil should be used with caution in IRD patients, particularly if they have concomitant comorbidities that put them at a high likelihood of developing severe COVID-19 outcomes.
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Affiliation(s)
- Fatemah Abutiban
- Department of Medicine, Ministry of Health, Jaber Alahmed Hospital, Kuwait City, Kuwait
| | - Khulood Saleh
- Department of Medicine, Ministry of Health, Farwaniyah Hospital, Kuwait City, Kuwait
| | - Sawsan Hayat
- Department of Medicine, Ministry of Health, Mubarak Alkabeer Hospital, Kuwait City, Kuwait
| | - Hoda Tarakmah
- Department of Medicine, Ministry of Health, Mubarak Alkabeer Hospital, Kuwait City, Kuwait
| | - Adeeba Al-Herz
- AlAmiri Hospital, Department of Medicine, Ministry of Health, Kuwait City, Kuwait
| | - Aqeel Ghanem
- Department of Medicine, Ministry of Health, Mubarak Alkabeer Hospital, Kuwait City, Kuwait
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Deibel E, Carreira PE, Vonk M, Del Papa N, Bečvář R, Guillén-Del-Castillo A, Campochiaro C, Poormoghim H, Liem S, Lazzaroni MG, Giollo A, Mekinian A, de Vries-Bouwstra J, De Santis M, Balbir-Gurman A, Mihai C, De Luca G, Moiseev S, Zanatta E, Foti R, Rednic S, Denton C, Cutolo M, Belloli L, Airo P, Garzanova L, Moroncini G, İnanç M, Panopoulos S, Tandaipan JL, Chatelus E, Rosato E, Kuwana M, Yavuz S, Alegre-Sancho JJ, Smith V, Szűcs G, Henes J, Rodríguez-Pintó I, Atzeni F, Spierings J, Truchetet ME, Milchert M, Brito de Araujo D, Riemekasten G, Bernardino V, Martin T, Del Galdo F, Vacca A, Mendoza F, Midtvedt Ø, Murdaca G, Santiago T, Codullo V, Cacciapaglia F, Walker U, Brunborg C, Tirelli F, Allanore Y, Furst DE, Matucci M, Gabrielli A, Distler O, Hoffmann-Vold AM. Does the Impact of COVID-19 on Patients With Systemic Sclerosis Change Over Time? Arthritis Care Res (Hoboken) 2024; 76:88-97. [PMID: 37667424 DOI: 10.1002/acr.25226] [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: 03/31/2023] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE The outcome of patients with COVID-19 improved over the pandemic, including patients with systemic rheumatic diseases. However, data on patients with systemic sclerosis (SSc) are lacking. This study aimed to assess the outcome of patients with both SSc and COVID-19 over several waves. METHODS Patients with both SSc and COVID-19 who were registered in the European Scleroderma Trials and Research group (EUSTAR) were collected between April 2020 and April 2021. Patients were assigned to waves 1, 2, or 3 depending on the date of their COVID-19 diagnosis. Primary endpoints were death, intensive care unit stay, or ventilatory support (severe outcome). Subgroup analyses of patients who were hospitalized or died were conducted. General and SSc-specific characteristics and treatment were compared over the waves. Descriptive statistics and multivariate logistic regression were applied. RESULTS A total of 333 patients were included; 57 patients (17%) had a severe outcome, and 30 patients (9%) died. Compared to wave 1, significantly fewer patients with SSc suffered from severe COVID-19 in waves 2 and 3 (28.2% vs 9.8% and 12.7%; P < 0.001), fewer patients required hospitalization (46.7% vs 19.6% and 25.5%; P < 0.001) or ventilatory support (24.0% vs 8.7% and 10.9%; P = 0.001), and fewer patients died (15.7% vs 5.0% and 7.5%; P = 0.011). Patients were significantly younger, more often men, had less frequent arterial hypertension, and less SSc cardiac involvement over waves 1 to 3. Patients received significantly less medium to high doses of corticosteroids as they did SSc treatment. CONCLUSION The outcome of patients with both SSc and COVID-19 improved significantly over time because of intrinsic and extrinsic factors.
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Affiliation(s)
- Elisabeth Deibel
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Madelon Vonk
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Radim Bečvář
- 1st Medical School, Charles University, Praha, Czech Republic
| | | | | | | | - Sophie Liem
- Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | - Maria De Santis
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy, and Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Carina Mihai
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Sergey Moiseev
- Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | | | - Rosario Foti
- A.O.U. Policlinico S. Marco Catania, Catania, Italy
| | - Simona Rednic
- University of Medicine & Pharmacy "Iuliu Hatieganu" Cluj, Cluj-Napoca, Romania
| | | | | | - Laura Belloli
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Paolo Airo
- ASST Spedali Civili of Brescia, University of Brescia, Italy
| | - Liudmila Garzanova
- VA Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Gianluca Moroncini
- Università Politecnica delle Marche, Polo Didattico, University of Ancona, Ancona, Italy
| | | | | | | | - Emmanuel Chatelus
- Centre National de Référence des Maladies Auto-immunes et Systémiques Rares Est/Sud-Ouest (RESO), Strasbourg, France
| | | | | | | | | | - Vanessa Smith
- Ghent University, Ghent University Hospital, and VIB Inflammation Research Center (IRC), Ghent, Belgium
| | | | - Joerg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases (INDIRA), University Hospital Tuebingen, Tuebingen, Germany
| | | | | | | | | | | | | | - Gabriela Riemekasten
- University Clinic Schleswig Holstein Lübeck, University of Lübeck, Lübeck, Germany
| | - Vera Bernardino
- Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Thierry Martin
- Centre de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO), Nouvel Hôpital Civil, Strasbourg, France
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Biomedical Research Centre, University of Leeds, Leeds, UK
| | | | | | | | - Giuseppe Murdaca
- University of Genova and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Tânia Santiago
- Centro Hospital e Universitário de Coimbra, University of Coimbra, Portugal
| | | | | | | | | | - Francesca Tirelli
- University Hospital Zurich, University of Zurich, Zurich, Switzerland, and University of Padova, Padova, Italy
| | | | | | - Marco Matucci
- University of Florence, Florence, Italy and IRCCS San Raffaele Hospital, Milan, Italy
| | - Armando Gabrielli
- Università Politecnica delle Marche, Polo Didattico, University of Ancona, Ancona, Italy
| | - Oliver Distler
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anna-Maria Hoffmann-Vold
- University Hospital Zurich, University of Zurich, Zurich, Switzerland and Oslo University Hospital, Oslo, Norway
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Kowalski EN, Wang X, Patel NJ, Kawano Y, Cook CE, Vanni KMM, Qian G, Bade KJ, Srivatsan S, Williams ZK, Wallace ZS, Sparks JA. Risk factors and outcomes for repeat COVID-19 infection among patients with systemic autoimmune rheumatic diseases: A case-control study. Semin Arthritis Rheum 2023; 63:152286. [PMID: 37913612 PMCID: PMC10842150 DOI: 10.1016/j.semarthrit.2023.152286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To investigate risk factors and outcomes of repeat COVID-19 infections among patients with systemic autoimmune rheumatic diseases (SARDs). METHODS We performed a case-control study investigating repeat COVID-19 infection within the Mass General Brigham Health Care System. We systematically identified all SARD patients with confirmed COVID-19 (15/Mar/2020 to 17/Oct/2022). Cases had confirmed repeat COVID-19 infections >60 days apart (index date: repeat COVID-19 date). Controls were matched to cases (up to 3:1) by calendar date of first infection and duration between first COVID-19 infection and index dates. We collected demographics, lifestyle, comorbidities, SARD features, and COVID-19 characteristics at initial infection and index date by medical record review. We used conditional logistic regression to identify associations with repeat COVID-19 infection, adjusting for potential confounders. We described the severity of repeat COVID-19 infection among cases. RESULTS Among 2203 SARD patients with COVID-19, we identified 76 cases with repeat COVID-19 infection (80.3 % female) and matched to 207 matched controls (77.8 % female) with no repeat infection. At first infection, cases were younger (mean 49.5 vs. 60.3 years, p < 0.0001), less likely to have hypertension (32.9 % vs. 45.9 %, p = 0.050), and less likely to have been hospitalized for COVID-19 (13.2 % vs. 24.6 %, p = 0.037) than controls. At index date, cases were more likely than controls to be rituximab users (18.4 % vs. 6.3 %, p = 0.0021). In the multivariable model, younger age (OR 0.67 per 10 years, 95 %CI 0.54-0.82), rituximab use vs. non-use (OR 3.38, 95 %CI 1.26-9.08), and methotrexate use vs. non-use (OR 2.24, 95 %CI 1.08-4.61) were each associated with repeat COVID-19 infection. Among those with repeat COVID-19 infection, 5/76 (6.6 %) were hospitalized and there were no deaths. CONCLUSION Younger age, rituximab, and methotrexate were each associated with repeat COVID-19 infection risk among patients with SARDs. Reassuringly, there were no deaths, and the hospitalization rate was low among those with repeat COVID-19 infection.
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Affiliation(s)
- Emily N Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Xiaosong Wang
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Naomi J Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Yumeko Kawano
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA; Harvard Medical School, Boston, MA, USA
| | - Claire E Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Kathleen M M Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Katarina J Bade
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Shruthi Srivatsan
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Zachary K Williams
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114, USA; Harvard Medical School, Boston, MA, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA; Harvard Medical School, Boston, MA, USA.
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Yadaw AS, Sahner DK, Sidky H, Afzali B, Hotaling N, Pfaff ER, Mathé EA. Preexisting Autoimmunity Is Associated With Increased Severity of Coronavirus Disease 2019: A Retrospective Cohort Study Using Data From the National COVID Cohort Collaborative (N3C). Clin Infect Dis 2023; 77:816-826. [PMID: 37207367 PMCID: PMC10506777 DOI: 10.1093/cid/ciad294] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Identifying individuals with a higher risk of developing severe coronavirus disease 2019 (COVID-19) outcomes will inform targeted and more intensive clinical monitoring and management. To date, there is mixed evidence regarding the impact of preexisting autoimmune disease (AID) diagnosis and/or immunosuppressant (IS) exposure on developing severe COVID-19 outcomes. METHODS A retrospective cohort of adults diagnosed with COVID-19 was created in the National COVID Cohort Collaborative enclave. Two outcomes, life-threatening disease and hospitalization, were evaluated by using logistic regression models with and without adjustment for demographics and comorbidities. RESULTS Of the 2 453 799 adults diagnosed with COVID-19, 191 520 (7.81%) had a preexisting AID diagnosis and 278 095 (11.33%) had a preexisting IS exposure. Logistic regression models adjusted for demographics and comorbidities demonstrated that individuals with a preexisting AID (odds ratio [OR], 1.13; 95% confidence interval [CI]: 1.09-1.17; P < .001), IS exposure (OR, 1.27; 95% CI: 1.24-1.30; P < .001), or both (OR, 1.35; 95% CI: 1.29-1.40; P < .001) were more likely to have a life-threatening disease. These results were consistent when hospitalization was evaluated. A sensitivity analysis evaluating specific IS revealed that tumor necrosis factor inhibitors were protective against life-threatening disease (OR, 0.80; 95% CI: .66-.96; P = .017) and hospitalization (OR, 0.80; 95% CI: .73-.89; P < .001). CONCLUSIONS Patients with preexisting AID, IS exposure, or both are more likely to have a life-threatening disease or hospitalization. These patients may thus require tailored monitoring and preventative measures to minimize negative consequences of COVID-19.
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Affiliation(s)
- Arjun S Yadaw
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
| | - David K Sahner
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
| | - Hythem Sidky
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
| | - Behdad Afzali
- Immunoregulation Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Nathan Hotaling
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
| | - Emily R Pfaff
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ewy A Mathé
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
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Herman JD, Atyeo C, Zur Y, Cook CE, Patel NJ, Vanni KM, Kowalski EN, Qian G, Srivatsan S, Shadick NA, Rao DA, Kellman B, Mann CJ, Lauffenburger D, Wallace ZS, Sparks JA, Alter G. Humoral immunity to an endemic coronavirus is associated with postacute sequelae of COVID-19 in individuals with rheumatic diseases. Sci Transl Med 2023; 15:eadf6598. [PMID: 37672567 PMCID: PMC10764151 DOI: 10.1126/scitranslmed.adf6598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/05/2023] [Indexed: 09/08/2023]
Abstract
Beyond the acute illness caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) infection, about one-fifth of infections result in long-term persistence of symptoms despite the apparent clearance of infection. Insights into the mechanisms that underlie postacute sequelae of COVID-19 (PASC) will be critical for the prevention and clinical management of long-term complications of COVID-19. Several hypotheses have been proposed that may account for the development of PASC, including persistence of virus and dysregulation of immune responses. Among the immunological changes noted in PASC, alterations in humoral immunity have been observed in some patient subsets. To begin to determine whether SARS-CoV-2- or other pathogen-specific humoral immune responses evolve uniquely in PASC, we performed comprehensive antibody profiling against SARS-CoV-2, a panel of endemic pathogens, and a panel of routine vaccine antigens using systems serology in two cohorts of patients with preexisting systemic autoimmune rheumatic disease (SARD) who either developed or did not develop PASC. A distinct qualitative shift observed in Fcγ receptor (FcγR) binding was observed in individuals with PASC. Specifically, individuals with PASC harbored weaker FcγR-binding anti-SARS-CoV-2 antibodies and stronger FcγR-binding antibody responses against the endemic coronavirus OC43. Individuals with PASC developed an OC43 S2-specific antibody response with stronger FcγR binding, linked to cross-reactivity across SARS-CoV-2 and common coronaviruses. These findings identify previous coronavirus imprinting as a potential marker for the development of PASC in individuals with SARDs.
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Affiliation(s)
- Jonathan D Herman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Caroline Atyeo
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Yonatan Zur
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Claire E Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Naomi J Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kathleen M Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Emily N Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Shruthi Srivatsan
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nancy A Shadick
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Deepak A Rao
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Benjamin Kellman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Colin J Mann
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Douglas Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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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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9
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Zaccardelli A, Wallace ZS, Sparks JA. Acute and postacute COVID-19 outcomes for patients with rheumatoid arthritis: lessons learned and emerging directions 3 years into the pandemic. Curr Opin Rheumatol 2023; 35:175-184. [PMID: 36752280 PMCID: PMC10065912 DOI: 10.1097/bor.0000000000000930] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE OF REVIEW To summarize the findings of studies investigating patients with rheumatoid arthritis (RA) and risk of acute and postacute COVID-19 outcomes 3 years into the pandemic. RECENT FINDINGS Most studies early in the pandemic included all patients with systemic autoimmune rheumatic diseases (SARDs), not only those with RA, due to limited sample size. Many of these studies found that patients with SARDs were at higher risk of COVID-19 infection and severe outcomes, including hospitalization, hyperinflammation, mechanical ventilation, and death. Studies performed later were able to focus on RA and found similar associations, while also identifying RA-specific factors such as immunosuppressive medications, disease activity/severity, and interstitial lung disease as risk factors for severe COVID-19. After COVID-19 vaccination, the risks for COVID-19 infection and severity were reduced for patients with RA, but a gap between the general population persisted, and some patients with RA are susceptible to breakthrough infection after vaccination. Preexposure prophylaxis, effective treatments, and changes in viral variants have also contributed to improved COVID-19 outcomes throughout the pandemic. Emerging data suggest that patients with RA may be at risk for postacute sequelae of COVID-19 (PASC). SUMMARY Although COVID-19 outcomes have improved over the pandemic for patients with RA, some experience poor acute and postacute outcomes after COVID-19. Clinicians and patients should remain vigilant about risk mitigation for infection and consider early treatment for RA patients with COVID-19. Future studies are needed to investigate clinical outcomes and mechanisms of PASC among patients with RA.
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Affiliation(s)
| | - Zachary S. Wallace
- Division of Rheumatology, Allergy, and Immunology
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital
- Harvard Medical School
| | - Jeffrey A. Sparks
- Harvard Medical School
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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10
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Patel NJ, Cook C, Vanni K, Fu X, Wang X, Kawano Y, Qian G, Hang B, Srivatsan S, Banasiak EP, Kowalski E, Bade K, Zhang Y, Sparks JA, Wallace ZS. Impact of vaccination on postacute sequelae of SARS CoV-2 infection in patients with rheumatic diseases. Ann Rheum Dis 2023; 82:565-573. [PMID: 36442978 PMCID: PMC10225013 DOI: 10.1136/ard-2022-223439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Vaccination decreases the risk of severe COVID-19 but its impact on postacute sequelae of COVID-19 (PASC) is unclear among patients with systemic autoimmune rheumatic diseases (SARDs) who may have blunted vaccine immunogenicity and be vulnerable to PASC. METHODS We prospectively enrolled patients with SARD from a large healthcare system who survived acute infection to complete surveys. The symptom-free duration and the odds of PASC (any symptom lasting ≥28 or 90 days) were evaluated using restricted mean survival time and multivariable logistic regression, respectively, among those with and without breakthrough infection (≥14 days after initial vaccine series). RESULTS Among 280 patients (11% unvaccinated; 48% partially vaccinated; 41% fully vaccinated), the mean age was 53 years, 80% were female and 82% were white. The most common SARDs were inflammatory arthritis (59%) and connective tissue disease (24%). Those with breakthrough infection had more upper respiratory symptoms, and those with non-breakthrough infection had more anosmia, dysgeusia and joint pain. Compared with those with non-breakthrough COVID-19 infection (n=164), those with breakthrough infection (n=116) had significantly more symptom-free days over the follow-up period (+21.4 days, 95% CI 0.95 to 41.91; p=0.04) and lower odds of PASC at 28 and 90 days (adjusted OR, aOR 0.49, 95% CI 0.29 to 0.83 and aOR 0.10, 95% CI 0.04 to 0.22, respectively). CONCLUSION Vaccinated patients with SARDs were less likely to experience PASC compared with those not fully vaccinated. While we cannot rule out the possibility that findings may be due to intrinsic differences in PASC risk from different SARS-CoV-2 variants, these findings support the benefits of vaccination for patients with SARDs and suggest that the immune response to acute infection is important in the pathogenesis of PASC in patients with SARDs.
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Affiliation(s)
- Naomi J Patel
- Rheumatology Unit and Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Claire Cook
- Rheumatology Unit and Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathleen Vanni
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Xiaoqing Fu
- Rheumatology Unit and Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Xiaosong Wang
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yumeko Kawano
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Grace Qian
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Buuthien Hang
- Rheumatology Unit and Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shruthi Srivatsan
- Rheumatology Unit and Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily P Banasiak
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Emily Kowalski
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Katarina Bade
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yuqing Zhang
- Rheumatology Unit and Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Zachary S Wallace
- Rheumatology Unit and Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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11
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Akiyama S, Hamdeh S, Micic D, Sakuraba A. Response to: 'Correspondence on 'Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis'' by Yang et al. Ann Rheum Dis 2023; 82:e80. [PMID: 33452000 DOI: 10.1136/annrheumdis-2021-219855] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Shintaro Akiyama
- Inflammatory Bowel Disease Center, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Shadi Hamdeh
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas, Kansas City, Kansas, USA
| | - Dejan Micic
- Inflammatory Bowel Disease Center, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Atsushi Sakuraba
- Inflammatory Bowel Disease Center, The University of Chicago Medicine, Chicago, Illinois, USA
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12
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Kharouf F, Eviatar T, Braun M, Pokroy-Shapira E, Brodavka M, Zloof Y, Agmon-Levin N, Toledano K, Oren S, Lidar M, Zisman D, Tavor Y, Amit-Vazina M, Sabbah F, Breuer GS, Dagan A, Beshara-Garzuzi R, Markovits D, Elias M, Feld J, Tayer-Shifman O, Gazitt T, Reitblatt T, Rubin L, Haddad A, Giryes S, Paran D, Peleg H, Molad Y, Elkayam O, Mevorach D, Balbir-Gurman A, Braun-Moscovici Y. A deep look into the storm: Israeli multi-center experience of coronavirus disease 2019 (COVID-19) in patients with autoimmune inflammatory rheumatic diseases before and after vaccinations. Front Immunol 2023; 14:1064839. [PMID: 36993961 PMCID: PMC10040776 DOI: 10.3389/fimmu.2023.1064839] [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: 10/08/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectiveWe aimed to characterize the course of COVID-19 in autoimmune inflammatory rheumatic disease (AIIRD) patients in Israel, taking into consideration several remarkable aspects, including the outcomes of the different outbreaks, the effect of vaccination campaigns, and AIIRD activity post-recovery.MethodsWe established a national registry of AIIRD patients diagnosed with COVID-19, including demographic data, AIIRD diagnosis, duration and systemic involvement, comorbidities, date of COVID-19 diagnosis, clinical course, and dates of vaccinations. COVID-19 was diagnosed by a positive SARS-CoV-2 polymerase chain reaction.ResultsIsrael experienced 4 outbreaks of COVID-19 until 30.11.2021. The first three outbreaks (1.3.2020 – 30.4.2021) comprised 298 AIIRD patients. 64.9% had a mild disease and 24.2% had a severe course; 161 (53.3%) patients were hospitalized, 27 (8.9%) died. The 4th outbreak (delta variant), starting 6 months after the beginning of the vaccination campaign comprised 110 patients. Despite similar demographic and clinical characteristics, a smaller proportion of AIIRD patients had negative outcomes as compared to the first 3 outbreaks, with regards to severity (16 patients,14.5%), hospitalization (29 patients, 26.4%) and death (7 patients, 6.4%). COVID-19 did not seem to influence the AIIRD activity 1-3 months post-recovery.ConclusionsCOVID-19 is more severe and has an increased mortality in active AIIRD patients with systemic involvement, older age and comorbidities. Vaccination with 3 doses of the mRNA vaccine against SARS-CoV-2 protected from severe COVID-19, hospitalization and death during the 4th outbreak. The pattern of spread of COVID-19 in AIIRD patients was similar to the general population.
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Affiliation(s)
- Fadi Kharouf
- The Department of Medicine, Rheumatology Unit and Rare Disease Research Center, Hadassah Medical Center, Jerusalem, Israel
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tali Eviatar
- Rheumatology Department, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Braun
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elisheva Pokroy-Shapira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Rheumatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Michal Brodavka
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Yair Zloof
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nancy Agmon-Levin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clinical Immunology, Angioedema and Allergy Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Kochava Toledano
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
| | - Shirly Oren
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Rheumatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Merav Lidar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Devy Zisman
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Yonit Tavor
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
| | - Mirit Amit-Vazina
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Service, Shamir Medical Center, Be’er Ya’akov, Israel
| | - Firas Sabbah
- Rheumatology Service, Baruch Padeh Medical Center, Tiberias, Israel
| | - Gabriel S. Breuer
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Rheumatology Unit, Shaare Tzedek Medical Center, Jerusalem, Israel
| | - Amir Dagan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Clinic, Assuta Ashdod Hospital, Ashdod, Israel
| | - Rima Beshara-Garzuzi
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Doron Markovits
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
| | - Muna Elias
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Joy Feld
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Oshrat Tayer-Shifman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Tal Gazitt
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | | | - Limor Rubin
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Allergy and Clinical Immunology Unit, Department of medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Amir Haddad
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Sami Giryes
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
| | - Daphna Paran
- Rheumatology Department, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Peleg
- The Department of Medicine, Rheumatology Unit and Rare Disease Research Center, Hadassah Medical Center, Jerusalem, Israel
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yair Molad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Rheumatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Ori Elkayam
- Rheumatology Department, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Mevorach
- The Department of Medicine, Rheumatology Unit and Rare Disease Research Center, Hadassah Medical Center, Jerusalem, Israel
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alexandra Balbir-Gurman
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
| | - Yolanda Braun-Moscovici
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- *Correspondence: Yolanda Braun-Moscovici,
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Yadaw AS, Afzali B, Hotaling N, Sidky H, Pfaff ER, Sahner DK, Mathé EA. Pre-existing autoimmunity is associated with increased severity of COVID-19: A retrospective cohort study using data from the National COVID Cohort Collaborative (N3C). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.02.23285353. [PMID: 36778264 PMCID: PMC9915827 DOI: 10.1101/2023.02.02.23285353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Importance Identifying individuals with a higher risk of developing severe COVID-19 outcomes will inform targeted or more intensive clinical monitoring and management. Objective To examine, using data from the National COVID Cohort Collaborative (N3C), whether patients with pre-existing autoimmune disease (AID) diagnosis and/or immunosuppressant (IS) exposure are at a higher risk of developing severe COVID-19 outcomes. Design setting and participants A retrospective cohort of 2,453,799 individuals diagnosed with COVID-19 between January 1 st , 2020, and June 30 th , 2022, was created from the N3C data enclave, which comprises data of 15,231,849 patients from 75 USA data partners. Patients were stratified as those with/without a pre-existing diagnosis of AID and/or those with/without exposure to IS prior to COVID-19. Main outcomes and measures Two outcomes of COVID-19 severity, derived from the World Health Organization severity score, were defined, namely life-threatening disease and hospitalization. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using logistic regression models with and without adjustment for demographics (age, BMI, gender, race, ethnicity, smoking status), and comorbidities (cardiovascular disease, dementia, pulmonary disease, liver disease, type 2 diabetes mellitus, kidney disease, cancer, and HIV infection). Results In total, 2,453,799 (16.11% of the N3C cohort) adults (age> 18 years) were diagnosed with COVID-19, of which 191,520 (7.81%) had a prior AID diagnosis, and 278,095 (11.33%) had a prior IS exposure. Logistic regression models adjusted for demographic factors and comorbidities demonstrated that individuals with a prior AID (OR = 1.13, 95% CI 1.09 - 1.17; p =2.43E-13), prior exposure to IS (OR= 1.27, 95% CI 1.24 - 1.30; p =3.66E-74), or both (OR= 1.35, 95% CI 1.29 - 1.40; p =7.50E-49) were more likely to have a life-threatening COVID-19 disease. These results were confirmed after adjusting for exposure to antivirals and vaccination in a cohort subset with COVID-19 diagnosis dates after December 2021 (AID OR = 1.18, 95% CI 1.02 - 1.36; p =2.46E-02; IS OR= 1.60, 95% CI 1.41 - 1.80; p =5.11E-14; AID+IS OR= 1.93, 95% CI 1.62 - 2.30; p =1.68E-13). These results were consistent when evaluating hospitalization as the outcome and also when stratifying by race and sex. Finally, a sensitivity analysis evaluating specific IS revealed that TNF inhibitors were protective against life-threatening disease (OR = 0.80, 95% CI 0.66-0.96; p =1.66E-2) and hospitalization (OR = 0.80, 95% CI 0.73 - 0.89; p =1.06E-05). Conclusions and Relevance Patients with pre-existing AID, exposure to IS, or both are more likely to have a life-threatening disease or hospitalization. These patients may thus require tailored monitoring and preventative measures to minimize negative consequences of COVID-19.
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Affiliation(s)
- Arjun S. Yadaw
- National Center for Advancing Translational Sciences (NCATS), NIH, Rockville, MD, USA
| | - Behdad Afzali
- Immunoregulation Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH, Bethesda, MD, USA
| | - Nathan Hotaling
- National Center for Advancing Translational Sciences (NCATS), NIH, Rockville, MD, USA
| | - Hythem Sidky
- National Center for Advancing Translational Sciences (NCATS), NIH, Rockville, MD, USA
| | - Emily R Pfaff
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - David K. Sahner
- National Center for Advancing Translational Sciences (NCATS), NIH, Rockville, MD, USA
| | - Ewy A. Mathé
- National Center for Advancing Translational Sciences (NCATS), NIH, Rockville, MD, USA
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Isnardi CA, Roberts K, Saurit V, Petkovic I, Báez RM, Quintana R, Tissera Y, Ornella S, D.Angelo Exeni ME, Pisoni CN, Castro Coello VV, Berbotto G, Haye Salinas MJ, Velozo E, Reyes Torres ÁA, Tanten R, Zelaya MD, Gobbi C, Alonso CG, de los Ángeles Severina M, Vivero F, Paula A, Cogo AK, Alle G, Pera M, Nieto RE, Cosatti M, Asnal C, Pereira D, Albiero JA, Savio VG, Maldonado FN, Gamba MJ, Germán NF, Baños A, Gallino Yanzi J, Gálvez Elkin MS, Morbiducci JS, Martire MV, Maldonado Ficco H, Schmid MM, Villafañe Torres JA, de los Ángeles Correa M, Medina MA, Cusa MA, Scafati J, Agüero SE, Lloves Schenone NM, Soriano ER, Graf C, Pons-Estel BA, Gomez G, Landi M, De la Vega MC, Pons-Estel GJ. Sociodemographic and clinical factors associated with poor COVID-19 outcomes in patients with rheumatic diseases: data from the SAR-COVID Registry. Clin Rheumatol 2023; 42:563-578. [PMID: 36201124 PMCID: PMC9535223 DOI: 10.1007/s10067-022-06393-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVE This study aims to describe the course and to identify poor prognostic factors of SARS-CoV-2 infection in patients with rheumatic diseases. METHODS Patients ≥ 18 years of age, with a rheumatic disease, who had confirmed SARS-CoV-2 infection were consecutively included by major rheumatology centers from Argentina, in the national, observational SAR-COVID registry between August 13, 2020 and July 31, 2021. Hospitalization, oxygen requirement, and death were considered poor COVID-19 outcomes. RESULTS A total of 1915 patients were included. The most frequent rheumatic diseases were rheumatoid arthritis (42%) and systemic lupus erythematosus (16%). Comorbidities were reported in half of them (48%). Symptoms were reported by 95% of the patients, 28% were hospitalized, 8% were admitted to the intensive care unit (ICU), and 4% died due to COVID-19. During hospitalization, 9% required non-invasive mechanical ventilation (NIMV) or high flow oxygen devices and 17% invasive mechanical ventilation (IMV). In multivariate analysis models, using poor COVID-19 outcomes as dependent variables, older age, male gender, higher disease activity, treatment with glucocorticoids or rituximab, and the presence of at least one comorbidity and a greater number of them were associated with worse prognosis. In addition, patients with public health insurance and Mestizos were more likely to require hospitalization. CONCLUSIONS In addition to the known poor prognostic factors, in this cohort of patients with rheumatic diseases, high disease activity, and treatment with glucocorticoids and rituximab were associated with worse COVID-19 outcomes. Furthermore, patients with public health insurance and Mestizos were 44% and 39% more likely to be hospitalized, respectively. STUDY REGISTRATION This study has been registered in ClinicalTrials.gov under the number NCT04568421. Key Points • High disease activity, and treatment with glucocorticoids and rituximab were associated with poor COVID-19 outcome in patients with rheumatic diseases. • Some socioeconomic factors related to social inequality, including non-Caucasian ethnicity and public health insurance, were associated with hospitalization due to COVID-19.
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Affiliation(s)
- Carolina A. Isnardi
- Present Address: Unidad de Investigación de la Sociedad Argentina de Reumatología, Buenos Aires, Argentina
| | - Karen Roberts
- Present Address: Unidad de Investigación de la Sociedad Argentina de Reumatología, Buenos Aires, Argentina
| | - Verónica Saurit
- grid.413199.70000 0001 0368 1276Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | | | - Roberto M. Báez
- Hospital Francisco López Lima, General Roca, Río Negro, Argentina
| | - Rosana Quintana
- Present Address: Centro Regional de Enfermedades Autoinmunes Y Reumáticas, Rosario, Argentina
| | - Yohana Tissera
- grid.497623.dPresent Address: Hospital Córdoba, Córdoba, Argentina
| | - Sofía Ornella
- HIGA San Martín de La Plata, La Plata, Buenos Aires, Argentina
| | | | - Cecilia N. Pisoni
- grid.418248.30000 0004 0637 5938CEMIC—Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
| | | | - Guillermo Berbotto
- Hospital Escuela Eva Perón, Sanatorio Británico, Granadero Baigorria; Rosario, Santa Fe, Argentina
| | - María J. Haye Salinas
- grid.441659.b0000 0001 2201 7776CEMMA, Universidad Nacional de La Rioja, La Rioja, Argentina
| | - Edson Velozo
- grid.441666.70000 0001 2284 8908Sanatorio y Universidad Adventista del Plata, Libertador San Martín, Entre Ríos, Argentina
| | - Álvaro A. Reyes Torres
- grid.414775.40000 0001 2319 4408Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Romina Tanten
- grid.414775.40000 0001 2319 4408Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Carla Gobbi
- grid.10692.3c0000 0001 0115 2557Cátedra de Clínica Médica I, Hospital Córdoba, FCM, UNC, Córdoba, Argentina
| | | | | | | | - Alba Paula
- Hospital Materno-Neonatal, Córdoba, Argentina
| | - Adriana K. Cogo
- Hospital Interzonal Luis Guemes, Haedo; Hospital San Juan de Dios, Castelar, Buenos Aires, Argentina
| | - Gelsomina Alle
- grid.414775.40000 0001 2319 4408Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mariana Pera
- Hospital Ángel C Padilla, San Miguel de Tucumán, Tucumán, Argentina
| | | | - Micaela Cosatti
- grid.418248.30000 0004 0637 5938CEMIC—Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | - Andrea Baños
- Fundación CIDEA, Ciudad Autónoma de Buenos Aires, Sindicato Empleados de Junín, Junín, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | - Maria de los Ángeles Correa
- grid.419103.eInstituto de Rehabilitación Psicofísica, Instituto de Diagnóstico E Investigaciones Metabólicas, Buenos Aires, Argentina
| | | | | | - Julia Scafati
- HIGA San Martín de La Plata, La Plata, Buenos Aires, Argentina
| | - Santiago E. Agüero
- Centro de Rehabilitación Dr Mauricio Figueroa, Artrosport Catamarca, San Fernando del Valle de Catamarca, Catamarca, Argentina
| | | | - Enrique R. Soriano
- grid.414775.40000 0001 2319 4408Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Cesar Graf
- Sociedad Argentina de Reumatología, Buenos Aires, Argentina
| | - Bernardo A. Pons-Estel
- Present Address: Centro Regional de Enfermedades Autoinmunes Y Reumáticas, Rosario, Argentina
| | - Gimena Gomez
- Present Address: Unidad de Investigación de la Sociedad Argentina de Reumatología, Buenos Aires, Argentina
| | - Margarita Landi
- Present Address: Unidad de Investigación de la Sociedad Argentina de Reumatología, Buenos Aires, Argentina
| | | | - Guillermo J. Pons-Estel
- Present Address: Unidad de Investigación de la Sociedad Argentina de Reumatología, Buenos Aires, Argentina
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15
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Siegel CH, Choi JM, D'Angelo D, Christos P, Lally L, Navarro-Millan I, Cooke J, Goyal P, Mandl LA, Barbhaiya M. Outcomes of COVID-19 and Factors Associated With Its Severity Among Hospitalized Patients With and Without Systemic Rheumatic Disease During the First Wave of the Pandemic in New York City. J Clin Rheumatol 2023; 29:7-15. [PMID: 35905465 PMCID: PMC9803346 DOI: 10.1097/rhu.0000000000001891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVE Conflicting data exist regarding whether patients with systemic rheumatic disease (SRD) experience more severe outcomes related to COVID-19. Using data from adult patients hospitalized with COVID-19 in New York City during the first wave of the pandemic, we evaluated whether patients with SRD were at an increased risk for severe outcomes. METHODS We conducted a medical records review study including patients aged ≥18 years with confirmed SARS-CoV-2 infection hospitalized at 3 NewYork-Presbyterian sites, March 3-May 15, 2020. Inverse probability of treatment weighting was applied to a multivariable logistic regression model to assess the association between SRD status and the composite of mechanical ventilation, intensive care unit admission, or death. RESULTS Of 3710 patients hospitalized with COVID-19 (mean [SD] age, 63.7 [17.0] years; 41% female, 29% White, and 34% Hispanic/Latinx), 92 (2.5%) had SRD. Patients with SRD had similar age and body mass index but were more likely to be female, ever smokers, and White or Black, compared with those without SRD. A higher proportion of patients with versus without SRD had hypertension and pulmonary disease, and used hydroxychloroquine, corticosteroids, and immunomodulatory/immunosuppressive medications before admission. In the weighted multivariable analysis, patients with SRD had an odds ratio of 1.24 (95% confidence interval, 1.10-1.41; p < 0.01) for the composite of mechanical ventilation, intensive care unit admission, or death, compared with patients without SRD. CONCLUSIONS During the initial peak of the pandemic in New York City, patients with versus without SRD hospitalized with COVID-19 had a 24% increased likelihood of having severe COVID-19 after multivariable adjustment.
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Affiliation(s)
- Caroline H. Siegel
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Jacky M. Choi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Debra D'Angelo
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Paul Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Lindsay Lally
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Iris Navarro-Millan
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Joseph Cooke
- Department of Medicine, Weill Cornell Medicine
- Department of Medicine, NewYork-Presbyterian/Queens, Queens, NY
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine
| | - Lisa A. Mandl
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Medha Barbhaiya
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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Kawano Y, Patel NJ, Wang X, Cook CE, Vanni KMM, Kowalski EN, Banasiak EP, Qian G, DiIorio M, Hsu TYT, Weinblatt ME, Todd DJ, Wallace ZS, Sparks JA. Temporal trends in COVID-19 outcomes among patients with systemic autoimmune rheumatic diseases: from the first wave through the initial Omicron wave. Ann Rheum Dis 2022; 81:1742-1749. [PMID: 35944947 PMCID: PMC9939910 DOI: 10.1136/ard-2022-222954] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/30/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To investigate temporal trends in incidence and severity of COVID-19 among patients with systemic autoimmune rheumatic diseases (SARDs) from the first wave through the initial Omicron wave. METHODS We conducted a retrospective cohort study investigating COVID-19 outcomes among patientswith SARD systematically identified to have confirmed COVID-19 from 1 March 2020 to 31 January 2022 at Mass General Brigham. We tabulated COVID-19 counts of total and severe cases (hospitalisations or deaths) and compared the proportion with severe COVID-19 by calendar period and by vaccination status. We used logistic regression to estimate the ORs for severe COVID-19 for each period compared with the early COVID-19 period (reference group). RESULTS We identified 1449 patients with SARD with COVID-19 (mean age 58.4 years, 75.2% female, 33.9% rheumatoid arthritis). There were 399 (28%) cases of severe COVID-19. The proportion of severe COVID-19 outcomes declined over calendar time (p for trend <0.001); 46% of cases were severe in the early COVID-19 period (1 March 2020-30 June 2020) vs 15% in the initial Omicron wave (17 December 2021-31 January 2022; adjusted OR 0.29, 95% CI 0.19 to 0.43). A higher proportion of those unvaccinated were severe compared with not severe cases (78% vs 60%). CONCLUSIONS The proportion of patients with SARD with severe COVID-19 has diminished since early in the pandemic, particularly during the most recent time periods, including the initial Omicron wave. Advances in prevention, diagnosis and treatment of COVID-19 may have improved outcomes among patients with SARD.
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Affiliation(s)
- Yumeko Kawano
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Naomi J Patel
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Xiaosong Wang
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Claire E Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathleen MM Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Emily N Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Emily P Banasiak
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Michael DiIorio
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Tiffany Y-T Hsu
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael E Weinblatt
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Derrick J Todd
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Zachary S Wallace
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA .,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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17
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Figueroa-Parra G, Gilbert EL, Valenzuela-Almada MO, Vallejo S, Neville MR, Patel NJ, Cook C, Fu X, Hagi R, McDermott GC, Dilorio MA, Masto L, Vanni KMM, Kowalski E, Qian G, Zhang Y, Wallace ZS, Duarte-García A, Sparks JA. Risk of severe COVID-19 outcomes associated with rheumatoid arthritis and phenotypic subgroups: a retrospective, comparative, multicentre cohort study. THE LANCET. RHEUMATOLOGY 2022; 4:e765-e774. [PMID: 36118532 PMCID: PMC9472567 DOI: 10.1016/s2665-9913(22)00227-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Rheumatoid arthritis has been associated with severe COVID-19, but few studies have investigated how phenotypes of rheumatoid arthritis affect these associations. We aimed to investigate the associations between rheumatoid arthritis and phenotypes of interstitial lung disease, serostatus, and bone erosions with COVID-19 severity. Methods We did a retrospective, comparative, multicentre cohort study at two large health-care systems (Mayo Clinic [19 hospitals and affiliated outpatient centres] and Mass General Brigham [14 hospitals and affiliated outpatient centres]) in the USA. Consecutive patients with rheumatoid arthritis meeting the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria and who had COVID-19 between March 1, 2020, and June 6, 2021, were matched 1:5 on age, sex, and calendar date with patients without rheumatoid arthritis (comparators). Data were received from electronic health records from Mayo Clinic and Mass General Brigham. We examined subgroups of patients with rheumatoid arthritis by phenotypic features: rheumatoid arthritis-associated interstitial lung disease, seropositivity (for anti-cyclic citrullinated peptide, rheumatoid factor, or both), and bone erosions. Severe COVID-19 was a composite of hospitalisation or death. We used Cox regression to estimate hazard ratios (HR) for severe COVID-19, comparing rheumatoid arthritis and subgroups to the comparator group. Findings We identified 582 patients with rheumatoid arthritis and 2875 matched comparators, all of whom had COVID-19 within the study dates. The mean age of those with rheumatoid arthritis was 62 [SD 14] years, 421 (72%) of 582 were women and 161 (28%) were men, 457 (79%) were White, 65 (11%) were Hispanic or Latino, and 41 (7%) were Black. Among patients with rheumatoid arthritis, 50 (9%) of 582 had interstitial lung disease, 388 (68%) of 568 were seropositive, and 159 (27%) of 582 had bone erosions. Severe COVID-19 occurred in 126 (22%) of 582 patients with rheumatoid arthritis versus 363 (13%) 2875 in the comparator group. Patients with rheumatoid arthritis had an HR of 1·75 (95% CI 1·45-2·10) for severe COVID-19 versus the comparator group. Patients with rheumatoid arthritis-associated interstitial lung disease had an HR of 2·50 (1·66-3·77) versus the comparator group for severe COVID-19. The risk for severe COVID-19 was also higher in patients with rheumatoid arthritis who were seropositive (HR 1·97 [95% CI 1·58-2·46]) or had erosive disease (1·93 [1·41-2·63]) than for those in the comparator group. Interpretation Patients with rheumatoid arthritis have an increased risk of severe COVID-19 across phenotypic subgroups, especially among patients with interstitial lung disease. These findings suggest that rheumatoid arthritis with interstitial lung disease, or its treatment, might be a substantial contributor to severe COVID-19 outcomes for patients with rheumatoid arthritis. Funding None.
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Affiliation(s)
| | - Emily L Gilbert
- Division of Rheumatology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Matthew R Neville
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Phoenix, AZ, USA
| | - Naomi J Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Claire Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Xiaoqing Fu
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Ramla Hagi
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Gregory C McDermott
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael A Dilorio
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Lucy Masto
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Kathleen M M Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
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18
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Qian G, Wang X, Patel NJ, Kawano Y, Fu X, Cook CE, Vanni KM, Kowalski EN, Banasiak EP, Bade KJ, Srivatsan S, Williams ZK, Todd DJ, Weinblatt ME, Wallace ZS, Sparks JA. Outcomes with and without outpatient SARS-CoV-2 treatment for patients with COVID-19 and systemic autoimmune rheumatic diseases: A retrospective cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.10.27.22281629. [PMID: 36324801 PMCID: PMC9628202 DOI: 10.1101/2022.10.27.22281629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective To investigate temporal trends, severe outcomes, and rebound among systemic autoimmune rheumatic disease (SARD) patients according to outpatient SARS-CoV-2 treatment. Methods We performed a retrospective cohort study investigating outpatient SARS-CoV-2 treatments among SARD patients at Mass General Brigham (23/Jan/2022-30/May/2022). We identified SARS-CoV-2 infection by positive PCR or antigen test (index date=first positive test) and SARDs using diagnosis codes and immunomodulator prescription. Outpatient treatments were confirmed by medical record review. The primary outcome was hospitalization or death within 30 days following the index date. COVID-19 rebound was defined as documentation of negative then newly-positive SARS-CoV-2 tests. The association of any vs. no outpatient treatment with hospitalization/death was assessed using multivariable logistic regression. Results We analyzed 704 SARD patients with COVID-19 (mean age 58.4 years, 76% female, 49% with rheumatoid arthritis). Treatment as outpatient increased over calendar time (p<0.001). A total of 426(61%) received outpatient treatment: 307(44%) with nirmatrelvir/ritonavir, 105(15%) with monoclonal antibodies, 5(0.7%) with molnupiravir, 3(0.4%) with outpatient remdesivir, and 6(0.9%) with combinations. There were 9/426 (2.1%) hospitalizations/deaths among those treated as outpatient compared to 49/278 (17.6%) among those with no outpatient treatment (adjusted odds ratio [aOR] 0.12, 0.05 to 0.25). 25/318 (8%) of patients who received oral outpatient treatment had documented COVID-19 rebound. Conclusion Outpatient treatment was strongly associated with lower odds of severe COVID-19 compared to no outpatient treatment. At least 8% of SARD patients experienced COVID-19 rebound. These findings highlight the importance of outpatient COVID-19 treatment for SARD patients and the need for further research on rebound. KEY MESSAGES What is already known on this topic? Previous studies suggest that monoclonal antibodies are an effective outpatient treatment option for patients at high-risk of severe COVID-19, including those with systemic autoimmune rheumatic diseases (SARDs).Nirmatrelvir/ritonavir and molnupiravir are recently-authorized effective oral outpatient SARS-CoV-2 treatment options, but clinical trials were performed among the general population, mostly among unvaccinated and prior to Omicron viral variants.Oral outpatient SARS-CoV-2 treatments may result in COVID-19 rebound, characterized by newly-positive COVID-19 testing and recurrent symptoms, but no studies have investigated rebound prevalence among SARD patients. What this study adds? This is one of the first studies investigating outpatient SARS-CoV-2 treatments among SARD patients that includes oral options and quantifies the prevalence of COVID-19 rebound.Outpatient treatment was associated with 88% reduced odds of severe COVID-19 compared to no treatment.At least 8% of SARDs receiving oral outpatient treatment experienced COVID-19 rebound. How this study might affect research practice or policy? These results should encourage clinicians to prescribe and SARD patients to seek prompt outpatient COVID-19 treatment.This research provides an early estimate of the prevalence of COVID-19 rebound after oral outpatient treatment to quantify this risk to clinicians and SARD patients and encourage future research.
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Affiliation(s)
- Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Xiaosong Wang
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Naomi J. Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
- Harvard Medical School, Boston, MA
| | - Yumeko Kawano
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
- Harvard Medical School, Boston, MA
| | - Xiaoqing Fu
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
| | - Claire E. Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
| | - Kathleen M.M. Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Emily N. Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Emily P. Banasiak
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Katarina J. Bade
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Shruthi Srivatsan
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
| | - Zachary K. Williams
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
| | - Derrick J. Todd
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
- Harvard Medical School, Boston, MA
| | - Michael E. Weinblatt
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
- Harvard Medical School, Boston, MA
| | - Zachary S. Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
- Harvard Medical School, Boston, MA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA (The Mongan Institute, 100 Cambridge Street, Suite 1600, Boston, MA, 02114)
| | - Jeffrey A. Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
- Harvard Medical School, Boston, MA
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19
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Herman JD, Atyeo C, Zur Y, Cook CE, Patel NJ, Vanni KM, Kowalski EN, Qian G, Shadick NA, Laffenburger D, Wallace ZS, Sparks JA, Alter G. Impact of cross-coronavirus immunity in post-acute sequelae of COVID-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.09.25.22280335. [PMID: 36203557 PMCID: PMC9536039 DOI: 10.1101/2022.09.25.22280335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Beyond the unpredictable acute illness caused by SARS-CoV-2, one-fifth of infections unpredictably result in long-term persistence of symptoms despite the apparent clearance of infection. Insights into the mechanisms that underlie post-acute sequelae of COVID-19 (PASC) will be critical for the prevention and clinical management of long-term complications of COVID-19. Several hypotheses have been proposed that may account for the development of PASC, including persistence of virus or the dysregulation of immunity. Among the immunological changes noted in PASC, alterations in humoral immunity have been observed in some patient subsets. To begin to determine whether SARS-CoV-2 or other pathogen specific humoral immune responses evolve uniquely in PASC, we performed comprehensive antibody profiling against SARS-CoV-2 and a panel of endemic pathogens or routine vaccine antigens using Systems Serology in a cohort of patients with pre-existing rheumatic disease who either developed or did not develop PASC. A distinct humoral immune response was observed in individuals with PASC. Specifically, individuals with PASC harbored less inflamed and weaker Fcγ receptor binding anti-SARS-CoV-2 antibodies and a significantly expanded and more inflamed antibody response against endemic Coronavirus OC43. Individuals with PASC, further, generated more avid IgM responses and developed an expanded inflammatory OC43 S2-specific Fc-receptor binding response, linked to cross reactivity across SARS-CoV-2 and common coronaviruses. These findings implicate previous common Coronavirus imprinting as a marker for the development of PASC.
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Affiliation(s)
- Jonathan D Herman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA
| | - Caroline Atyeo
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Yonatan Zur
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Claire E Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Naomi J Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Kathleen M Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily N Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Nancy A Shadick
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Douglas Laffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
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20
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Ammitzbøll C, Andersen JB, Vils SR, Mistegaard CE, Mikkelsen S, Erikstrup C, Thomsen MK, Hauge E, Troldborg A. Isolation, Behavioral Changes, and Low Seroprevalence of SARS-CoV-2 Antibodies in Patients With Systemic Lupus Erythematosus or Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2022; 74:1780-1785. [PMID: 34057311 PMCID: PMC8212085 DOI: 10.1002/acr.24716] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/03/2021] [Accepted: 05/25/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Patients with chronic rheumatic diseases (CRDs), such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), require special attention during the COVID-19 pandemic as they are considered at risk of severe infections. Our objective was to assess the seroprevalence of SARS-CoV-2 in patients with SLE and RA and to assess patient behavior, disease-related symptoms, and mental health. METHODS More than 900 participants were included: 405 patients with RA or SLE (CRD patients) and 513 blood donors. All participants had blood SARS-CoV-2 total antibodies measured (sensitivity 96.7%, specificity 99.5%) and answered a questionnaire concerning behavior, anxiety, and symptoms of depression (Patient Health Questionnaire 9). The CRD patients were further asked about physical activity, adherence to medication, and disease-related symptoms. RESULTS CRD patients had a significantly lower seroprevalence of SARS-CoV-2 antibodies (n = 1 of 365, 0.3%) compared to blood donors (n = 10 of 513, 1.9%; P = 0.03). Almost 60% of patients were unable to exercise as usual, and increased pain and disease activity was experienced by 34% and 24% of patients, respectively. Almost 10% of patients reduced or discontinued their immunosuppressive treatments at their own initiative. Symptoms of moderate depression were present in 19% of patients compared to 6.8% of blood donors (P < 0.001). CONCLUSION Low seroprevalence in patients with CRDs indicates successful mitigation of exposure to SARS-CoV-2. However, this mitigation appears to occur at the expense of physical activity, experience of increased pain, disease activity, and symptoms of depression. There is a need for care providers to be aware of these negative side effects and for further studies to investigate the possible long-term consequences.
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Affiliation(s)
| | | | | | | | - Susan Mikkelsen
- Aarhus University and Aarhus University HospitalAarhusDenmark
| | | | | | | | - Anne Troldborg
- Aarhus University and Aarhus University HospitalAarhusDenmark
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21
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Di Iorio M, Cook CE, Vanni KM, Patel NJ, D'Silva KM, Fu X, Wang J, Prisco LC, Kowalski E, Zaccardelli A, Martin LW, Qian G, Hsu TYT, Wallace ZS, Sparks JA. DMARD disruption, rheumatic disease flare, and prolonged COVID-19 symptom duration after acute COVID-19 among patients with rheumatic disease: A prospective study. Semin Arthritis Rheum 2022; 55:152025. [PMID: 35617780 PMCID: PMC9116968 DOI: 10.1016/j.semarthrit.2022.152025] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/22/2022] [Accepted: 05/10/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To describe disease-modifying antirheumatic drug (DMARD) disruption, rheumatic disease flare/activity, and prolonged COVID-19 symptom duration among COVID-19 survivors with systemic autoimmune rheumatic diseases (SARDs). METHODS We surveyed people with pre-existing SARDs who had confirmed COVID-19 at Mass General Brigham to investigate post-acute sequelae of COVID-19. We obtained data on demographics, clinical characteristics, COVID-19 symptoms/course, and patient-reported measures. We examined baseline predictors of prolonged COVID-19 symptom duration (defined as lasting ≥28 days) using logistic regression. RESULTS We analyzed surveys from 174 COVID-19 survivors (mean age 52 years, 81% female, 80% White, 50% rheumatoid arthritis) between March 2021 and January 2022. Fifty-one percent of 127 respondents on any DMARD reported a disruption to their regimen after COVID-19 onset. For individual DMARDs, 56-77% had any change, except for hydroxychloroquine (23%) and rituximab (46%). SARD flare after COVID-19 was reported by 41%. Global patient-reported disease activity was worse at the time of survey than before COVID-19 (mean 6.6±2.9 vs. 7.6±2.3, p<0.001). Median time to COVID-19 symptom resolution was 25 days (IQR 11, 160). Prolonged symptom duration of ≥28 days occurred in 45%. Hospitalization for COVID-19 (OR 3.54, 95%CI 1.27-9.87) and initial COVID-19 symptom count (OR 1.38 per symptom, 95%CI 1.17-1.63) were associated with prolonged symptom duration. Respondents experiencing prolonged symptom duration had higher RAPID3 scores (p=0.007) and more pain (p<0.001) and fatigue (p=0.03) compared to those without prolonged symptoms. CONCLUSION DMARD disruption, SARD flare, and prolonged COVID-19 symptom duration were common in this prospective study of COVID-19 survivors, suggesting substantial impact on SARDs after acute COVID-19.
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Affiliation(s)
- Michael Di Iorio
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States
| | - Claire E. Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, United States
| | - Kathleen M.M. Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA 02115, United States
| | - Naomi J. Patel
- Harvard Medical School, Boston, MA, United States,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, United States
| | - Kristin M. D'Silva
- Harvard Medical School, Boston, MA, United States,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, United States
| | - Xiaoqing Fu
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, United States
| | - Jiaqi Wang
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA 02115, United States
| | - Lauren C. Prisco
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA 02115, United States
| | - Emily Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA 02115, United States
| | - Alessandra Zaccardelli
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA 02115, United States
| | - Lily W. Martin
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA 02115, United States
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA 02115, United States
| | - Tiffany Y-T. Hsu
- Harvard Medical School, Boston, MA, United States,Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA 02115, United States
| | - Zachary S. Wallace
- Harvard Medical School, Boston, MA, United States,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, United States,Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Jeffrey A. Sparks
- Harvard Medical School, Boston, MA, United States,Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA 02115, United States,Corresponding author
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22
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Severe COVID-19 outcomes among patients with autoimmune rheumatic diseases or transplantation: a population-based matched cohort study. BMJ Open 2022. [PMCID: PMC9361749 DOI: 10.1136/bmjopen-2022-062404] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives To assess the risk of severe COVID-19 outcomes in patients with autoimmune rheumatic diseases (ARDs) and transplant recipients compared with matched general population comparators. Design Population-based matched cohort study using administrative health data sets. Setting British Columbia, Canada. Participants All adults with test-positive SARS-CoV-2 infections. SARS-CoV-2-positive patients with ARDs and those with transplantation were matched to SARS-CoV-2-positive general population comparators on age (±5 years), sex, month/year of initial positive SARS-CoV-2 test and health authority. Outcome measures COVID-19-related hospitalisations, intensive care unit (ICU) admissions, invasive ventilation and COVID-19-specific mortality. We performed multivariable conditional logistic regression models adjusting for socioeconomic status, Charlson Comorbidity Index, hypertension, rural address and number of previous COVID-19 PCR tests. Results Among 6279 patients with ARDs and 222 transplant recipients, all SARS-CoV-2 test positive, risk of hospitalisation was significantly increased among patients with ARDs (overall ARDs (adjusted OR (aOR) 1.30; 95% CI 1.19 to 1.43)); highest within ARDs: adult systemic vasculitides (aOR 2.18; 95% CI 1.17 to 4.05) and transplantation (aOR 10.56; 95% CI 6.88 to 16.22). Odds of ICU admission were significantly increased among patients with ARDs (overall ARDs (aOR 1.30; 95% CI 1.11 to 1.51)); highest within ARDs: ankylosing spondylitis (aOR 2.03; 95% CI 1.18 to 3.50) and transplantation (aOR 8.13; 95% CI 4.76 to 13.91). Odds of invasive ventilation were significantly increased among patients with ARDs (overall ARDs (aOR 1.60; 95% CI 1.27 to 2.01)); highest within ARDs: ankylosing spondylitis (aOR 2.63; 95% CI 1.14 to 6.06) and transplantation (aOR 8.64; 95% CI 3.81 to 19.61). Risk of COVID-19-specific mortality was increased among patients with ARDs (overall ARDs (aOR 1.24; 95% CI 1.05 to 1.47)); highest within ARDs: ankylosing spondylitis (aOR 2.15; 95% CI 1.02 to 4.55) and transplantation (aOR 5.48; 95% CI 2.82 to 10.63). Conclusions The risk of severe COVID-19 outcomes is increased in certain patient groups with ARDs or transplantation, although the magnitude differs across individual diseases. Strategies to mitigate risk, such as booster vaccination, prompt diagnosis and early intervention with available therapies, should be prioritised in these groups according to risk.
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23
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Lee SW, Lee J, Moon SY, Jin HY, Yang JM, Ogino S, Song M, Hong SH, Abou Ghayda R, Kronbichler A, Koyanagi A, Jacob L, Dragioti E, Smith L, Giovannucci E, Lee IM, Lee DH, Lee KH, Shin YH, Kim SY, Kim MS, Won HH, Ekelund U, Shin JI, Yon DK. Physical activity and the risk of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related mortality in South Korea: a nationwide cohort study. Br J Sports Med 2022; 56:901-912. [PMID: 34301715 PMCID: PMC8300550 DOI: 10.1136/bjsports-2021-104203] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine the potential associations between physical activity and risk of SARS-CoV-2 infection, severe illness from COVID-19 and COVID-19 related death using a nationwide cohort from South Korea. METHODS Data regarding 212 768 Korean adults (age ≥20 years), who tested for SARS-CoV-2, from 1 January 2020 to 30 May 2020, were obtained from the National Health Insurance Service of South Korea and further linked with the national general health examination from 1 January 2018 to 31 December 2019 to assess physical activity levels. SARS-CoV-2 positivity, severe COVID-19 illness and COVID-19 related death were the main outcomes. The observation period was between 1 January 2020 and 31 July 2020. RESULTS Out of 76 395 participants who completed the general health examination and were tested for SARS-CoV-2, 2295 (3.0%) were positive for SARS-CoV-2, 446 (0.58%) had severe illness from COVID-19 and 45 (0.059%) died from COVID-19. Adults who engaged in both aerobic and muscle strengthening activities according to the 2018 physical activity guidelines had a lower risk of SARS-CoV-2 infection (2.6% vs 3.1%; adjusted relative risk (aRR), 0.85; 95% CI 0.72 to 0.96), severe COVID-19 illness (0.35% vs 0.66%; aRR 0.42; 95% CI 0.19 to 0.91) and COVID-19 related death (0.02% vs 0.08%; aRR 0.24; 95% CI 0.05 to 0.99) than those who engaged in insufficient aerobic and muscle strengthening activities. Furthermore, the recommended range of metabolic equivalent task (MET; 500-1000 MET min/week) was associated with the maximum beneficial effect size for reduced risk of SARS-CoV-2 infection (aRR 0.78; 95% CI 0.66 to 0.92), severe COVID-19 illness (aRR 0.62; 95% CI 0.43 to 0.90) and COVID-19 related death (aRR 0.17; 95% CI 0.07 to 0.98). Similar patterns of association were observed in different sensitivity analyses. CONCLUSION Adults who engaged in the recommended levels of physical activity were associated with a decreased likelihood of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related death. Our findings suggest that engaging in physical activity has substantial public health value and demonstrates potential benefits to combat COVID-19.
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Affiliation(s)
- Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea (the Republic of)
| | - Jinhee Lee
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Korea (the Republic of)
| | - Sung Yong Moon
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea (the Republic of)
| | - Hyun Young Jin
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea (the Republic of)
| | - Jee Myung Yang
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Shuji Ogino
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sung Hwi Hong
- Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Ramy Abou Ghayda
- Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, CIBERSAM, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Pg. Lluis Companys, Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, CIBERSAM, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Elena Dragioti
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Chelmsford, UK
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - I-Min Lee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dong Hoon Lee
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Youn Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea (the Republic of)
| | - So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea (the Republic of)
| | - Min Seo Kim
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Korea (the Republic of)
| | - Hong-Hee Won
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Korea (the Republic of)
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Dong Keon Yon
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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24
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Kawano Y, Patel NJ, Wang X, Cook CE, Vanni KM, Kowalski EN, Banasiak EP, Qian G, DiIorio M, Hsu TYT, Weinblatt ME, Todd DJ, Wallace ZS, Sparks JA. Temporal trends in COVID-19 outcomes among patients with systemic autoimmune rheumatic diseases: From the first wave to Omicron. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.06.19.22276599. [PMID: 35765565 PMCID: PMC9238187 DOI: 10.1101/2022.06.19.22276599] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives To investigate temporal trends in incidence and severity of COVID-19 among patients with systemic autoimmune rheumatic diseases (SARDs) from the first wave through the Omicron wave. Methods We conducted a retrospective cohort study investigating COVID-19 outcomes among SARD patients systematically identified to have confirmed COVID-19 from March 1, 2020 to January 31, 2022 at a large healthcare system in Massachusetts. We tabulated COVID-19 counts of total and severe cases (hospitalizations or deaths) and compared the proportion with severe COVID-19 by calendar period and by vaccination status. We used logistic regression to estimate the ORs for severe COVID-19 for each period compared to the early COVID-19 period (reference group). Results We identified 1449 SARD patients with COVID-19 (mean age 58.4 years, 75.2% female, 33.9% rheumatoid arthritis). There were 399 (27.5%) cases of severe COVID-19. The proportion of severe COVID-19 outcomes declined over calendar time (p for trend <0.001); 45.6% of cases were severe in the early COVID-19 period (March 1-June 30, 2020) vs. 14.7% in the Omicron wave (December 17, 2021-January 31, 2022; adjusted odds ratio 0.29, 95%CI 0.19-0.43). A higher proportion of those unvaccinated were severe compared to not severe cases (78.4% vs. 59.5%). Conclusions The proportion of SARD patients with severe COVID-19 has diminished since early in the pandemic, particularly during the most recent time periods, including the Omicron wave. Advances in prevention, diagnosis, and treatment of COVID-19 may have improved outcomes among SARD patients. KEY MESSAGES What is already known about this subject?: Patients with systemic autoimmune rheumatic diseases (SARDs) may be at increased risk for severe COVID-19, defined as hospitalization or death.Previous studies of SARD patients suggested improving COVID-19 outcomes over calendar time, but most were performed prior to the wide availability of COVID-19 vaccines or the Omicron wave that was characterized by high infectivity.What does this study add?: The proportion of SARD patients with severe COVID-19 outcomes was lower over calendar timeThe adjusted odds ratio of severe COVID-19 in the Omicron wave was 0.29 (95%CI 0.19-0.43) compared to early COVID-19 period.The absolute number of severe COVID-19 cases during the peak of the Omicron variant wave was similar to the peaks of other waves.SARD patients with severe vs. not severe COVID-19 were more likely to be unvaccinated.How might this impact on clinical practice or future developments?: These findings suggest that advances in COVID-19 prevention, diagnosis, and treatment have contributed to improved outcomes among SARD patients over calendar time.Future studies should extend findings into future viral variants and consider the roles of waning immunity after vaccination or natural infection among SARD patients who may still be vulnerable to severe COVID-19.
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Affiliation(s)
- Yumeko Kawano
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Naomi J. Patel
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Xiaosong Wang
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Claire E. Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Kathleen M.M. Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Emily N. Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Emily P. Banasiak
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Michael DiIorio
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Tiffany Y. T. Hsu
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michael E. Weinblatt
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Derrick J. Todd
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Zachary S. Wallace
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey A. Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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25
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Arruda LCM, Gaballa A, Da Silva Rodrigues R, Makower B, Uhlin M. SARS-CoV-2 (COVID-19)-specific T cell and B cell responses in convalescent rheumatoid arthritis: Monozygotic twins pair case observation. Scand J Immunol 2022; 95:e13151. [PMID: 35212005 PMCID: PMC9115348 DOI: 10.1111/sji.13151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 12/01/2022]
Abstract
Rheumatoid arthritis (RA) patients present higher risk of SARS-CoV-2 infection (COVID-19), and proper management of the disease in this population requires a better understanding of how the immune system controls the virus. We analyzed the T cell and B cell phenotypes, and their repertoire in a pair of monozygotic twins with RA mismatched for COVID-19 infection. Twin- was not infected, while Twin+ was infected and effectively controlled the infection. We found no significant changes on the αβ T cell composition, while γδ T cells and B cells presented considerable expansion of memory population in Twin+ and robust T/B cell responses to several SARS-CoV-2 peptides. T cell receptor β/γ-chain and immunoglobulin heavy chain next-generation sequencing depicted a remarkable higher diversity in Twin+ compared with Twin-, despite no significant changes being found in variable/joining family usage. Repertoire overlap analyses showed that, although being identical twins, very few clones were shared between them, indicating that COVID-19 may lead to deep changes on the immune cell repertoire in RA patients. Altogether, our results indicate that RA patients may develop robust and persistent COVID-19-specific T/B cell responses; γδ T cells and B cells may play a key role in the management of COVID-19 in RA, and the infection may lead to a profound reshaping of immune cell receptor specificities.
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Affiliation(s)
- Lucas C. M. Arruda
- Department of Clinical Science, Intervention and TechnologyKarolinska InstituteStockholmSweden
| | - Ahmed Gaballa
- Department of Clinical Science, Intervention and TechnologyKarolinska InstituteStockholmSweden
| | - Rui Da Silva Rodrigues
- Department of Clinical Immunology and Transfusion MedicineKarolinska University HospitalStockholmSweden
| | | | - Michael Uhlin
- Department of Clinical Science, Intervention and TechnologyKarolinska InstituteStockholmSweden
- Department of Clinical Immunology and Transfusion MedicineKarolinska University HospitalStockholmSweden
- Department of Applied PhysicsScience for Life LaboratoryRoyal Institute of TechnologyStockholmSweden
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26
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Boekel L, Hooijberg F, Vogelzang EH, Besten YR, Leeuw M, Atiqi S, van Vollenhoven RF, Wijbrandts CA, Gerritsen M, Krieckaert C, Dijkshoorn B, Bakhlakh S, Crooijmans JJ, Voskuyl A, van der Horst-Bruinsma IE, Lems W, Kuijpers TW, van Ham SM, Wieske L, Eftimov F, Kummer LY, van Dam PK, Stalman EW, Steenhuis M, Keijzer S, Cristianawati O, Keijser J, Loeff FC, Tas SW, Nurmohamed MT, Boers M, Rispens T, Wolbink G. Antibody development and disease severity of COVID-19 in non-immunised patients with rheumatic immune-mediated inflammatory diseases: data from a prospective cohort study. RMD Open 2022; 8:rmdopen-2021-002035. [PMID: 35383121 PMCID: PMC8983412 DOI: 10.1136/rmdopen-2021-002035] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/10/2022] [Indexed: 02/07/2023] Open
Abstract
Background Research on the disease severity of COVID-19 in patients with rheumatic immune-mediated inflammatory diseases (IMIDs) has been inconclusive, and long-term prospective data on the development of SARS-CoV-2 antibodies in these patients are lacking. Methods Adult patients with rheumatic IMIDs from the Amsterdam Rheumatology and Immunology Center, Amsterdam were invited to participate. All patients were asked to recruit their own sex-matched and age-matched control subject. Clinical data were collected via online questionnaires (at baseline, and after 1–4 and 5–9 months of follow-up). Serum samples were collected twice and analysed for the presence of SARS-CoV-2-specific antibodies. Subsequently, IgG titres were quantified in samples with a positive test result. Findings In total, 3080 consecutive patients and 1102 controls with comparable age and sex distribution were included for analyses. Patients were more frequently hospitalised compared with controls when infected with SARS-CoV-2; 7% vs 0.7% (adjusted OR: 7.33, 95% CI: 0.96 to 55.77). Only treatment with B-cell targeting therapy was independently associated with an increased risk of COVID-19-related hospitalisation (adjusted OR: 14.62, 95% CI: 2.31 to 92.39). IgG antibody titres were higher in hospitalised compared with non-hospitalised patients, and slowly declined with time in similar patterns for patients in all treatment subgroups and controls. Interpretation We observed that patients with rheumatic IMIDs, especially those treated with B-cell targeting therapy, were more likely to be hospitalised when infected with SARS-CoV-2. Treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and biological DMARDs other than B-cell targeting agents is unlikely to have negative effects on the development of long-lasting humoral immunity against SARS-CoV-2.
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Affiliation(s)
- Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Femke Hooijberg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Erik H Vogelzang
- Department of Medical Microbiology and Infection Control, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Yaëlle R Besten
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Maureen Leeuw
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Sadaf Atiqi
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Ronald F van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands
| | - Carla A Wijbrandts
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Martijn Gerritsen
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - C Krieckaert
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Bas Dijkshoorn
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Siham Bakhlakh
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Juliette J Crooijmans
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Alexandre Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands
| | - Irene E van der Horst-Bruinsma
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands
| | - Willem Lems
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Laura Y Kummer
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands.,Department of Neurology and Neurophysiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Pj Koos van Dam
- Department of Neurology and Neurophysiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Sofie Keijzer
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Olvi Cristianawati
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Jim Keijser
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Floris C Loeff
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands
| | - Maarten Boers
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands.,Department of Epidemiology & Data Science, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
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27
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Grainger R, Kim AHJ, Conway R, Yazdany J, Robinson PC. COVID-19 in people with rheumatic diseases: risks, outcomes, treatment considerations. Nat Rev Rheumatol 2022; 18:191-204. [PMID: 35217850 PMCID: PMC8874732 DOI: 10.1038/s41584-022-00755-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic has brought challenges for people with rheumatic disease in addition to those faced by the general population, including concerns about higher risks of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and poor outcomes of COVID-19. The data that are now available suggest that rheumatic disease is associated with a small additional risk of SARS-CoV-2 infection, and that outcomes of COVID-19 are primarily influenced by comorbidities and particular disease states or treatments. Despite considerable advances in our knowledge of which therapeutic agents provide benefits in COVID-19, and of what constitutes effective vaccination strategies, the specific considerations that apply to people with rheumatic disease are yet to be definitively addressed. An overview of the most important COVID-19 studies to date that relate to people with rheumatic disease can contribute to our understanding of the clinical-care requirements of this population.
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Affiliation(s)
- Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Richard Conway
- Department of Rheumatology, St James's Hospital, Dublin, Ireland
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Philip C Robinson
- University of Queensland School of Clinical Medicine, Faculty of Medicine, Herston, Queensland, Australia.
- Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Herston Road, Herston, Queensland, Australia.
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28
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Topless RK, Gaffo A, Stamp LK, Robinson PC, Dalbeth N, Merriman TR. Gout and the risk of COVID-19 diagnosis and death in the UK Biobank: a population-based study. THE LANCET. RHEUMATOLOGY 2022; 4:e274-e281. [PMID: 35128470 PMCID: PMC8798088 DOI: 10.1016/s2665-9913(21)00401-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is a paucity of data on outcomes for people with gout and COVID-19. We aimed to assess whether gout is a risk factor for diagnosis of COVID-19 and COVID-19-related death, and to test for sex- and drug-specific differences in risk. METHODS We used data from the UK Biobank, which included 15 871 people with gout. We used multivariable-adjusted logistic regression in the following analyses using a case-control study design: to test for an association between gout and COVID-19 diagnosis in the entire UK Biobank cohort (n=459 837); to test for an association between gout and COVID-19-related death in people who were known to have died or survived with COVID-19 (n=15 772); to test for an association between gout and COVID-19-related death in the entire UK Biobank cohort (n=459 837); and to assess risk of COVID-19-related death in a subset of patients from the UK Biobank cohort with prescription data, stratified by prescription of urate-lowering therapy and colchicine (n=341 398). Models 1 and 2 were adjusted for age group, sex, ethnicity, Townsend deprivation index, BMI, and smoking status. Model 2 was also adjusted for diagnosis of 16 other diseases that are established comorbidities of gout or established risk factors for COVID-19-related death. FINDINGS Gout was associated with diagnosis of COVID-19 (odds ratio [OR] 1·20, 95% CI 1·11-1·29) but not with risk of COVID-19-related death in the cohort of patients diagnosed with COVID-19 (1·20, 0·96-1·51). In the entire cohort, gout was associated with COVID-19-related death (1·29, 1·06-1·56); women with gout had an increased risk of COVID-19-related death (1·98, 1·34-2·94), whereas men with gout did not (1·16, 0·93-1·45). We found no significant differences in the risk of COVID-19-related death according to prescription of urate-lowering therapy or colchicine. When patients with gout were stratified by vaccination status, the risk of diagnosis with COVID-19 was significant in the non-vaccinated group (1·21, 1·11-1·30) but not the vaccinated group (1·09, 0·65-1·85). INTERPRETATION Gout is a risk factor for COVID-19-related death in the UK Biobank cohort, with an increased risk in women with gout, which was driven by risk factors independent of the metabolic comorbidities of gout. FUNDING Health Research Council of New Zealand.
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Affiliation(s)
- Ruth K Topless
- Biochemistry Department, University of Otago, Dunedin, New Zealand
| | - Angelo Gaffo
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham Veteran Affairs Medical Center, Birmingham, AL, USA
| | - Lisa K Stamp
- University of Otago Christchurch, Christchurch, New Zealand
| | | | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tony R Merriman
- Biochemistry Department, University of Otago, Dunedin, New Zealand
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
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29
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Patel NJ, D'Silva KM, Li MD, Hsu TY, DiIorio M, Fu X, Cook C, Prisco L, Martin L, Vanni KM, Zaccardelli A, Zhang Y, Kalpathy‐Cramer J, Sparks JA, Wallace ZS. Assessing the Severity of COVID-19 Lung Injury in Rheumatic Diseases Versus the General Population Using Deep Learning-Derived Chest Radiograph Scores. Arthritis Care Res (Hoboken) 2022; 75:657-666. [PMID: 35313091 PMCID: PMC9081965 DOI: 10.1002/acr.24883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/01/2022] [Accepted: 03/15/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE COVID-19 patients with rheumatic disease have a higher risk of mechanical ventilation than the general population. The present study was undertaken to assess lung involvement using a validated deep learning algorithm that extracts a quantitative measure of radiographic lung disease severity. METHODS We performed a comparative cohort study of rheumatic disease patients with COVID-19 and ≥1 chest radiograph within ±2 weeks of COVID-19 diagnosis and matched comparators. We used unadjusted and adjusted (for age, Charlson comorbidity index, and interstitial lung disease) quantile regression to compare the maximum pulmonary x-ray severity (PXS) score at the 10th to 90th percentiles between groups. We evaluated the association of severe PXS score (>9) with mechanical ventilation and death using Cox regression. RESULTS We identified 70 patients with rheumatic disease and 463 general population comparators. Maximum PXS scores were similar in the rheumatic disease patients and comparators at the 10th to 60th percentiles but significantly higher among rheumatic disease patients at the 70th to 90th percentiles (90th percentile score of 10.2 versus 9.2; adjusted P = 0.03). Rheumatic disease patients were more likely to have a PXS score of >9 (20% versus 11%; P = 0.02), indicating severe pulmonary disease. Rheumatic disease patients with PXS scores >9 versus ≤9 had higher risk of mechanical ventilation (hazard ratio [HR] 24.1 [95% confidence interval (95% CI) 6.7, 86.9]) and death (HR 8.2 [95% CI 0.7, 90.4]). CONCLUSION Rheumatic disease patients with COVID-19 had more severe radiographic lung involvement than comparators. Higher PXS scores were associated with mechanical ventilation and will be important for future studies leveraging big data to assess COVID-19 outcomes in rheumatic disease patients.
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Affiliation(s)
- Naomi J. Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General HospitalBostonMAUSA
| | - Kristin M. D'Silva
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General HospitalBostonMAUSA,Clinical Epidemiology Program, Mongan Institute, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Matthew D. Li
- Department of Radiology, Massachusetts General HospitalBostonMAUSA
| | - Tiffany Y‐T. Hsu
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's HospitalBostonMAUSA
| | - Michael DiIorio
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's HospitalBostonMAUSA
| | - Xiaoqing Fu
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General HospitalBostonMAUSA,Clinical Epidemiology Program, Mongan Institute, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Claire Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General HospitalBostonMAUSA,Clinical Epidemiology Program, Mongan Institute, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | - Lauren Prisco
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's HospitalBostonMAUSA
| | - Lily Martin
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's HospitalBostonMAUSA
| | - Kathleen M.M. Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's HospitalBostonMAUSA
| | - Alessandra Zaccardelli
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's HospitalBostonMAUSA
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General HospitalBostonMAUSA,Clinical Epidemiology Program, Mongan Institute, Department of MedicineMassachusetts General HospitalBostonMAUSA
| | | | - Jeffrey A. Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's HospitalBostonMAUSA
| | - Zachary S. Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General HospitalBostonMAUSA,Clinical Epidemiology Program, Mongan Institute, Department of MedicineMassachusetts General HospitalBostonMAUSA
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30
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Di Iorio M, Cook CE, Vanni KM, Patel NJ, D’Silva KM, Fu X, Wang J, Prisco LC, Kowalski E, Zaccardelli A, Martin LW, Qian G, Hsu TYT, Wallace ZS, Sparks JA. DMARD disruption, disease flare, and prolonged symptom duration after acute COVID-19 among participants with rheumatic disease: A prospective study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.02.08.22270696. [PMID: 35169813 PMCID: PMC8845434 DOI: 10.1101/2022.02.08.22270696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To describe disease-modifying antirheumatic drug (DMARD) disruption, rheumatic disease flare/activity, and prolonged COVID-19 symptom duration among COVID-19 survivors with systemic autoimmune rheumatic diseases (SARDs). METHODS We surveyed patients with SARDs after confirmed COVID-19 at Mass General Brigham to investigate post-acute sequelae of COVID-19. We obtained data on demographics, clinical characteristics, COVID-19 symptoms/course, and patient-reported measures. We examined baseline predictors of prolonged COVID-19 symptom duration (defined as lasting ≥28 days) using logistic regression. RESULTS We analyzed surveys from 174 COVID-19 survivors (mean age 52 years, 81% female, 80% White, 50% rheumatoid arthritis) between March 2021 and January 2022. Fifty-one percent of 127 respondents on any DMARD reported a disruption to their regimen after COVID-19 onset. For individual DMARDs, 56-77% had any change, except for hydroxychloroquine (23%) and rituximab (46%). SARD flare after COVID-19 was reported by 41%. Global patient-reported disease activity was worse at the time of survey than before COVID-19 (mean 6.6±2.9 vs. 7.6±2.3, p<0.001). Median time to COVID-19 symptom resolution was 14 days (IQR 9,29). Prolonged symptom duration of ≥28 days occurred in 45%. Hospitalization for COVID-19 (OR 3.54, 95%CI 1.27-9.87) and initial COVID-19 symptom count (OR 1.38 per symptom, 95%CI 1.17-1.63) were associated with prolonged symptom duration. Respondents experiencing prolonged symptom duration had higher RAPID3 scores (p=0.007) and more pain (p<0.001) and fatigue (p=0.03) compared to those without prolonged symptoms. CONCLUSION DMARD disruption, SARD flare, and prolonged symptom duration were common in this prospective study of COVID-19 survivors, suggesting substantial impact on SARDs after acute COVID-19.
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Affiliation(s)
- Michael Di Iorio
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Claire E. Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Kathleen M.M. Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Naomi J. Patel
- Harvard Medical School, Boston, MA, USA,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Kristin M. D’Silva
- Harvard Medical School, Boston, MA, USA,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Xiaoqing Fu
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Jiaqi Wang
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Lauren C. Prisco
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Emily Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alessandra Zaccardelli
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Lily W. Martin
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Tiffany Y-T. Hsu
- Harvard Medical School, Boston, MA, USA,Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Zachary S. Wallace
- Harvard Medical School, Boston, MA, USA,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA,Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey A. Sparks
- Harvard Medical School, Boston, MA, USA,Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
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31
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Vanni KM, Patel NJ, DiIorio M, Kowalski E, Qian G, Cook CE, Ritter SY, Wallace ZS, Sparks JA. Breakthrough infection after three doses of COVID-19 mRNA vaccine in systemic autoimmune rheumatic diseases: two cases in patients on TNF inhibitor monotherapy. RMD Open 2022; 8:e002082. [PMID: 35110366 PMCID: PMC8811273 DOI: 10.1136/rmdopen-2021-002082] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Kathleen Mm Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Naomi J Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael DiIorio
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Emily Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Claire E Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Susan Y Ritter
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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32
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Choi HK, McCormick N, Yokose C. Excess comorbidities in gout: the causal paradigm and pleiotropic approaches to care. Nat Rev Rheumatol 2022; 18:97-111. [PMID: 34921301 DOI: 10.1038/s41584-021-00725-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 02/07/2023]
Abstract
Gout is a common hyperuricaemic metabolic condition that leads to painful inflammatory arthritis and a high comorbidity burden, especially cardiometabolic-renal (CMR) conditions, including hypertension, myocardial infarction, stroke, obesity, hyperlipidaemia, type 2 diabetes mellitus and chronic kidney disease. Substantial advances have been made in our understanding of the excess CMR burden in gout, ranging from pathogenesis underlying excess CMR comorbidities, inferring causal relationships from Mendelian randomization studies, and potentially discovering urate crystals in coronary arteries using advanced imaging, to clinical trials and observational studies. Despite many studies finding an independent association between blood urate levels and risk of incident CMR events, Mendelian randomization studies have largely found that serum urate is not causal for CMR end points or intermediate risk factors or outcomes (such as kidney function, adiposity, metabolic syndrome, glycaemic traits or blood lipid concentrations). Although limited, randomized controlled trials to date in adults without gout support this conclusion. If imaging studies suggesting that monosodium urate crystals are deposited in coronary plaques in patients with gout are confirmed, it is possible that these crystals might have a role in the inflammatory pathogenesis of increased cardiovascular risk in patients with gout; removing monosodium urate crystals or blocking the inflammatory pathway could reduce this excess risk. Accordingly, data for CMR outcomes with these urate-lowering or anti-inflammatory therapies in patients with gout are needed. In the meantime, highly pleiotropic CMR and urate-lowering benefits of sodium-glucose cotransporter 2 (SGLT2) inhibitors and key lifestyle measures could play an important role in comorbidity care, in conjunction with effective gout care based on target serum urate concentrations according to the latest guidelines.
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Affiliation(s)
- Hyon K Choi
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA.
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
- Arthritis Research Canada, Vancouver, British Columbia, Canada.
| | - Natalie McCormick
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Chio Yokose
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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33
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Benavent D, Garrido-Cumbrera M, Plasencia-Rodríguez C, Marzo-Ortega H, Christen L, Correa-Fernández J, Plazuelo-Ramos P, Webb D, Navarro-Compán V. Poor health and functioning in patients with axial spondyloarthritis during the COVID-19 pandemic and lockdown: REUMAVID study (phase 1). Ther Adv Musculoskelet Dis 2022; 14:1759720X211066685. [PMID: 35069810 PMCID: PMC8777346 DOI: 10.1177/1759720x211066685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/15/2021] [Indexed: 12/24/2022] Open
Abstract
Aim: To evaluate the overall health and functioning in patients with axial
spondyloarthritis (axSpA) and related factors affecting these during the
COVID-19 pandemic and lockdown measures. Methods: Data from 587 axSpA patients participating in the first phase (April–July
2020) of the REUMAVID study who completed the ASAS Health Index (ASAS-HI)
were analysed. REUMAVID is a cross-sectional study that collects data
through an online survey to assess the impact of the COVID-19 pandemic on
patients with rheumatic and musculoskeletal diseases across seven European
countries. Poor health was defined as ASAS-HI ⩾ 12. The World Health
Organization Five well-being index, self-perceived health status and change
in health status during COVID-19 pandemic were evaluated as secondary
outcomes. Logistic regression models were used to identify the factors
associated with poor health. Results: According to the ASAS-HI, 147 (25.0%) patients reported poor health. Pain and
moving around were the main affected categories. In addition, 14.0% reported
their self-perceived health status as ‘bad’ or ‘very bad’ and 46.8% as worse
than before the pandemic. In the multivariate analysis, smoking (OR = 1.98),
diabetes (OR = 4.89) and taking painkillers (OR = 2.82) or corticosteroids
use (OR = 2.20) were significantly associated with poor health, while
engaging in physical activity (OR = 0.54) and being actively employed
(OR = 0.48) were inversely associated with this. Conclusions: During the first wave of the COVID-19 pandemic, one in four axSpA patients
reported poor health and functioning, while the self-perceived health status
of almost half of these patients worsened. Nonsmoking, physical activity and
being employed were associated with better outcomes.
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Affiliation(s)
- Diego Benavent
- Rheumatology Service, IdiPAZ, La Paz University Hospital, Paseo de la Castellana, 261, Madrid 28046, Spain
| | | | | | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, LTHT and LIRMM, University of Leeds, Leeds, UK
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Conway R, Nikiphorou E, Demetriou CA, Low C, Leamy K, Ryan JG, Kavanagh R, Fraser AD, Carey JJ, O’Connell P, Flood RM, Mullan RH, Kane DJ, Ambrose N, Stafford F, Robinson PC, Liew JW, Grainger R, McCarthy GM. OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:SI151-SI156. [PMID: 35258593 PMCID: PMC8992296 DOI: 10.1093/rheumatology/keac142] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/01/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Richard Conway
- Correspondence to: Richard Conway, Department of Rheumatology, St. James’s Hospital, Dublin 8, Ireland. E-mail:
| | - Elena Nikiphorou
- Department of Rheumatology
- Centre for Rheumatic Diseases, King’s College London, London, UK
| | - Christiana A Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Candice Low
- Department of Rheumatology, St. Vincent’s University Hospital
| | - Kelly Leamy
- Department of Rheumatology, Mater Misericordiae Hospital, Dublin
| | - John G Ryan
- Department of Rheumatology, Cork University Hospital, Wilton
| | | | - Alexander D Fraser
- Department of Rheumatology, University Hospitals Limerick
- Graduate Entry Medical School, University of Limerick, Limerick
| | - John J Carey
- Department of Rheumatology, Galway University Hospitals
- School of Medicine, National University of Ireland Galway, Galway
| | - Paul O’Connell
- Department of Rheumatology, Beaumont Hospital
- School of Medicine, Royal College of Surgeons in Ireland
| | - Rachael M Flood
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Rheumatology, Tallaght University Hospital
| | - Ronan H Mullan
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Rheumatology, Tallaght University Hospital
| | - David J Kane
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Rheumatology, Tallaght University Hospital
| | - Nicola Ambrose
- Department of Rheumatology, Blackrock Clinic, Dublin, Ireland
| | | | | | - Jean W Liew
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
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Andersen KM, Bates BA, Rashidi ES, Olex AL, Mannon RB, Patel RC, Singh J, Sun J, Auwaerter PG, Ng DK, Segal JB, Garibaldi BT, Mehta HB, Alexander GC. Long-term use of immunosuppressive medicines and in-hospital COVID-19 outcomes: a retrospective cohort study using data from the National COVID Cohort Collaborative. THE LANCET. RHEUMATOLOGY 2022; 4:e33-e41. [PMID: 34806036 PMCID: PMC8592562 DOI: 10.1016/s2665-9913(21)00325-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many individuals take long-term immunosuppressive medications. We evaluated whether these individuals have worse outcomes when hospitalised with COVID-19 compared with non-immunosuppressed individuals. METHODS We conducted a retrospective cohort study using data from the National COVID Cohort Collaborative (N3C), the largest longitudinal electronic health record repository of patients in hospital with confirmed or suspected COVID-19 in the USA, between Jan 1, 2020, and June 11, 2021, within 42 health systems. We compared adults with immunosuppressive medications used before admission to adults without long-term immunosuppression. We considered immunosuppression overall, as well as by 15 classes of medication and three broad indications for immunosuppressive medicines. We used Fine and Gray's proportional subdistribution hazards models to estimate the hazard ratio (HR) for the risk of invasive mechanical ventilation, with the competing risk of death. We used Cox proportional hazards models to estimate HRs for in-hospital death. Models were adjusted using doubly robust propensity score methodology. FINDINGS Among 231 830 potentially eligible adults in the N3C repository who were admitted to hospital with confirmed or suspected COVID-19 during the study period, 222 575 met the inclusion criteria (mean age 59 years [SD 19]; 111 269 [50%] male). The most common comorbidities were diabetes (23%), pulmonary disease (17%), and renal disease (13%). 16 494 (7%) patients had long-term immunosuppression with medications for diverse conditions, including rheumatological disease (33%), solid organ transplant (26%), or cancer (22%). In the propensity score matched cohort (including 12 841 immunosuppressed patients and 29 386 non-immunosuppressed patients), immunosuppression was associated with a reduced risk of invasive ventilation (HR 0·89, 95% CI 0·83-0·96) and there was no overall association between long-term immunosuppression and the risk of in-hospital death. None of the 15 medication classes examined were associated with an increased risk of invasive mechanical ventilation. Although there was no statistically significant association between most drugs and in-hospital death, increases were found with rituximab for rheumatological disease (1·72, 1·10-2·69) and for cancer (2·57, 1·86-3·56). Results were generally consistent across subgroup analyses that considered race and ethnicity or sex, as well as across sensitivity analyses that varied exposure, covariate, and outcome definitions. INTERPRETATION Among this cohort, with the exception of rituximab, there was no increased risk of mechanical ventilation or in-hospital death for the rheumatological, antineoplastic, or antimetabolite therapies examined. FUNDING None.
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Affiliation(s)
- Kathleen M Andersen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Benjamin A Bates
- Rutgers Center for Pharmacoepidemiology and Treatment Science, New Brunswick, NJ, USA
| | - Emaan S Rashidi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy L Olex
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Roslyn B Mannon
- Division of Nephrology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Rena C Patel
- Department of Medicine and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jasvinder Singh
- Medicine Service, VA Medical Center, Birmingham, AL, USA
- Department of Medicine, School of Medicine and Division of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jing Sun
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Paul G Auwaerter
- The Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Derek K Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jodi B Segal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Brian T Garibaldi
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hemalkumar B Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
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36
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Patel NJ, D'Silva KM, Hsu TYT, DiIorio M, Fu X, Cook C, Prisco L, Martin L, Vanni KMM, Zaccardelli A, Zhang Y, Sparks JA, Wallace ZS. Coronavirus Disease 2019 Outcomes Among Recipients of Anti-CD20 Monoclonal Antibodies for Immune-Mediated Diseases: A Comparative Cohort Study. ACR Open Rheumatol 2021; 4:238-246. [PMID: 34890478 PMCID: PMC8916578 DOI: 10.1002/acr2.11386] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 01/27/2023] Open
Abstract
Objective Patients with immune‐mediated diseases treated with anti‐CD20 monoclonal antibodies may have worse coronavirus disease 2019 (COVID‐19) outcomes due to impaired humoral immunity, but differences compared with the general population are unknown. Methods We identified patients with immune‐mediated diseases who received anti‐CD20 monoclonal antibodies within 1 year prior to the index date of polymerase chain reaction–confirmed COVID‐19 between January 31, 2020, and January 31, 2021. General population comparators with COVID‐19 were matched up 5:1 by age, sex, and polymerase chain reaction date. Unadjusted and multivariable adjusted (for age, race, body mass index, and Charlson Comorbidity Index) hazard ratios (HRs) and 95% confidence intervals (CIs) for hospitalization, mechanical ventilation, and death in recipients of anti‐CD20 monoclonal antibodies versus comparators were estimated by using Cox regression. Results We identified 114 cases patients COVID‐19 who had received anti‐CD20 monoclonal antibodies for immune‐mediated diseases (mean age 55 years, 70% female) and 559 matched comparators with COVID‐19 (mean age 54 years, 70% female). Patients treated with anti‐CD20 monoclonal antibodies had higher mortality (adjusted HR 2.16; 95% CI: 1.03‐4.54) than matched comparators. Risks of hospitalization (adjusted HR 0.88; 95% CI: 0.62‐1.26) and mechanical ventilation use (adjusted HR 0.82; 95% CI: 0.36‐1.87) were similar. Similar trends were seen in analyses according to type of indication (eg, rheumatic or neurologic disease) and duration of anti‐CD20 monoclonal antibody use (<1 or ≥1 year) and after patients with interstitial lung disease, those with cancer, and those on glucocorticoids prior to COVID‐19 diagnosis were excluded. Conclusion Patients who received anti‐CD20 monoclonal antibodies for immune‐mediated diseases prior to COVID‐19 had higher mortality following COVID‐19 than matched comparators, highlighting the urgent need to mitigate excess risks in recipients of anti‐CD20 monoclonal antibodies during the ongoing pandemic.
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Affiliation(s)
- Naomi J Patel
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kristin M D'Silva
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tiffany Y-T Hsu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael DiIorio
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Xiaoqing Fu
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Claire Cook
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lauren Prisco
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lily Martin
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kathleen M M Vanni
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Yuqing Zhang
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Zachary S Wallace
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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37
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Bower H, Frisell T, di Giuseppe D, Delcoigne B, Ahlenius GM, Baecklund E, Chatzidionysiou K, Feltelius N, Forsblad-d'Elia H, Kastbom A, Klareskog L, Lindqvist E, Lindström U, Turesson C, Sjowall C, Askling J. Effects of the COVID-19 pandemic on patients with inflammatory joint diseases in Sweden: from infection severity to impact on care provision. RMD Open 2021; 7:rmdopen-2021-001987. [PMID: 34880127 PMCID: PMC8655349 DOI: 10.1136/rmdopen-2021-001987] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives To compare risks for COVID-19-related outcomes in inflammatory joint diseases (IJDs) and across disease-modifying antirheumatic drugs (DMARDs) during the first two waves of the pandemic and to assess effects of the pandemic on rheumatology care provision. Methods Through nationwide multiregister linkages and cohort study design, we defined IJD and DMARD use annually in 2015–2020. We assessed absolute and relative risks of hospitalisation or death listing COVID-19. We also assessed the incidence of IJD and among individuals with IJD, rheumatologist visits, DMARD use and incidence of selected comorbidities. Results Based on 115 317 patients with IJD in 2020, crude risks of hospitalisation and death listing COVID-19 (0.94% and 0.33% across both waves, respectively) were similar during both waves (adjusted HR versus the general population 1.33, 95% CI 1.23 to 1.43, for hospitalisation listing COVID-19; 1.23, 95% CI 1.08 to 1.40 for death listing COVID-19). Overall, biological disease-modifying antirheumatic drugs (bDMARDs)/targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) did not increase risks of COVID-19 related hospitalisation (with the exception of a potential signal for JAK inhibitors) or death. During the pandemic, decreases were observed for IJD incidence (−7%), visits to rheumatology units (−16%), DMARD dispensations (+6.5% for bDMARD/tsDMARDs and −8.5% for conventional synthetic DMARDs compared with previous years) and for new comorbid conditions, but several of these changes were part of underlying secular trends. Conclusions Patients with IJD are at increased risk of serious COVID-19 outcomes, which may partially be explained by medical conditions other than IJD per se. The SARS-CoV-2 pandemic has exerted measurable effects on aspects of rheumatology care provision demonstrated, the future impact of which will need to be assessed.
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Affiliation(s)
- Hannah Bower
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Daniela di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Bénédicte Delcoigne
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Gerd-Marfie Ahlenius
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå Universitet, Umeå, Sweden
| | - Eva Baecklund
- Unit of Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Nils Feltelius
- Swedish Medical Products Agency, Uppsala, Sweden.,Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alf Kastbom
- Department of Biomedical and Clinical Sciences, Linkopings Universitet, Linkoping, Sweden
| | - Lars Klareskog
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Lindqvist
- Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Christopher Sjowall
- Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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38
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Specker C, Aries P, Braun J, Burmester G, Fischer-Betz R, Hasseli R, Holle J, Hoyer BF, Iking-Konert C, Krause A, Krüger K, Krusche M, Leipe J, Lorenz HM, Moosig F, Schmale-Grede R, Schneider M, Strangfeld A, Voll R, Voormann A, Wagner U, Schulze-Koops H. Updated recommendations of the German Society for Rheumatology for the care of patients with inflammatory rheumatic diseases in the context of the SARS-CoV-2/COVID-19 pandemic, including recommendations for COVID-19 vaccination. Z Rheumatol 2021; 80:33-48. [PMID: 34491403 PMCID: PMC8422376 DOI: 10.1007/s00393-021-01055-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Christof Specker
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany.
- Klinik für Rheumatologie & Klinische Immunologie, Kliniken Essen-Mitte, Pattbergstr. 2, 45239, Essen, Germany.
| | - Peer Aries
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumatologie im Struenseehaus, Hamburg, Germany
| | - Jürgen Braun
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumazentrum Ruhrgebiet, Ruhr Universität Bochum, Bochum, Germany
| | - Gerd Burmester
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Germany
| | - Rebecca Fischer-Betz
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Rebecca Hasseli
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Julia Holle
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | - Bimba Franziska Hoyer
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, 1. Medizinische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christof Iking-Konert
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- III. Medizinische Klinik und Poliklinik Sektion Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Andreas Krause
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Klaus Krüger
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumatologisches Praxiszentrum München, Munich, Germany
| | - Martin Krusche
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Germany
| | - Jan Leipe
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Mannheim, Germany
| | - Hanns-Martin Lorenz
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Frank Moosig
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | | | - Matthias Schneider
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Anja Strangfeld
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheumaforschungszentrum Berlin, Berlin, Germany
| | - Reinhard Voll
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Klinik für Rheumatologie und Klinische Immunologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Germany
| | - Anna Voormann
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
| | - Ulf Wagner
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Hendrik Schulze-Koops
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany.
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Ludwig-Maximilians-Universität München, Pettenkoferstraße 8a, Munich, Germany.
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Shahram F, Esalatmanesh K, Khabbazi A, Rezaieyazdi Z, Mirfeizi Z, Sadeghi A, Soroosh M, Kavosi H, Alikhani M, Mostafaei S. Coronavirus disease 2019 in patients with Behcet's disease: a report of 59 cases in Iran. Clin Rheumatol 2021; 41:1177-1183. [PMID: 34842999 PMCID: PMC8628030 DOI: 10.1007/s10067-021-06004-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/10/2021] [Accepted: 11/24/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To present the clinical characteristics, disease course, management, and outcomes of COVID-19 infection in patients with Behcet's disease (BD). METHODS In this retrospective cohort study, we retrieved BD patients with definite diagnosis of COVID-19 infection. Demographic data, comorbidities, features related both to BD and COVID-19 infection, treatments, and outcomes were collected. Comparisons between patients with or without hospitalization were performed. All statistical analyzes were performed using SPSS version 25. We considered p < 0.05 statistically significant. RESULTS We identified 61 episodes of COVID-19 infection in 59 BD patients. The prevalence was 0.69%. The median age was 45 years (IQR = 20), and the median disease duration was 162 months (IQR = 195). BD features were similar except for higher rate of arterial involvement and positive pathergy test in infected patients. Thirty-five episodes (62.5%) happened in non-active patients; 39% had a comorbid disease. COVID manifestations were the same as the general population. Flu-like symptoms were the most common (85%), followed by fever (66%), ageusia/anosmia (56%), headache (51%), and pulmonary involvement (48%). There was no change in BD symptoms in 74%. Fifteen patients (25.4%) were hospitalized, and one patient (1.7%) died. Receiving glucocorticoids (p < 0.03) and cytotoxic drugs (p < 0.02) were associated with an increased rate of hospitalization. CONCLUSION The incidence of COVID-19 infection in BD patients was not higher than general population in Iran. They showed milder form of disease with lower morbidity and mortality rate. Most were on immunosuppressive drugs, or had a comorbidity apart from BD. No significant effect on BD course was shown. Key Points • The incidence of COVID-19 infection in patients with Behcet's disease is not higher. • They showed milder form of infection with lower morbidity and mortality rate. • No significant effect on Behcet's disease course was shown with COVID19 infection. • BD patients can be managed according to the guidelines used for general population.
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Affiliation(s)
- Farhad Shahram
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Kargar Avenue, 14117-13137, Tehran, Iran.
| | - Kamal Esalatmanesh
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Alireza Khabbazi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Rezaieyazdi
- Rheumatic Diseases Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Mirfeizi
- Rheumatic Diseases Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Sadeghi
- Department of Internal Medicine, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Hoda Kavosi
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Kargar Avenue, 14117-13137, Tehran, Iran
| | - Majid Alikhani
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Kargar Avenue, 14117-13137, Tehran, Iran
| | - Shayan Mostafaei
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Kargar Avenue, 14117-13137, Tehran, Iran.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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40
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Baslılar S, Pehlivan O. Evaluation of factors affecting the frequency and clinical course of COVID-19 in patients using anti-TNF-alpha agents. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2021; 67:1286-1292. [PMID: 34816922 DOI: 10.1590/1806-9282.20210568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/01/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Patients being treated with anti-tumor necrosis factor-alpha (anti-TNF-alpha) agents were reported to have better prognosis related to COVID-19. We evaluated the factors affecting the frequency, clinical course, and outcome of COVID-19 in patients treated with anti-TNF-alpha agents. METHODS Patients with rheumatoid diseases and chronic inflammatory bowel diseases treated with anti-TNF-alpha agents were evaluated retrospectively. The laboratory data in routine visits, frequency of COVID-19, pneumonia, hospitalization and/or intensive care unit (ICU) follow-up and, mortality were recorded. The factors related to COVID-19 frequency and clinical outcome were evaluated. RESULTS A total of 324 patients (177 males [54.6%] and 147 females [45.4%], mean age: 45.3±12.16 years) was included in the study. In all, 44 (13.6%) patients had COVID-19; of these, 11 (25%) developed pneumonia, 7 (15.9%) were hospitalized, and 1 (2.3%) was followed up in ICU. There was no mortality. The patients with COVID-19 pneumonia were older (mean age: 52±11 years versus 41±12 years, p=0.01), had hypertension and coronary artery disease more frequently (5 cases [55.6%] versus 4 cases [44.4], p=0.02 and 2 cases [100%] versus 0 cases [0%], p=0.014, respectively), and lower eosinophil % (1.35±1.79% versus 2.3±1.45%, p=0.016). The diabetes mellitus was more frequent (66.7 versus 33.3%, p=0.013), and mean eosinophil % was lower among inpatients compared with outpatients (1.29±2.22% versus 2.19±1.37%, p=0.02). CONCLUSIONS We concluded that the patients treated with anti-TNF-alpha agents having COVID-19 might have mild clinical course and better prognosis.
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Affiliation(s)
- Seyma Baslılar
- Umraniye Training and Research Hospital, Department of Pulmonology - Istanbul, Turkey
| | - Ozlem Pehlivan
- Umraniye Training and Research Hospital, Department of Rheumatology - Istanbul, Turkey
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Conway R, Grimshaw AA, Konig MF, Putman M, Duarte-García A, Tseng LY, Cabrera DM, Chock YPE, Degirmenci HB, Duff E, Egeli BH, Graef ER, Gupta A, Harkins P, Hoyer BF, Jayatilleke A, Jin S, Kasia C, Khilnani A, Kilian A, Kim AH, Lin CMA, Low C, Proulx L, Sattui SE, Singh N, Sparks JA, Tam H, Ugarte-Gil MF, Ung N, Wang K, Wise LM, Yang Z, Young KJ, Liew JW, Grainger R, Wallace ZS, Hsieh E. SARS-CoV-2 Infection and COVID-19 Outcomes in Rheumatic Disease: A Systematic Literature Review And Meta-Analysis. Arthritis Rheumatol 2021; 74:766-775. [PMID: 34807517 PMCID: PMC9011807 DOI: 10.1002/art.42030] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/22/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022]
Abstract
Objective The relative risk of SARS–CoV‐2 infection and COVID‐19 disease severity among people with rheumatic and musculoskeletal diseases (RMDs) compared to those without RMDs is unclear. This study was undertaken to quantify the risk of SARS–CoV‐2 infection in those with RMDs and describe clinical outcomes of COVID‐19 in these patients. Methods We conducted a systematic literature review using 14 databases from January 1, 2019 to February 13, 2021. We included observational studies and experimental trials in RMD patients that described comparative rates of SARS–CoV‐2 infection, hospitalization, oxygen supplementation/intensive care unit (ICU) admission/mechanical ventilation, or death attributed to COVID‐19. Methodologic quality was evaluated using the Joanna Briggs Institute critical appraisal tools or the Newcastle‐Ottawa scale. Risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated, as applicable for each outcome, using the Mantel‐Haenszel formula with random effects models. Results Of the 5,799 abstracts screened, 100 studies met the criteria for inclusion in the systematic review, and 54 of 100 had a low risk of bias. Among the studies included in the meta‐analyses, we identified an increased prevalence of SARS–CoV‐2 infection in patients with an RMD (RR 1.53 [95% CI 1.16–2.01]) compared to the general population. The odds of hospitalization, ICU admission, and mechanical ventilation were similar in patients with and those without an RMD, whereas the mortality rate was increased in patients with RMDs (OR 1.74 [95% CI 1.08–2.80]). In a smaller number of studies, the adjusted risk of outcomes related to COVID‐19 was assessed, and the results varied; some studies demonstrated an increased risk while other studies showed no difference in risk in patients with an RMD compared to those without an RMD. Conclusion Patients with RMDs have higher rates of SARS–CoV‐2 infection and an increased mortality rate.
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Affiliation(s)
- Richard Conway
- Department of Rheumatology, St. James's Hospital, Dublin, Ireland and Clinical Lecturer Trinity College Dublin, Ireland
| | - Alyssa A Grimshaw
- Cushing/Whitney Medical Library, Yale University New Haven, Connecticut, USA
| | - Maximilian F Konig
- Division of Rheumatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Diego M Cabrera
- Section of Rheumatology, Allergy & Immunology, Yale School of Medicine, New Haven, CT, USA
| | - Yu Pei Eugenia Chock
- Section of Rheumatology, Allergy & Immunology, Yale School of Medicine, New Haven, CT, USA
| | | | - Eimear Duff
- Department of Rheumatology, St. James's Hospital, Dublin, Ireland
| | - Bugra Han Egeli
- Graduate Medical Sciences, Boston University School of Medicine, 72 E Concord St L-317, 02118, Boston, MA, USA and Department of Pediatrics, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth R Graef
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Akash Gupta
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Patricia Harkins
- Department of Rheumatology, St. James's Hospital, Dublin, Ireland
| | - Bimba F Hoyer
- Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | | | - Shangyi Jin
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID),, Beijing, 100730, China
| | | | - Aneka Khilnani
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Adam Kilian
- Division of Rheumatology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Alfred Hj Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Chung Mun Alice Lin
- National Institute of Health Research, Newcastle Biomedical Research Centre and the Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Candice Low
- St. Vincent's University Hospital, Dublin, Ireland
| | - Laurie Proulx
- Patient Author, Canadian Arthritis Patient Alliance, Ottawa, Ontario, Canada
| | - Sebastian E Sattui
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Namrata Singh
- Division of Rheumatology, University of Washington, Seattle, WA, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Herman Tam
- Division of Rheumatology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Manuel F Ugarte-Gil
- Lima, Peru and Hospital Guillermo Almenara Irigoyen, EsSalud, Universidad Cientifica del Sur, Lima, Peru
| | - Natasha Ung
- Campbelltown Hospital, Campbelltown, New South Wales, Australia and University of Western Sydney, New South Wales, Australia
| | - Kaicheng Wang
- Section of Rheumatology, Allergy & Immunology, Yale School of Medicine, New Haven, CT, USA and Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Leanna M Wise
- Division of Rheumatology, University of Southern California; Los Angeles, CA, USA
| | - Ziyi Yang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID),, Beijing, 100730, China
| | - Kristen J Young
- Division of Rheumatic Diseases, University of Texas Southwestern, Dallas, TX, USA
| | - Jean W Liew
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Zachary S Wallace
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Evelyn Hsieh
- Section of Rheumatology, VA Connecticut Healthcare System, West Haven, CT, USA
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Avina-Galindo AM, Fazal ZA, Marozoff S, Kwan J, Lu N, Hoens AM, Kopec J, Lacaille D, Xie H, Loree JM, Avina-Zubieta JA. Immunosuppression and COVID-19 infection in British Columbia: Protocol for a linkage study of population-based administrative and self-reported survey data. PLoS One 2021; 16:e0259601. [PMID: 34797824 PMCID: PMC8604283 DOI: 10.1371/journal.pone.0259601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Cases of the novel coronavirus disease (COVID-19) continue to spread around the world even one year after the declaration of a global pandemic. Those with weakened immune systems, due to immunosuppressive medications or disease, may be at higher risk of COVID-19. This includes individuals with autoimmune diseases, cancer, transplants, and dialysis patients. Assessing the risk and outcomes of COVID-19 in this population has been challenging. While administrative databases provide data with minimal selection and recall bias, clinical and behavioral data is lacking. To address this, we are collecting self-reported survey data from a randomly selected subsample with and without COVID-19, which will be linked to administrative health data, to better quantify the risk of COVID-19 infection associated with immunosuppression. Methods and analysis Using administrative and laboratory data from British Columbia (BC), Canada, we established a population-based case-control study of all individuals who tested positive for SARS-CoV-2. Each case was matched to 40 randomly selected individuals from two control groups: individuals who tested negative for SARS-CoV-2 (i.e., negative controls) and untested individuals from the general population (i.e., untested controls). We will contact 1000 individuals from each group to complete a survey co-designed with patient partners. A conditional logistic regression model will adjust for potential confounders and effect modifiers. We will examine the odds of COVID-19 infection according to immunosuppressive medication or disease type. To adjust for relevant confounders and effect modifiers not available in administrative data, the survey will include questions on behavioural variables that influence probability of being tested, acquiring COVID-19, and experiencing severe outcomes. Ethics and dissemination This study has received approval from the University of British Columbia Clinical Research Ethics Board [H20-01914]. Findings will be disseminated through scientific conferences, open access peer-reviewed journals, COVID-19 research repositories and dissemination channels used by our patient partners.
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Affiliation(s)
| | - Zahra A. Fazal
- Arthritis Research Canada, Vancouver, Canada
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jessie Kwan
- Arthritis Research Canada, Vancouver, Canada
- Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Na Lu
- Arthritis Research Canada, Vancouver, Canada
| | - Alison M. Hoens
- Arthritis Research Canada, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacek Kopec
- Arthritis Research Canada, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, Canada
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jonathan M. Loree
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | - J. Antonio Avina-Zubieta
- Arthritis Research Canada, Vancouver, Canada
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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A prospective multicenter study assessing humoral immunogenicity and safety of the mRNA SARS-CoV-2 vaccines in Greek patients with systemic autoimmune and autoinflammatory rheumatic diseases. J Autoimmun 2021; 125:102743. [PMID: 34757289 PMCID: PMC8552665 DOI: 10.1016/j.jaut.2021.102743] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/23/2021] [Accepted: 10/24/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate humoral responses and safety of mRNA SARS-CoV-2 vaccines in systemic autoimmune and autoinflammatory rheumatic disease (SAARD) patients subjected or not to treatment modifications during vaccination. METHODS A nationwide, multicenter study, including 605 SAARD patients and 116 controls, prospectively evaluated serum anti-SARS-CoV-2 S1-protein IgG antibody titers, side-effects, and disease activity, one month after complete vaccination, in terms of distinct treatment modification strategies (none, partial and extended modifications). Independent risk factors associated with hampered humoral responses were identified by data-driven multivariable logistic regression analysis. RESULTS Patients with extended treatment modifications responded to vaccines similarly to controls as well as SAARD patients without immunosuppressive therapy (97.56% vs 100%, p = 0.2468 and 97.56% vs 97.46%, p > 0.9999, respectively). In contrast, patients with partial or without therapeutic modifications responded in 87.50% and 84.50%, respectively. Furthermore, SAARD patients with extended treatment modifications developed higher anti-SARS-CoV-2 antibody levels compared to those without or with partial modifications (median:7.90 vs 7.06 vs 7.1, p = 0.0003 and p = 0.0195, respectively). Mycophenolate mofetil (MMF), rituximab (RTX) and methotrexate (MTX) negatively affected anti-SARS-CoV-2 humoral responses. In 10.5% of vaccinated patients, mild clinical deterioration was noted; however, no differences in the incidence of deterioration were observed among the distinct treatment modification SAARD subgroups. Side-effects were generally comparable between SAARD patients and controls. CONCLUSIONS In SAARD patients, mRNA SARS-CoV-2 vaccines are effective and safe, both in terms of side-effects and disease flares. Treatment with MMF, RTX and/or MTX compromises anti-SARS-CoV-2 antibody responses, which are restored upon extended treatment modifications without affecting disease activity.
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The Association between Noninfectious Uveitis and Coronavirus Disease 2019 Outcomes: An Analysis of United States Claims-Based Data. Ophthalmology 2021; 129:334-343. [PMID: 34648828 PMCID: PMC8503974 DOI: 10.1016/j.ophtha.2021.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/15/2021] [Accepted: 10/05/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose To identify if noninfectious uveitis (NIU) is associated with a greater risk of Coronavirus Disease 2019 (COVID-19) infection, hospitalization, and death. Design A retrospective cohort study from January 20, 2020 to December 31, 2020, using a national claims-based database. Participants Enrollees who had continuous enrollment with both medical and pharmacy coverage for 3 years before January 20, 2020. Patients with an NIU diagnosis within 3 years of the start of the study were included in the NIU cohort. Those with infectious uveitis codes or new NIU diagnoses during the risk period were excluded. Methods Cox proportional hazard models were used to identify unadjusted hazard ratios (HRs) and adjusted HRs for all covariates for each outcome measure. Adjusted models accounted for patient demographics, health status, and immunosuppressive medication use during the risk period. Main Outcome Measures Rates of COVID-19 infection, COVID-19-related hospitalization, and COVID-19-related in-hospital death identified with International Classification of Disease 10th revision codes. Results This study included 5 806 227 patients, of whom 29 869 (0.5%) had a diagnosis of NIU. On unadjusted analysis, patients with NIU had a higher rate of COVID-19 infection (5.7% vs. 4.5%, P < 0.001), COVID-19-related hospitalization (1.2% vs. 0.6%, P < 0.001), and COVID-19-related death (0.3% vs. 0.1%, P < 0.001). However, in adjusted models, NIU was not associated with a greater risk of COVID-19 infection (HR, 1.05; 95% confidence interval [CI], 1.00–1.10; P = 0.04), hospitalization (HR, 0.98; 95% CI, 0.88–1.09; P = 0.67), or death (HR, 0.90, 95% CI, 0.72–1.13, P = 0.37). Use of systemic corticosteroids was significantly associated with a higher risk of COVID-19 infection, hospitalization, and death. Conclusions Patients with NIU were significantly more likely to be infected with COVID-19 and experience severe disease outcomes. However, this association was due to the demographics, comorbidities, and medications of patients with NIU, rather than NIU alone. Patients using systemic corticosteroids were significantly more likely to be infected with COVID-19 and were at greater risk of hospitalization and in-hospital death. Additional investigation is necessary to identify the impact of corticosteroid exposure on COVID-19-related outcomes.
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Ramirez GA, Argolini LM, Bellocchi C, Moroni L, Della-Torre E, Farina N, Caporali RF, Beretta L, Gerosa M, Bozzolo EP, Dagna L. Impact of the COVID-19 pandemic in patients with systemic lupus erythematosus throughout one year. Clin Immunol 2021; 231:108845. [PMID: 34478882 PMCID: PMC8405598 DOI: 10.1016/j.clim.2021.108845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/11/2021] [Accepted: 08/29/2021] [Indexed: 12/21/2022]
Abstract
Little is known about the impact of coronavirus disease 2019 (COVID-19) pandemic to the care of patients with systemic lupus erythematosus (SLE) in the long-term. By crossing population data with the results of a web-based survey focused on the timeframes January–April and May–December 2020, we found that among 334/518 responders, 28 had COVID-19 in 2020. Seventeen cases occurred in May–December, in parallel with trends in the general population and loosening of containment policy strength. Age > 40 years (p = 0.026), prednisone escalation (p = 0.008) and infected relatives (p < 0.001) were most significantly associated with COVID-19. Weaker associations were found with asthma, lymphadenopathy and azathioprine or cyclosporine treatment. Only 31% of patients with infected relatives developed COVID-19. Healthcare service disruptions were not associated with rising hospitalisations. Vaccination prospects were generally welcomed. Our data suggest that COVID-19 has a moderate impact on patients with SLE, which might be significantly modulated by public health policies, including vaccination.
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Affiliation(s)
- Giuseppe A Ramirez
- Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy.
| | | | - Chiara Bellocchi
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Luca Moroni
- Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Emanuel Della-Torre
- Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Farina
- Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Roberto F Caporali
- Unit of Clinical Rheumatology, ASST Gaetano Pini -CTO, Milan, Italy; Department of Clinical Science of Community Health and Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Maria Gerosa
- Unit of Clinical Rheumatology, ASST Gaetano Pini -CTO, Milan, Italy; Department of Clinical Science of Community Health and Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Enrica P Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lorenzo Dagna
- Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
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Sparks JA, Wallace ZS, Robinson PC. Coronavirus disease 2019: update on coronavirus disease 2019 outcomes and vaccine efficacy in patients with immune-mediated inflammatory disease. Curr Opin Rheumatol 2021; 33:412-418. [PMID: 34171857 PMCID: PMC8373387 DOI: 10.1097/bor.0000000000000812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Although the literature to date on COVID-19 outcomes in those with immune-mediated inflammatory disease has been largely reassuring there remain many unanswered questions. These include the impact of specific medications on outcomes and the antibody response after COVID-19 vaccination. RECENT FINDINGS We summarized the current literature related to COVID-19 outcomes in immune-mediated inflammatory diseases in rheumatology, gastroenterology, dermatology, and neurology. Overall, we found either no difference or modest differences in risk for severe COVID-19 for people with immune-mediated diseases compared with the general population. When considering disease-specific factors, glucocorticoid use and underlying immune-mediated disease activity were generally associated with worse outcomes. Specific medications varied in associations: tumor necrosis factor inhibitors generally had lower odds for severe COVID-19 outcomes, whereas rituximab use generally had higher odds for severe outcomes. We also detailed the recent reports of antibody response to COVID-19 vaccination in people with immune-mediated inflammatory diseases. SUMMARY Investigations of immune-mediated inflammatory diseases across several organ systems have offered important insight into the COVID-19 disease course. Overall, these studies have provided reassurance to patients and clinicians while also identifying groups who may be at higher risk for poor outcomes.
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Affiliation(s)
| | - Zachary S. Wallace
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Philip C. Robinson
- University of Queensland School of Clinical Medicine, Faculty of Medicine
- Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Herston, Queensland, Australia
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Patel NJ, D'Silva KM, Hsu TYT, DiIorio M, Fu X, Cook C, Prisco L, Martin L, Vanni KMM, Zaccardelli A, Zhang Y, Sparks JA, Wallace ZS. COVID-19 Outcomes Among Users of CD20 Inhibitors for Immune-Mediated Diseases: A Comparative Cohort Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 34401883 PMCID: PMC8366799 DOI: 10.1101/2021.08.05.21261643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: Patients with immune-mediated diseases treated with CD20 inhibitors may have worse COVID-19 outcomes due to impaired humoral immunity, but differences versus the general population are unknown. Methods: We identified patients with immune-mediated diseases who received CD20 inhibitors within one year prior to the index date of PCR-confirmed COVID-19 between January 31, 2020, and January 31, 2021. Comparators with COVID-19 were matched up to 5:1 by age, sex, and PCR date. Hazard ratios (HRs) and 95% confidence intervals (CIs) for hospitalization, mechanical ventilation, and death in CD20 inhibitor users versus comparators were estimated using Cox regression. Results: We identified 114 cases with COVID-19 who had received CD20 inhibitors for immune-mediated diseases (mean age 55 years, 70% female) and 559 matched comparators with COVID-19 (mean age 54 years, 70% female). CD20 inhibitor-treated cases had higher mortality (aHR 2.16; 95% CI: 1.03 to 4.54) than matched comparators. Risks of hospitalization (aHR 0.88; 95% CI: 0.62 to 1.26) and mechanical ventilation (aHR 0.82; 95% CI: 0.36 to 1.87) were similar. Similar trends were seen in analyses according to type of indication (e.g., rheumatic or neurologic disease) and duration of CD20 inhibitor use (<1 or ≥1 year), and after excluding patients with interstitial lung disease, cancer, and those on glucocorticoids prior to COVID-19 diagnosis. Conclusions: Patients who received CD20 inhibitors for immune-mediated diseases prior to COVID-19 had higher mortality following COVID-19 than matched comparators, highlighting the urgent need to mitigate excess risks in CD20 inhibitor users during the ongoing pandemic.
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Bower H, Frisell T, Di Giuseppe D, Delcoigne B, Ahlenius GM, Baecklund E, Chatzidionysiou K, Feltelius N, Forsblad-d'Elia H, Kastbom A, Klareskog L, Lindqvist E, Lindström U, Turesson C, Sjöwall C, Askling J. Impact of the COVID-19 pandemic on morbidity and mortality in patients with inflammatory joint diseases and in the general population: a nationwide Swedish cohort study. Ann Rheum Dis 2021; 80:1086-1093. [PMID: 33622688 PMCID: PMC8206171 DOI: 10.1136/annrheumdis-2021-219845] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To estimate absolute and relative risks for all-cause mortality and for severe COVID-19 in inflammatory joint diseases (IJDs) and with antirheumatic therapies. METHODS Through Swedish nationwide multiregister linkages, we selected all adult patients with rheumatoid arthritis (RA, n=53 455 in March 2020), other IJDs (here: spondyloarthropathies, psoriatic arthritis and juvenile idiopathic arthritis, n=57 112), their antirheumatic drug use, and individually matched population referents. We compared annual all-cause mortality March-September 2015 through 2020 within and across cohorts, and assessed absolute and relative risks for hospitalisation, admission to intensive care and death due to COVID-19 March-September 2020, using Cox regression. RESULTS During March-September 2020, the absolute all-cause mortality in RA and in other IJDs was higher than 2015-2019, but relative risks versus the general population (around 2 and 1.5) remained similar during 2020 compared with 2015-2019. Among patients with IJD, the risks of hospitalisation (0.5% vs 0.3% in their population referents), admission to intensive care (0.04% vs 0.03%) and death (0.10% vs 0.07%) due to COVID-19 were low. Antirheumatic drugs were not associated with increased risk of serious COVID-19 outcomes, although for certain drugs, precision was limited. CONCLUSIONS Risks of severe COVID-19-related outcomes were increased among patients with IJDs, but risk increases were also seen for non-COVID-19 morbidity. Overall absolute and excess risks are low and the level of risk increases are largely proportionate to those in the general population, and explained by comorbidities. With possible exceptions, antirheumatic drugs do not have a major impact on these risks.
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Affiliation(s)
- Hannah Bower
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Gerd-Marie Ahlenius
- Rheumatology Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Eva Baecklund
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | | | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alf Kastbom
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lars Klareskog
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Christopher Sjöwall
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johan Askling
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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49
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Specker C, Aries P, Braun J, Burmester G, Fischer-Betz R, Hasseli R, Holle J, Hoyer BF, Iking-Konert C, Krause A, Krüger K, Krusche M, Leipe J, Lorenz HM, Moosig F, Schmale-Grede R, Schneider M, Strangfeld A, Voll R, Voormann A, Wagner U, Schulze-Koops H. [Updated recommendations of the German Society for Rheumatology for the care of patients with inflammatory rheumatic diseases in the context of the SARS-CoV‑2/COVID‑19 pandemic, including recommendations for COVID‑19 vaccination]. Z Rheumatol 2021; 80:570-587. [PMID: 34309739 PMCID: PMC8311067 DOI: 10.1007/s00393-021-01056-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Christof Specker
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.
- Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte, Pattbergstr. 2, 45239, Essen, Deutschland.
| | - Peer Aries
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumatologie im Struenseehaus, Hamburg, Deutschland
| | - Jürgen Braun
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumazentrum Ruhrgebiet, Ruhr Universität Bochum, Bochum, Deutschland
| | - Gerd Burmester
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Rebecca Fischer-Betz
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, , Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Rebecca Hasseli
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Bad Nauheim, Deutschland
| | - Julia Holle
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - Bimba Franziska Hoyer
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, 1. Medizinische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Christof Iking-Konert
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- III. Medizinische Klinik und Poliklinik Sektion Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland
| | - Andreas Krause
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Klaus Krüger
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumatologisches Praxiszentrum München, München, Deutschland
| | - Martin Krusche
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Jan Leipe
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Mannheim, Deutschland
| | - Hanns-Martin Lorenz
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Frank Moosig
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | | | - Matthias Schneider
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, , Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Anja Strangfeld
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland
| | - Reinhard Voll
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | - Anna Voormann
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
| | - Ulf Wagner
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Hendrik Schulze-Koops
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland.
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50
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Rodriguez-Pla A, Vikram HR, Khalid V, Wesselius LJ. COVID-19 pneumonia in a patient with granulomatosis with polyangiitis on rituximab: case-based review. Rheumatol Int 2021; 41:1509-1514. [PMID: 34091704 PMCID: PMC8180184 DOI: 10.1007/s00296-021-04905-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022]
Abstract
A 77-year-old man with past medical history of granulomatosis with polyangiitis (GPA) on rituximab and prednisone, presented to the hospital with worsening cough and shortness of breath. He had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by nasal swab polymerase chain reaction (PCR) while asymptomatic, 6 weeks earlier. He started with cough and shortness of breath 2 weeks after his initial positive test. After developing symptoms, he tested negative twice by nasal swab PCR, but the PCR of his bronchioloalveolar lavage was positive for SARS-CoV-2. He did not develop antibodies against coronavirus. Prednisone 15 mg daily was continued, and he received remdesivir, and convalescent plasma with quick recovery. We reviewed the literature to search for similar cases. Our case suggests that SARS-CoV-2 infection in patients on rituximab may have an atypical presentation and the diagnosis may be delayed due to negative PCR testing in the nasal swab. Patients may benefit from treatment with convalescent plasma.
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Affiliation(s)
| | | | - Vanood Khalid
- Division of Hospital Internal Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Lewis J Wesselius
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
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