POS1194 THE EFFECT OF SARS-COV-2 ON THE COURSE AND THE TREATMENT OF RHEUMATIC INFLAMMATORY DISEASES. EXPERIENCE FORM THE NORTHWESTERN GREECE
Authors: Pelechas E. , Kaltsonoudis E. , Migos M. , Karagianni P. , Kavvadias A. , Voulgari P. , Drosos A. 
Published: May 2021

Background:

COVID-19 has been shown to significantly affect the vulnerable population [1,2]. Among them, patients suffering from inflammatory rheumatic diseases, and especially the immunosuppressed [3].

Objectives:

to assess the effect of SARS-CoV-2 on the course and the treatment of rheumatic inflammatory diseases.

Methods:

from February to December 2020, 46 patients with inflammatory rheumatic diseases were included (32 female) that got infected with the SARS-CoV-2. Mean age was 65 years old, 17 were smokers, 12 had arterial hypertension, 8 diabetes mellitus, and 3 hypothyroidism. Most of them had their comorbidities well-controlled and their rheumatic disease was in remission. More specifically, 24 patients had rheumatoid arthritis, 13 psoriatic arthritis, and 9 ankylosing spondylitis. All patients were under treatment with conventional synthetic (cs) and/or biological (b) disease-modifying anti-rheumatic drugs (DMARDs), while 7 of them were also on treatment with glucocorticoids (GC) (<5mg/day). Twenty-eight patients were on tumor necrosis alpha (TNF-α) inhibitors (19 as monotherapy), 4 on anti- interleukin (IL)-6 monotherapy, 3 on Janus Kinase (JAK) inhibitors plus on low dose methotrexate (MTX), and the rest (11 patients) were on a csDMARD with or without GCs.

Results:

positive patients with the SARS-CoV-2, instructed to discontinue their immunosuppressive treatment, except GCs that were adjusted for their disease. Most patients (37 out of 46) had a mild disease course and their symptomatology was nothing more than a simple flu-like syndrome. Furthermore, on 9 of them olfactory dysfunction and gastrointestinal manifestations as well as low grade fever were noted but without the need of a hospital admission. On the other hand, only 5 patients needed hospitalization (2 on MTX monotherapy and 3 on combination therapy) due to dyspnea with low oxygen saturation (hypoxemia) and high fever. From those 5, 3 had a short in-hospital stay, while 2 developed pneumonia and a longer in-hospital stay was required in order to get the appropriate treatment. None of the patients did not require an intensive care unit admission. Finally, in 14 patients that got infected from February to May 2020, viral antibodies had been measured. All patients had high titres of IgG antibodies in their serum for as long as six months after their infection. Of note, none of the infected patients were smokers.

Conclusion:

patients with rheumatic diseases that are in remission using low doses of GCs and DMARDs, have almost the same chances with the general population to have a serious course of their infection with the SARS-Cov-2. In addition, in these patients, the immune response appears to be adequate, both in the production and maintenance of antibodies, which appear to be maintained for at least 6 months after infection.

References:

[1]Patel JA, Nielsen FBH, Badiani AA, Assi S, Unadkat VA, Patel B, et al. Poverty, inequality and COVID-19: the forgotten vulnerable. Public Health. 2020;183:110-111. Doi: 10.1016/j.puhe.2020.05.006.

[2]Poteat T, Millet GA, Nelson LE, Beyrer C. Understanding COVID-19 risks and vulnerabilities among black communities in America: the lethal force of syndemics. Ann Epidemiol. 2020;47:1-3. Doi: 10.1016/j.annepidem.2020.05.004.

[3]Gianfrancesco MA, Hyrich KL, Gossec L, Strangfeld A, Carmona L, Mateus EF, et al. Rheumatic disease and COVID-19: initial data from the COVID-19 Global Rheumatology Alliance provider registries. Lancet Rheumatol. 2020;2(5):e250-e253. Doi: 10.1016/S2665-9913(20)30095-3.

Disclosure of Interests:

None declared.