AB0694 COVID-19 İNFECTION IN PATIENTS WITH RHEUMATIC DISEASES: TWO CENTERS EXPERIENCE

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a new viral infection characterized by dry cough, fever, shortness of breath, fatigue and lymphopenia. It may be complicated by interstitial pneumonia leading to severe acute respiratory distress syndrome(1). The COVID-19 outbreak has increased concerns in those with rheumatological diseases(2). Objective(s): To present the clinical course of COVID-19 infection in patients with rheumatological disease and comorbid conditions of patients and drug use. Method(s): 70 COVID-19 patients with autoimmune and autoinflammatory rheumatic diseases over the age of 18 who were followed up in the internal diseases-rheumatology department of Sivas Cumhuriyet University Hospital and Sivas Numune Hospital between April 2020 and January 2021 were included in this study. An application was made to the ethics committee of Sivas Cumhuriyet University Hospital and approval was obtained. Demographic data, comorbidities, smoking, treatments for their diseases, symptoms and hospitalization status of the patients were evaluated. Result(s): The median age of the women patients was 48 years (min: 20-max: 73), 41 years in men (min: 21-max: 78). 15 patients (21.4%) were male, 55 patients (78.6%) were female. The most common rheumatic disease was rheumatoid arthritis (RA, 21, 30%) followed by ankylosing spondylitis (19, 27.1%), familial Mediterranean fever (13, 18.6%), Behet's disease (12, 17.1%). 22 (31.4%) patients hydroxychloroquine sulfate, 14 (20%) leflunomide, 7 (10%) patients methotrexate, 6 (8.6%) patients sulfasalazine, 10 (14.3%) patients azathioprine/ mycophenolate mofetil, 22 (31.4%) patients were using colchicine. As a biological medicine; 20 (28.6%) patients were using infliximab, 5 (7.1%) patients were using adalimumab, 6 (8.6%) patients were using rituximab, and 4 (5.7%) patients were using tocilizumab. Other are summarized in Table 1. The most common comorbidities were hypertension (25.7%) and diabetes mellitus (DM 17.1%). While 56 patients (80%) had symptoms of COVID-19, 14 patients (20%) were asymptomatic. The most common symptoms was fever (32, 45.7%) followed by cough (29, 41.4%), dyspnea (28, 40%), myalgia (25, 35.7%), loss of taste and smell (18, 25.7%). 21 pneumonia cases were diagnosed. 22 (31.4%) patients were hospitalized. Mortality rate was 2/70, 2.9%. Two RA patients who just treated with rituximab and tocilizumab were died. 10 cases were using >10 mg/day prednisolone, 2 died, 8 cases were hospitalized and had severe disease. They had hypertension and DM. Characteristics of the patients are summarized in Table 2. Conclusion(s): The course of COVID-19 in rheumatic diseases is not clearly. Meta-analysis has shown that the frequency of COVID-19 is increased in autoimmune diseases. However, this increase was mostly associated with the use of> 10mg/day prednisolone. It has been stated that the use of biological drugs and Dmard causes the SARS-CoV 2 process with a milder course and therefore their use is safe (3). Similar results have been obtained in global registry registers (4). In our data, there was no increase in the mortality rate compared to the normal population. However, especially the use of rituximab may increase the rate of severe disease and mortality, so its use should be careful. There is a need for more comprehensive studies.