AB1132 FEATURES OF THE COURSE OF COVID-19 IN ELDERLY PATIENTS WITH IMMUNO-INFLAMMATORY RHEUMATIC DISEASES (PRELIMINARY DATA).

Abstract

BackgroundIt is assumed that patients with immuno-inflammatory rheumatic diseases (IIRDs) in old age are susceptible to a more severe course of COVID-19 both due immunological disorders (autoimmune disease and its activity, immunosuppressive therapy, immunosenescence leading to systemic subclinical chronic inflammation with increased secretion of IL-6, IL-1, IL-18, TNF-ɑ) and due to the presence of comorbid pathology. There are no Russian data on the course of COVID-19 in elderly patients with IIRDs.ObjectivesTo study the features of the course of COVID-19 in elderly patients with IIRDs.MethodsThe study included 93 patients with IIRDs: 72 women, 21 men, average age 67.5±6.1 years. Of them, 62 patients suffered from rheumatoid arthritis, 9 - systemic sclerosis, 5 - ankylosing spondylitis, 4 - Sjogren’s disease, 4 - systemic vasculitis, 3 - psoriatic arthritis, 2 - osteoarthritis, 1 - systemic lupus erythematosus, 1 - polymyositis, 1 - rheumatic polymyalgia, 1 - gout. At the moment of COVID-19, 10 patients had high activity of IIRDs, 26 - moderate, 40 - low, 17 - remission. 69 patients were treated with disease-modifying antirheumatic drugs-DMARDs (40 - methotrexate, 12 - leflunomide, 8 - sulfasalazine, 7 - hydroxychloroquine), 45 - glucocorticoids (34 - low doses, 11 - medium or high doses). 36 patients received biologic or target DMARDs: 24 - rituximab (the interval from the last administration to the development of COVID-19 symptoms averaged 7 months), 4 – TNF-α inhibitors, 3 - abatacept, 2 - secukinumab, 1 - tofacitinib, 1 - baricitinib, 1 - ustekinumab. Comorbidities included hypertension (n=74), coronary artery disease (n=27), obesity (n=17), diabetes mellitus (n=8), bronchial asthma (n=5), chronic obstructive pulmonary disease (n=4), chronic kidney disease (n=3). The patients were interviewed by a research doctor, additional information was obtained from medical documentation.ResultsThe most common symptoms of COVID-19 were fever - 67.7%, weakness/drowsiness - 53.7%, cough - 48.4%, as well as anosmia and dyspnea - 35.5% each, headache - 20.4%, body aches - 16.1%, congestion nose - 8.6%, chest pain - 7.5%, dysgeusia - 5.4%, diarrhea/vomiting - 3.2%. According to CT chest scan, 8 patients had 0% of lung damage, 31 - 25%, 32 - 50%, 12 - 75%, in other cases the study was not carried out (n=9) or data are not available (n=1). In 2 patients the course of COVID-19 was complicated by bacterial pneumonia, in 1 - bacterial-fungal. An asymptomatic course was noted only in 2 patients (PCR+/IgM +, CT 0, close contact with a confirmed case of COVID-19). Recovery was noted in 90 patients, fatal outcome - in 3. Exacerbation of IIRDs after COVID-19 was noted in 48.4% of patients, which required intensifying antirheumatic therapy.ConclusionPreliminary data indicate that COVID-19 is characterized by moderate and severe course in elderly patients with IIRDs. Further studies are required to identify risk factors for severe course and complications in order to provide timely qualified care.Disclosure of InterestsNone declared