AB0688 SEVERITY OF COVID-19 INFECTION IN RHEUMATIC IMMUNE-MEDIATEDINFLAMMATORY DISEASES. STUDY IN A SINGLE UNIVERSITY HOSPITAL
Authors: D. Martínez-López, D. Prieto-Peña, L. Sanchez-Bilbao, A. Herrero-Morant, C. Álvarez-Reguera, M. Trigueros-Vazquez, M. A. González-Gay, R. Blanco
Journal: Annals of the Rheumatic Diseases (2021)

Background: Immune-mediated inflammatory diseases (IMID) may have a global increased risk of infections due to the disease itself, and/or immunosuppressive therapy. The severity and characteristics of COVID-19 in patients with rheumatic IMID (R-IMID) remain unknown. Objectives: To analyze the severity of COVID-19 infection in R-IMID. Methods: Cross-sectional study in a single University Hospital. We included all consecutive patients with a diagnosis of a R-IMID and a positive test for COVID-19 up to November 6th, 2020. Confirmed infection was defined if the patient had a positive nasopharyngeal swab for SARS-CoV-2. Medical records of 11,199 patients with COVID-19 in our region, and 6891 with R-IMID from our hospital were reviewed. COVID-19 case severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) COVID-19 guidelines (1 ). Mild/moderate COVID19 was compared with critical. Results: We included 147 patients (96 women/51 men), mean age 60±18 years. Most cases were mild to moderate (n=123, 83.7%), 30 of them (20.4%) were asymptomatic. The remaining patients presented severe (n=5, 3.4%) or critical (n=19, 12.9%) disease (Table 1). Fatal outcome occurred in 12 patients (8.2%). More frequent underlying R-IMID were Rheumatoid Arthritis (n=36; 24.5%), Psoriatic Arthritis (n=30; 20.4%), axial spondyloarthritis (n=24; 16.3%), conectivopathies (n=19; 12.9%), polymyalgia rheumatica (n=16; 10.9%) and vasculitis (n=9; 6.1%) (Figure 1). Main comorbidities were hypertension (n=65, 44.2%), dyslipidemia (n=64, 43.5%), age higher than 65 years old (n=55, 37.4%), obesity (n=35, 23.8%), coronary vascular disease (CVD) (n=27, 18.4%) and diabetes mellitus (n=22, 15%). Comorbidities and R-IMID associated with critical disease (p&lt;0.05) were hypertension, age higher than 65 years,CVD and Polymyalgia Rheumatica. Critical compared with mild/moderate disease showed significantly higher levels of creatinine and D-dimer, and lower level of lymphocytes and platelets (Table 1) and received more frequently systemic glucocorticoids. Tocilizumab and Anakinra were used only in critical patients, 2 cases each. Conclusion: Although most cases are mild, COVID-19 can be a severe life threatening disease in patients with R-IMID. Hypertension, older age, CVD and polymyalgia rheumatica were associated with critical disease. References: [1]COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/ . Table 1. Clinical severity of 147 with R-IMID diagnosed with COVID-19, (analytical findings and Immunosuppressants are at COVID diagnosis) Overall N= 147 Mild/Moderate N= 123 Severe N= 5 Critical N= 19 Mild/moderate vs critical; p Analytical findings (mean±SD) Creatinine (mg/dl) 1.04±1.14 1.27±0.65 1.18±0.47 1.35±0.61 0.001 * Platelets (x10 3 /µL) 206 ±93 226 ± 95 154 ±87 159 ±62 0.01* Lymphocytes (x10 3 /µL) 1.11±0.65 1.27±0.65 0.8±0.29 0.71±0.5 0.001* D-Dimer (ng/mL) 1162±1356 915±986 782±483 1947±2024 0.026* Immunosuppressants, n(%) Oral GC 38 (25.9) 32 (26) 0 5 (26.3) 0.8 HCQ 25 (17) 23 (18.7) 0 2 (10.5) 0.58 MTX/ Other cDMARDs 27 (18.4)/19 (13) 26 (21.1)/18 (14.6) 0/ 0) 1 (5.3/1 (5.3) 0.18/0.45 TNF inhibitors 13 (8.8) 12 (9.8) 1 (20) 0 0.33 RTX 5 (3.4) 2 (1.6) 1 (20) 2 (10.5) 0.15 Other bDMARDs 13 (8.8) 10 (8.1) 1 (20) 2 (10.5) 0.28 JAKINIB 3 (2) 3 (2.4) 0 0 0.87 COVID-19 therapy, n (%) No treatment 94 (64) 88 (71.5) 1 (20) 5 (26.3) 0.0003* HCQ 37 (25.2) 25 (20.3) 4 (80) 8 (42.1) 0.07 Systemic GC 17 (11.6) 8 (6.5) 1 (20) 8 (42.1) 0.00001* Antivirals 20 (13.6) 13 (10.6) 0 7 (36.8) 0.07 Anti IL1/IL6 agents 4 (2.7) 0 0 4 (21.1) 0.00001* GC: Glucocorticoids, HCQ: Hydroxychloroquine, MTX: Methotrexate, RTX: Rituximab * P &lt; 0.05 Figure 1. Severity of COVID-19 according to underlying R-IMID. Data are number of cases GCA: Giant cell arteritis, PsA: Psoriatic arthritis, RA: Rheumatoid arthritis, SLE: Systemic lupus erythematosus, SpA: Axial spondyloarthritis, SSc: Systemic scleroderma. Disclosure of Interests: David Martínez-López: None declared, Diana Prieto-Peña Grant/research support from: UCB Pharma, Roche, Sanofi, Pfizer, Abbvie and Lilly, Lara Sanchez-Bilbao: None declared, Alba Herrero-Morant: None declared, Carmen Álvarez-Reguera: None declared, Martin Trigueros-Vazquez: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, MSD, Consultant of: Abbvie, Pfizer, Roche, Sanofi, MSD, Grant/research support from: Abbvie, MSD, Janssen and Roche., Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD, Grant/research support from: Abvie, MSD and Roche