Evaluation of impact of new coronavirus infection on clinical course of rheumatic diseases in real clinical practice
Authors: Mazurov V. I. , Belyaeva I. B. , Sarantseva L. E. , Chudinov A. L. , Oktyabrskaya I. V. , Bashkinov R. A. , Trofimov E. A. , Gaidukova I. Z. , Zhugrova E. S. , Smulskaya O. A. , Inamova O. V. , Petrova M. S. , Khokhlova Yu. V. , Vasilenko E. A. , Melnikov E. S. 
Published: June 2023

Aim. To evaluate the effect of COVID-19 on the clinical course of immunoinﬂammatory rheumatic diseases (IRD).

Material and methods. The clinical course of IRD was analyzed in 324 patients who underwent new coronavirus infection (NCI) from March 2020 to February 2021 and were treated at Clinical Rheumatology Hospital No. 25 (Saint-Petersburg, Russia) for exacerbation of the underlying disease.

Results. The risk factors of severe COVID-19 course in IRD were: age older than 60 years, presence of comorbid conditions (IHD, CHD, COLD), use of glucocorticoids in dose more than 12.5 mg per day and erythrocyte sedimentation rate values ≥ 40 mm/h before development of NCI. The use of immunosuppressive therapy and biological therapy had no effect on the worsening of the course of the viral infection in patients with IRD. The development of post-covid syndrome (asthenia, dyspnea, weight loss, memory loss) was noted in ¼ of the patients. Post-covid articular syndrome was characterized by the formation of arthritis associated with viral infection in 3.6% of patients, transformation of undifferentiated arthritis (UDA) into speciﬁc nosological forms in 49.0% (more often into early rheumatoid arthritis, RA), and exacerbation of joint syndrome in 83.4% of patients with advanced stage RA. In patients with diffuse connective tissue disease (DCTD), a signiﬁcant increase in immunological activity due to antinuclear antibodies (maximum 1: 163840) was noted. We present clinical cases of arthritis associated with viral infection and fatal outcome in a patient with systemic sclerosis and interstitial lung damage after COVID-19.

Conclusions. In the cohort of patients with IRD observed at Clinical Rheumatology Hospital No. 25 (Saint-Petersburg, Russia) COVID-19 had a moderate to severe course in half of patients, initiated the development of pneumonic complications in 68.6% of patients, arthritis associated with viral infection in 3.6%, transformation of UDA into IRD in 49.0% of cases and exacerbation of the main disease in the great majority of patients. Patients with DCTD with interstitial lung damage have a high risk of adverse outcome of NCI, especially in cases of unstable course of the disease, pronounced immunosuppression and require special monitoring.

The authors present their own clinical experience with the use of Alﬂutop in a comorbid patient with osteoarthritis and increased pain after undergoing CCI, which indicates its effectiveness and cardiovascular safety. An important practical advantage of Alﬂutop should be considered the absence of its effect on the parameters of hemocoagulation and the reduction in the need for NSAIDs, which reduces the risk of thrombotic complications characteristic of long-term COVID. A short course of Alﬂutop (ten intramuscular injections of 2.0 ml every other day) contributes to ease of use and increased adherence to therapy in patients with osteoarthritis.