Increased Rheumatoid Factor production in patients with severe COVID-19

BACKGROUND

Searching for Rheumatoid Factors (RF) in patients with coronavirus disease (COVID-19) has rarely been described.

OBJECTIVES

To investigate the association between RF isotypes (IgM, IgA, and IgG) and different clinical presentations of COVID-19 in a series of Tunisian patients.

STUDY DESIGN

Eighty-two COVID-19 patients were enrolled in this study. Symptomatic cases were recruited from the Department of COVID-19 and the intensive care unit (ICU) of the University Hospital of Mahdia, Tunisia, from January 2021 to March 2021. Different RF isotypes were assessed using a commercial enzyme-linked immunosorbent assay (ELISA).

RESULTS

Forty-one patients (50%) had RF of any isotype. Thirty-two patients (39%) were tested positive for RF-IgM. Symptomatic forms of the disease were associated with RF-IgM positivity (p = 0.005). The mean concentration of RF-IgM was higher in the severe form than in the moderate and asymptomatic forms (p = 0.006).

CONCLUSIONS

Our study suggests that the production of RF-IgM isotype is increased in patients with severe COVID-19.

AB0302 DIASTOLIC DYSFUNCTION IN RHEUMATOID ARTHRITIS PATIENTS: A COMPARATIVE CROSS-SECTIONAL STUDY

Background

Cardiac failure is an independent risk factor for mortality in Rheumatoid arthritis (RA) and diastolic dysfunction (DD) may act as a precursor for cardiac failure.

Objectives

The aim of our study is to determine the frequency of diastolic dysfunction in rheumatoid arthritis (RA) patients compared to a control group and to focus on associated factors.

Methods

This was a comparative cross-sectional study, including patients diagnosed with RA according to the ACR/EULAR 2010 criteria and control subjects. Each patient underwent transthoracic echocardiography and the DD was assessed by E/A and E/a ratio.

Results

Seventy-two patients with RA and 72 control subjects were included. In our study, there was a clear female predominance in both groups (93.1% vs 94.4%). The mean age of RA patients was 52.9 ± 11.72 years [21-75 years] and that of the control group was 49.26 ± 10.74 years [19-76 years]. In RA group, the mean duration of disease was 12.4 ± 9.9 years [6 months-40 years]. The means of DAS 28 (CRP), DAS 28 (ESR) and HAQ score were respectively 3.4 ± 1.4 [1.2-6.7]; 3.9 ± 1.4 [1.4-7.4] and 0.9 ± 0.7 [0-2.5]. 51.4% of patients had an increased ESR and 37.5% of cases had an increased CRP (CRP>6). In RA group, DD was present in 26 patients (36.1% of cases). The mean value of the impaired E/A ratio was 0.7 ± 0.1 [0.4-0.9] and the mean value of the impaired E/a ratio was 9.8 ± 1.5 [8.5-14.4]. These patients (23 women and 3 men) had a mean age of 56 ± 10.4 years [33-74 years]. Among them, 7 patients had hypertension, 9 patients had cardiac symptoms, 21 patients had a long-standing RA, 17 patients had positive ACPAs and 11 patients had positive RF. In control group, DD was present in 10 patients (13.9% of cases). The mean value of the impaired E/A ratio was 0.6 ± 0.1 [0.4-0.9] and the mean value of the impaired E/a ratio was 9 ± 0.6 [8.4 to 10.1]. Left ventricular diastolic dysfunction was more frequent in RA patients compared with the control group with a significant difference (p<0.01). No significant association was found between diastolic impairment and RA parameters.

Conclusion

Subjects with RA have a higher frequency of diastolic dysfunction than those without RA. Therefore, correct assessment of diastolic function should be considered of pivotal importance in the routine follow-up of RA patients. The identification of predictor factors requires further study.

References

[1]Cavazzana I, Vizzardi E, Franceschini F. Diastolic dysfunction in rheumatoid arthritis : Monaldi Arch Chest Dis 2019; 891137 2019;89.

Disclosure of Interests

None declared

AB0169 INTEREST OF THE ECHOCARDIOGRAPHY IN SCREENING OF CARDIAC INVOLVEMENT IN RHEUMATOID ARTHRITIS PATIENTS

Background:

Rheumatoid arthritis (RA) is the most common chronic inflammatory disease which usually affects peripheral joints.Extra-articular manifestations can occur during the course of this disease and even before the onset of arthritis, such as cardiac impairment that is a common cause of mortality in RA.

Objectives:

The aim of our study is to identify the prevalence of cardiac manifestations in RA using the echocardiography exam and to elaborate its associated factors.

Methods:

This is a cross-sectional study including consecutive RA’s patients which consulted the rheumatology department in Taher Sfar hospital. The diagnosis of RA was elaborate according to ACR/EULAR 2010 criteria. The epidemiological, clinical and biological data were collected from patients’ records. Echocardiography was performed by a trained cardiologist in the same hospital, using the transthoracic approach.

Results:

Our study included 67 patients: 63 women (94%) and 4 men (6%), with an average age of 52.55 years [21-75 years] and mean disease duration of 11.85 years [10-40]. Joints deformities were present in 37 cases (55.2%) and radiographic joint damage in 49 cases (73.1%). 34 (50.7%) of the patients had an ESR greater than 30 mm/hour and 24 (35.8%) had a CRP greater than 6mg/L. The mean DAS28-CRP was 3.35 [1.24-6.7] and the mean DAS28-ESR was 4 [1.4-7.35]. Cardiac symptomatology was present in 22 cases (32.8%), dominated by dyspnea on effort in 22 cases (32.8%), dyspnea at rest in 4 cases (6%), chest pain in 8 cases (11.9%)and palpitation in 2 cases (3%). The echocardiography abnormalities were found in 44 cases. Valve damage was detected in 35 patients (52.2%), of which only 2 were significant. Valvular abnormalities were dominated by mitral valve regurgitation and mitral valve thickening in 11 cases (16.4%) each, aortic valve regurgitation in 6 cases (9%),aortic valve thickening in 2 cases (3%), aortic valve stenosis in 3 cases (4.5%),aortic valve calcification in 12 cases (17. 9%) aortic valve nodule in 1 case (1.5%), pulmonary insufficiency in 10 cases (14.9%) and tricuspid insufficiency in 25 cases (37.3%).Pericarditis was found in 2 cases (3%), pulmonary arterial hypertension (PAH) in 5 cases (7,5%) and Left ventricular hypertrophy in 14 cases (20,9%). The study of E/A and E/E’ ratios revealed diastolic dysfunction in 23 cases (34.3%).The mean of longitudinal global strain measure was -17,83 [-21,9 to -10] and it revealed systolic dysfunction in 18 cases (26.86%). Cardiac impairment detected by echocardiography did not appear to be associated with the age (p=0.39) or the disease duration (p=0.62) nor the importance of biological inflammation(p=0.1). However, joints deformities and RA activity (DAS28) were significant predictors of cardiac involvement (p=0.01; p=0.03).

Conclusion:

Our study shows that cardiac impairment in RA was often asymptomatic and was correlated with the disease activity. The echocardiography with the strain measure represents an excellent tool for its detection in early stages.

References:

[1]Guedes C, Bianchi-Fior P, Cormier B, Barthelemy B, Rat AC, Boissier MC. Cardiac manifestations of rheumatoid arthritis: A case-control transesophageal echocardiography study in 30 patients. Arthritis Care Res. 2001;45(2):129–35.

Disclosure of Interests:

None declared