The impact of covid-19 on patients with autoimmune diseases
Estefanía Fajardo
The PANLAR 2022 Congress to be held in Miami from August 10 to 13 will feature a variety of topics, approaches, research, and works that will allow, in person, to debate and learn.
It was precisely the covid-19 pandemic that prevented face-to-face attendance for two years, and it is about this disease that different analyzes have been carried out, many of them from autoimmune diseases, which will be presented at this congress. There are 34 works related to covid-19 and its vaccination, which will have space to disseminate the analyzes and conclusions from different countries and perspectives.
The approaches also review secondary pathologies, as well as prolonged covid and its effects on patients. Is covid more frequent in patients with autoimmune diseases? Is it more or less severe in these patients? Is it more or less deadly? Questions that seek an answer through these investigations and analyzes presented at the congress.
BY COUNTRY
Different groups of researchers presented analyzes of their countries, and even of two of these, for the radiography of covid-19 effects on patients, as well as in the development of their diseases or in the health systems themselves in our region. The common conclusions of these analyzes is that, although there is a fear in the development of the SARS-CoV-2 virus, the risks in the population with rheumatic diseases are not notably higher compared to the rest, in the same way it happens with hospitalization and severe development of the disease.
-Argentina (ABS-1189): One of the papers presents the differences between the first and second waves of Sars-CoV-2 infection, in patients with inflammatory diseases in Argentina through a national, multicenter, longitudinal, and observational registry.
After the analysis, it was possible to conclude that during the second wave of covid-19, a decrease in the rate of general and ICU hospitalization was observed among patients with immune-mediated/autoinflammatory diseases, probably as a result of vaccination and improvement of the treatments.
-Mexico and Argentina (ABS-1546, ABS-1452): One of the studies evaluated the factors associated with covid-19 mortality, in patients with immune-mediated rheumatic inflammatory diseases in Mexico and Argentina, merging the data from the records of both countries, CMR-COVID from Mexico and SAR-COVID from Argentina for a total record of 3,181 patients.
The conclusions establish that mortality in patients with IMIDs and covid-19 in the CMR-COVID and SAR-COVID registries was 5.7%, particularly higher in Mexican patients. The factors associated with mortality in immune-mediated/autoinflammatory diseases and covid-19 were those described in the general population, such as advanced age and comorbidities, and the specific factors of the pathologies, such as moderate/high activity disease, the use of corticosteroids and treatment with CD20 inhibitors. Reaffirming, also, the importance of adequate control and treatment of the disease.
Another study aimed to evaluate and compare the clinical course, severity and complications of SARS-CoV-2 infection in patients with rheumatic immune-mediated inflammatory diseases from Mexico and Argentina. This resulted in the presence of symptoms in the majority of these patients, of whom a quarter were hospitalized and 6% died of covid-19. Mexicans had a more severe disease and, after accounting for risk factors, were twice as likely to die.
-Chile (ABS-1172): The objective of the presented work is to report the clinical characteristics of Chilean patients with rheumatic diseases and covid-19, entered into the Global Rheumatology Alliance physician registry platform. 54 patients were included in this analysis.
Within the conclusions, it is analyzed that the majority of the Chilean rheumatic patients included were hospitalized with a low mortality rate, although there was a high percentage of patients who required at least non-invasive mechanical ventilation. No worsening of arthralgias or activation of rheumatic disease were reported.
-Mexico (ABS-1587): This study investigated the HLA class I and II alleles associated with the severity of covid-19 in Tapachula, Chiapas, and classified according to the outcome and severity of the infection with a control group.
The conclusion indicates that the existing indigenous genome in Mexico is capable of providing some protection against covid-19, just as the African gene provides protection against contracting the infection, which suggests focusing protection on those populations that do not have these genes due to increased morbidity and mortality.
-El Salvador (ABS-1294): This study aimed to determine the frequency of covid-19 infection among rheumatic patients who are treated at the Rheumatology Service of the Salvadoran Institute of Social Security during the year 2020-2021, as well as describe some epidemiological characteristics related to comorbidities and the level of activity of their rheumatic disease.
-Dominican Republic (ABS-1554): This study found higher antibody positivity in patients with MTX, followed by HCQ and ADA. Despite the use of immunosuppressive drugs, all patients who submit to antibody measurements after covid-19 infection showed immunity. Covid-19 infection was more frequent in rheumatoid arthritis, this being the most prevalent inflammatory rheumatic disease in the study population.
In this report, it was found that most of the patients were in remission of their diseases at the time of infection, being on immunosuppressive therapy and in most cases, hospitalization was not necessary.
WORKS OF INTEREST
Researchers from Brazil also presented 'Covid-19 and autoimmune diseases: Case series', (ABS-1287) with five cases of patients who, concomitantly or within 60 days of covid-19 infection, developed symptoms or signs that subsequently led to a diagnosis of autoimmune disease through the revision of medical records.
During the covid-19 pandemic, it was observed that, among patients with severe disease, there is a phase characterized by hyperreactivity of the immune system. SARS-CoV-2 infection could function as a triggering factor in the appearance of autoimmune conditions, as previous research has pointed out. This research adds to a few other reports that have identified a temporal association between covid-19 and autoimmune diseases.
Another related work is: 'The influence of 2 years of the covid-19 pandemic on muscle strength and physical performance in patients with systemic sclerosis (SSc): A Cohort Study'. (ABS-1404)
This study seeks to evaluate the inclusion of the pandemic in the muscular strength and physical performance of patients with SSc and to verify the associations of muscular strength and physical performance with inflammatory markers in a cohort study of 40 patients.
The conclusion indicates that, despite the covid-19 pandemic and the restrictions imposed, no deterioration in muscle strength or physical performance was detected in this population of patients with SSc. Some of these muscle strength and physical performance parameters were associated with the PCR inflammatory marker. More research is needed to assess the actual impact and possible associations.
There are also analyzes carried out in hospitals that refer to factors associated with mortality in rheumatic patients infected with covid-19 (ABS-1615). The factors that showed a significant bivariate association with the mortality of these patients were female sex, level of education, low sociocultural level, and prolonged hospital stay.
Otherwise, is psoriatic arthritis (PsA) a risk factor for severe covid-19 infection? (ABS-1258) With data from the Argentine SAR-COVID registry, a transversal study was carried out that included patients with PsA and RA, who had SARS-CoV-2 infection (129 patients with PsA and 808 with RA).
Although patients with PsA had a higher frequency of cardiovascular and metabolic comorbidities than those with AR, no differences were observed in terms of the severity of covid-19. Most of the patients had mild disease with a low mortality rate.
One of these works (ABS-1333) reports that extrapulmonary manifestations due to covid-19 are frequent, and that some symptoms and signs of this disease may be present in patients with rheumatic diseases. For this reason, the discussion of the manifestations common to covid-19 and autoimmune diseases is proposed.
This is done by analyzing two cases of patients with autoimmune disease diagnosed with covid-19. The conclusions show that extrapulmonary manifestations of covid-19 have been reported in almost all systems. Some neurological manifestations include encephalopathy, myalgias, and ageusia. Renal manifestations include acute kidney injury, proteinuria, and hematuria. Deep vein thrombosis and pulmonary embolism have also been reported in association with infection due to SARS-CoV-2. These same signs and symptoms can appear in patients with autoimmune diseases, specifically SLE.
Both diseases can present as nonspecific and overlapping symptoms. Therefore, it is of utmost importance to consider both when evaluating patients in our daily practice, in order to ensure a proper diagnosis and treatment for patients living with rheumatic diseases.
The Adult Multisystem Inflammatory Syndrome has been fundamental in the pandemic, and is also a starting point of 'When the intensivist meets the rheumatologist' (ABS-1379)
Considering that multisystem inflammatory syndrome is a rare complication of covid-19 infection in adults; 70% of cases appear as a post-infectious phenomenon with a low mortality rate despite the severity of extrapulmonary manifestations. The medical records of two patients diagnosed in two tertiary centers in Medellin, Colombia were reviewed.
The clinical expression of the syndrome is heterogeneous, ranging from mild manifestations despite the intensity of the inflammatory process to severe features including myocarditis. High-dose systemic glucocorticoids are the therapy of choice, achieving a rapid response of the compromised system.
Another study (ABS-1597) indicates that, as the covid-19 pandemic unfolds, various hematological complications, including immune thrombocytopenic purpura (ITP), with a variable incidence, were reported in multiple studies.
One of the posters (ABS-1599) compares changes in prenatal laboratory and ultrasound tests by trimester, as well as screening for anxiety and depression in pregnant women with AKI due to the pandemic. This after an analysis of 68.
In this, the researchers demonstrated a higher frequency of positivity for state and trait anxiety in pregnant women with AKI recruited during the pandemic, as well as a higher frequency of depression and suicidal ideation, although making it clear that this increase was not statistically significant. Otherwise, they indicated that concern about the pandemic and health status could positively influence better adherence to screening and routine tests during pregnancy.
DRUGS AND PROLONGED COVID
The drugs analysis and their factors associated with the development of covid-19 in patients was an important element to consider. One of them (ABS-1265) evaluated whether Glucocorticoids, Rituximab and Interstitial Lung Disease are associated with poor outcomes of SARS-CoV-2 infection in patients with Rheumatoid Arthritis.
In this, 801 patients were included, and the conclusions indicate that treatment with RTX and GC, advanced age, diabetes, and Interstitial Lung Disease are associated with poor results of covid-19. Also, older patients and those taking GC had a higher mortality rate.
Also, within the selected works, an analysis of the correlation between SARS-CoV-2 infection and systemic autoimmune diseases (ABS-1440) is presented with the aim of evaluating the proportion of patients with autoimmune rheumatic diseases who are admitted to the ICU or die at the Navarra University Hospital, Pamplona, Spain.
In this cohort, 18 patients required hospital admission, of which 16.7% reached the ICU. Among the admitted patients, 72.2% were obese and 50% were hypertensive. Two patients died from SARS-CoV-2, one of them with Rheumatoid Arthritis and the other with Spondylarthritis. Additionally, it was established that the most affected groups were Rheumatoid Arthritis and Spondylarthritis, both in SARS-CoV-2 infection and in admissions.
Besides a comparison by gender (ABS-1445), the result in this cohort was that 18 patients required hospital admission, of which 66.6% were women.
In this cohort, 16.6% required ICU admission, 66% being women. Two patients died from SARS-CoV-2, one had Rheumatoid Arthritis and the other Spondylarthritis, and 50% of this number were women.
It was also established that the most affected groups were Rheumatoid Arthritis and Spondylarthritis, both in terms of SARS-CoV-2 infection and admissions, and a higher number of reinfections was observed in women. Finally, among the admitted patients, 72.2% were obese and 50% were hypertensive.
Additionally, the prevalence of prolonged covid in rheumatic patients (ABS-1474) was presented. In this investigation, 1,915 patients with a mean age of 51 years were included and the result was 12%. Non-Caucasian ethnicity, higher education, cyclophosphamide treatment, covid-19 symptoms, severe illness, and longer ICU stay were related to this.
Remember that the complete schedule of activities, with the details of all the sessions day by day, can be reviewed here . Also, you will be able to consult all the works presented in the book of abstracts of the congress (1)
REFERENCES
- JCR: Journal of Clinical Rheumatology: July 2022 - Volume 28 - Issue S1 - p S1-S95. Available at https://journals.lww.com/jclinrheum/Citation/2022/07001/PANLAR_Abstracts_2022.1.aspx
