The Outcomes of COVID-19 Infection in Rheumatic Diseases in Stable Disease Condition: A Case Series Study
Ljudmila Stojanovich1,2, Aleksandra Djokovic2,3, Natasa Stanisavljevic2,4*, Dusan Saponjski2,5 and Jovica Saponjski2,6
1Special Hospital “Dr Zutic”, Serbia
2University of Belgrade, Faculty of Medicine, Belgrade, Serbia
3Department of Cardiology, Division of Interventional Cardiology, University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia
4Department of Hematology, University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia
5Center of Radiology and MR, University Clinical Center of Serbia, Belgrade, Serbia
6Clinic of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
*Corresponding Author: Natasa Stanisavljevic, Department of Hematology, University Hospital Center Bezanijska Kosa, Belgrade, Serbia.
April 19, 2022; Published: June 14, 2022
Background: The COVID-19 pandemic raised many concerns regarding patients with autoimmune rheumatic diseases (ARD) namely considering the potentially harmful effects of this infectious disease as well as the consequences of the immunosuppressant therapy applied.
Aim: To evaluate the presentations and outcome of COVID-19 in various ARD in stable conditions.
Methods: This is a consecutive clinical series study of 18 outpatient ARD patients (eight systemic lupus erythematosus (SLE), two SLE associated with antiphospholipid syndrome (APS), one patient with primary APS, five with rheumatoid arthritis, one with polymyalgia rheumatica, and one with Still syndrome), who was diagnosed with COVID-19. Data were collected between May 2020 and February 2021, during scheduled visits at a non-covid center, where patients were monitored regularly. We analyzed the presence of the following clinical symptoms: persistent fever higher than 37·5°C, non-productive cough, fatigue, myalgias, arthralgias, anosmia, ageusia, headache, nausea, vomiting, diarrhea, and dyspnea. The onset date and duration of these symptoms, prescribed medications, and management of background medications were also evaluated.
Results: In this case series of ARD patients in a stable disease condition, nine patients were treated with prednisolone, nine patients with hydroxychloroquine, six patients were on Aspirin, and five on methotrexate. None of the patients had interstitial pneumonia, clinical manifestations of COVID-19 were mild, and none were hospitalized. Less than half of the patients (8 of them) had a fever. All patients in a post-covid period were feeling well, without thrombotic complications.
Conclusion: All ARD patients analyzed, presented in a stable disease condition, had been diagnosed with a mild form of COVID-19, not requiring hospitalization. The stable disease condition might be the most important prognostic factor regarding the severity of COVID-19 and its prognosis in this population of patients.
Keywords: COVID-19; Autoimmune Rheumatic Diseases
- Taisheng L., et al. "Clinical observation and management of COVID-19 patients". Emerging Microbes and Infections 9 (2020): 687-690.
- Li J., et al. "Epidemiology of COVID-19: A systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes". Journal of Medical Virology 93 (2021): 1449-1458.
- Pollard CA., et al. “The COVID-19 pandemic: a global health crisis". Physiology Genomics 52 (2020): 549-557.
- Zhang JY., et al. “Risk Factors for Severe Disease and Efficacy of Treatment in Patients Infected With COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis”. Clinical Infectious Diseases 71 (2020): 2199-2206.
- Petrakis D., et al. “Obesity - a risk factor for increased COVID-19 prevalence, severity and lethality (Review)”. Molecular Medicine Reports 22 (2020): 9-19.
- Stojanovich L. “Influenza vaccination of patients with SLE and RA”. Clinical and Developmental Immunology 13 (2006): 373-375.
- Agmon‐Levin N., et al. “The Interaction between Anti‐Ro/SSA and Anti‐La/SSB Autoantibodies and Anti‐Infectious Antibodies in a Wide Spectrum of Auto‐Immune Diseases: Another Angle of the Autoimmune Mosaic”. Clinical and Experimental Rheumatology 35 (2017): 929-935.
- Favalli EG., et al. “What is the true incidence of COVID‐19 in patients with rheumatic diseases?” Annals of the Rheumatic Diseases 80 (2021): e18.
- Favalli EG., et al. “Incidence and clinical course of COVID‐19 in patients with connective tissue diseases: a descriptive observational analysis”. Journal of Rheumatology 47 (2020): 1296.
- Galeotti C, Barry J. “Autoimmune and inflammatory diseases following COVID-19”. Nature Reviews Rheumatology 16 (2020): 413-414.
- Ehrenfeld M., et al. “Covid-19, and autoimmunity”. Autoimmune Review 19 (2020): 102597.
- Pablos JL., et al. “Prevalence of hospital PCR-confirmed COVID-19 cases in patients with chronic inflammatory and autoimmune rheumatic diseases”. Annals of the Rheumatic Diseases 79 (2020): 1170-1173.
- Zulfiqar A., et al. “Immune thrombocytopenic purpura in a patient with Covid-19”. The New England Journal of Medicine 382 (2020): e43.
- Lazarian, G., et al. “Autoimmune hemolytic anemia associated with COVID-19 infection”. British Journal of Haematology 190 (2020): 24-39.
- Fanouriakis A., et al. “2019 update of the EULAR recommendations for the management of systemic lupus erythematosus”. Annals of the Rheumatic Diseases 78 (2019): 736-745.
- Mihai C., et al. “COVID‐19 in a patient with systemic sclerosis treated with tocilizumab for SSc‐ILD”. Annals of the Rheumatic Diseases 79 (2020): 668‐669.
- Monti S., et al. “Clinical course of COVID‐19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies”. Annals of the Rheumatic Diseases 79 (2020): 667‐668.
- Gianfrancesco MA., et al. “Rheumatic disease and COVID‐ 19: initial data from the COVID‐19 Global Rheumatology Alliance provider registries”. Lancet Rheumatology 60 (2020): 30095‐30103.
- Tan EM., et al. “The 1982 revised criteria for the classification of systemic lupus erythematosus”. Arthritis and Rheumatology 25 (1982): 1271-1277.
- Miyakis S., et al. “International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)”. Journal of Thrombosis and Haemostasis 4 (2006): 295-306.
- Petri M., et al. “Reliability of SELENA, SLEDAI and flare as clinical trial outcome measures”. Arthritis and Rheumatology 41 (1998): 218.
- Gladman DD., et al. “Systemic lupus erythematosus disease activity index 2000”. Journal of Rheumatology 29 (2002): 288-291.
- Ibañez D., et al. “Summarizing disease features over time: II. Variability measures of SLEDAI-2K”. Journal of Rheumatology 34 (2007): 336-340.
- Bombardier C., et al. “Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE”. Arthritis and Rheumatology 35 (1992): 630-640.
- Anderson J., et al. “Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice”. Arthritis Care Research (Hoboken) 64 (2012): 640-647.
- Felson DT., et al. “American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials”. Arthritis and Rheumatology 63 (2011): 573-586.
- World Health Organization. “Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: interim guidance” (2020).
- Berkwits M., et al. “The COVID-19 Pandemic and the JAMA Network”. JAMA 324 (2020): 1159-1160.
- Wu Z and McGoogan JM. “Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention”. JAMA 323 (2020): 1239-1242.
- Oran DP and Topol EJ. “Prevalence of Asymptomatic SARS-CoV-2 Infection”. Annals of Internal Medicine 174 (2021): 286-287.
- Ruiz-Irastorza G., et al. “Update on antimalarials and systemic lupus erythematosus”. Current Opinion in Rheumatology 32 (2020): 572-582.
- Alarcón GS., et al. “Effect of hydroxychloroquine on the survival of patients with systemic lupus erythematosus: data from LUMINA, a multiethnic US cohort (LUMINA L)”. Annals of the Rheumatic Diseases 66 (2007): 1168-1172.
- European League Against Rheumatism (EULAR) guidance for patients on COVID 19.
- Liu J., et al. “Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro”. Cell Discovery 6 (2020): 16.
- Gautret P., et al. “Effect of hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, an update with an intention-to-treat analysis and clinical outcomes”. International Journal of Antimicrobial Agents 56 (2020): 105949.
- Bhimraj A., et al. “Infectious Diseases Society of America guidelines on the treatment and management of patients with COVID-19”. Clinical Infectious Diseases (2020): ciaa478.
- Mathian A., et al. "Clinical course of coronavirus disease 2019 (COVID‐19) in a series of 17 patients with systemic lupus erythematosus under long‐term treatment with hydroxychloroquine". Annals of the Rheumatic Diseases 79 (2020): 837-839.
- Kamran S., et al. "Clearing the Fog: Is Hydroxychloroquine Effective in Reducing Coronavirus Disease-2019 Progression? A Randomized Controlled Trial". Cureus 13 (2021): e14186.
- Devaux C., et al. "Can hydroxychloroquine be protective against COVID-19-associated thrombotic events?" Journal of Microbiology, Immunology and Infection 54 (2021): 37-45.
- Ruiz-Irastorza G., et al. "Effect of antimalarials on thrombosis and survival in patients with systemic lupus erythematosus". Lupus 15 (2006): 577-583.
- Strangfeld A., et al. "Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry". Annals of the Rheumatic Diseases (2021): annrheumdis-2020-219498.
- Saadoun D., et al. "SARS-CoV-2 outbreak in immune-mediated inflammatory diseases: the Euro-COVIMID multicentre cross-sectional study". Lancet Rheumatology (2021).
- American College of Rheumatology (ACR). COVID-19 Vaccine Clinical Guidance Task Force. COVID-19 vaccine clinical guidance summary for patients with rheumatic and musculoskeletal diseases (2021).
- Tang W., et al. "SARS-CoV-2 vaccines in patients with SLE". Lupus Science and Medicine 8 (2021): e000479.