POS1254 INCIDENCE AND OUTCOME OF COVID-19 IN ROUTINE RHEUMATOLOGY CARE: DATA FROM A SINGLE OUTPATIENT CENTER IN GERMANY
Authors: S. G. Werner, P. Höhenrieder, R. Chatelain, H. E. Langer
Journal: Annals of the Rheumatic Diseases (2021)

Background: Coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and its associated disease COVID-19 (Corona Virus Disease 2019) has become a worldwide pandemic since its first cases in December 2019 in Wuhan Province in China. Until now little is known about the incidence and the course of the disease in a routine setting of rheumatology outpatient care. Objectives: Aim of the study was to identify cases with COVID-19, to analyse course and outcome of the disease and the potential role of antirheumatic medication. Methods: On the occasion of a routine follow-up examination all consecutive patients of our rheumatology outpatient center were questioned about the history of established COVID-19, about typical symptoms or about contacts with patients in the period from March to the end of December 2020. Diagnostic work-up (results of PCR or antibody testing, imaging) was documented. Antibody ELISA-tests (IgG, IgA, IgM, Euroimmun) were performed in patients reporting typical signs and symptoms. Course and outcome of COVID-19 were divided in 5 groups (mild, moderate, severe, most severe, and lethal). Results: About 2.000 patients were screened. Positive findings for SARS-CoV-2 confirmed by PCR or serological testing were detected in n=33/2000 (1.65%) patients (n=14/33 (43%) rheumatoid arthritis (RA), n=8/33 (24%) psoriatic arthritis (PsA), n=7/33 (21%) spondyloarthritis (SpA), n=4/33 (12%) other diseases). No patient died and no patient required intensive care or invasive mechanical ventilation. N=2/33 patients (6%) suffered a severe course with hospitalization, one of these required intermittent oxygen administration. Both patients had no ongoing therapy with disease modifying antirheumatic drugs (DMARDs). One patient suffered from SpA, one patient from RA. Both patients had relevant comorbidities with chronic lung disease and breast cancer. Symptoms were absent or mild in n=21/33 (64%) patients, moderate in n=10/33 (30%). N=22/31 (71%) of patients with absent, mild or moderate symptoms were treated at least with one DMARD. Conclusion: For an at-risk population, the incidence of COVID-19 was unexpectedly low. Overall, patients had a mild course despite immunosuppressive therapy. This finding is consistent with published data from a single university center (1) and other university outpatient clinics (2). Possibly DMARD-therapy may protect against the occurrence of cytokine storm and vasculitic complications, which lead to severe courses and lethal outcomes in some of the patients. The data support the recommendation not to discontinue DMARDs for fear of COVID-19. References: [1]Simon D et al. Patients with immune-mediated inflammatory diseases receiving cytokine inhibitors have low prevalence of SARS-CoV-2 seroconversion. Nat Commun. 2020 Jul 24;11(1):3774. doi: 10.1038/s41467-020-17703-6. PMID: 32709909; PMCID: PMC7382482. [2]Gianfrancesco M et al. COVID-19 Global Rheumatology Alliance. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis. 2020 Jul;79(7):859-866. doi: 10.1136/annrheumdis-2020-217871. Epub 2020 May 29. PMID: 32471903; PMCID: PMC7299648. Disclosure of Interests: None declared