AB1156 COVID19 CLINICAL COURSE AND OUTCOMES IN PATIENTS WITH RHEUMATIC DISEASES: DATA FROM SINGLE INPATIENT CLINIC

Abstract

BackgroundConsiderations regarding clinical manifestations and outcomes of COVID19 in patients (pts) with autoimmune rheumatic diseases (ARD) still remain ambiguous.ObjectivesThis study aims to assess the clinical course of moderate and sever COVID19 and its outcomes in hospitalized pts with ARD in comparing with osteoarthritis (OA) pts.MethodsWe have analyzed clinical picture and outcomes of COVID19 in 84 pts with RD admitted to inpatient clinic. 36 ARD pts and 48 OA pts were observed during whole period of hospitalization. Clinical, laboratory and instrumental data characteristic of COVID19 were monitored in both groups. The following COVID19 outcomes: ICU admission, mechanical or non-invasive ventilation and death were registered. The impact of concomitant diseases and antirheumatic therapy on adverse outcome was taken into account.ResultsThe ARD group preferably consisted of SLE pts (10 pts - 27.78%), RA pts (12 pts - 33.33 %), and systemic vasculitis – SV (12 pts - 33.33%), there were only 2 pts with psoriatic arthritis -PsA (5.56%). In OA group there were 23 pts with knee lesion, 14 pts with hip lesion and 11 pts with both. The structure of ARD and OA groups were similar on demography and associated conditions (CVD, T2DM, obesity). Severe coronovirus pneumonia (CT≥3) was diagnosed in 27.78% pts from ARD group and 35.42% pts from OA group (p>0.05, χ2-criterion). Prevalence of leucopenia, elevated CRP and ferritin in compared groups was comparable, but lymphopenia and elevated IL6 levels>1000 pg/ml were detected oftener in ARD group (77.78% vs 41.46%, p< 0.05; 44.44% vs 18.75%, p<0.05 respectively). There were no significant differences in mean indexes of WBC (6.55±2.41 vs 6.93±1.84, p>0.05), CRP (69.48±9.32 vs 62.19±7.35, p>0.05), ferritin (471.03±26.18 vs 428.14±19.02, p>0.05). However ICU admission and non-invasive ventilation was oftener in ARD group than in OA group: 38.89% vs 18.75% (p<0.05 χ2-criterion). Fatal outcome was registered in 3 pts (8.33%) from ARD group (SLE -2, ANCA-vasculitis-1) and in 3 pts (6.25%) with concomitant CVD, T2DM and/or obesity from OA group. All deceased pts from ARD group had been treated with GC≥ 8mg, csDMARD and biological agents (rituximab in 2 cases).ConclusionThe severity of COVID19 clinical course in general was identical in pts with ARD and in OA pts. At the same time lymphopenia and significantly elevated IL6 levels were detected in ARD group oftener than in OA group. Despite the comparable mortality rate in observed groups, more pts from ARD even without concomitant conditions required ICU admission and non-invasive ventilation. Deceased pts with ARD received moderate dose of GC, conventional and biological DMARDs, preferentially rituximab. In OA mortality from COVID19 was associated with CVD and/or metabolic disorders.