Abstract
BackgroundThe course of novel coronavirus disease 2019 (COVID-19) has been of special concern in patients with inflammatory rheumatic diseases (IRDs) due to the immune dysregulation that may be associated with these diseases and the medications used for IRDs, that may affect innate immune responses.ObjectiveIn this cohort study, we aimed to report the disease characteristics and variables associated with COVID-19 outcome among Turkish patients with IRDs.MethodsBetween April and June, 2020, 167 adult IRD patients with COVID-19 were registered from 31 centers in 14 cities in Turkey. Disease outcome was classified in 4 categories; (i) outpatient management, (ii) hospitalization without oxygen requirement, (iii) hospitalization with oxygen requirement, and (iv) intensive care unit (ICU) admission or death. Multivariable ordinal logistic regression analysis was conducted to determine variables associated with a worse outcome.Results165 patients (mean age: 50 ± 15.6 years, 58.2% female) were included. Twenty-four patients (14.5%) recovered under outpatient management, 141 (85.5%) were hospitalized, 49 (30%) required inpatient oxygen support, 22 (13%) were treated in the ICU (17 received invasive mechanic ventilation) and 16 (10%) died. Glucocorticoid use (OR: 4.53, 95%CI 1.65-12.76), chronic kidney disease (OR: 12.8, 95%CI 2.25-103.5), pulmonary disease (OR: 2.66, 95%CI 1.08-6.61) and obesity (OR: 3.7, 95%CI 1.01-13.87) were associated with a worse outcome. Biologic disease-modifying antirheumatic drugs (DMARDs) do not seem to affect COVID-19 outcome while conventional synthetic DMARDs may have a protective effect (OR: 0.36, 95%CI 0.17-0.75). Estimates for the associations between IRD diagnoses and outcome were inconclusive.ConclusionsAmong IRD patients with COVID-19, comorbidities and glucocorticoid use were associated with a worse outcome, while biologic DMARDs do not seem to be associated with a worse outcome.
Highlights
The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) runs a variable clinical course including asymptomatic infection, flu-like symptoms, isolated anosmia or hyposmia, mild to severe pneumonia, involvement of various organs or a cytokine storm, which may eventually prove fatal [1].All age groups and patient populations can be affected by COVID-19, individuals with an older age, and those with co-morbidities have a higher risk for more severe disease [2]
This study showed that one third of Inflammatory rheumatic diseases (IRDs) patients required oxygen support, 13% were treated in the intensive care unit (ICU) and the overall mortality rate was 10% due to COVID-19
We found that glucocorticoid use, having chronic kidney disease, pulmonary disease and obesity are associated with a worse outcome and the risk of a worse outcome is decreased in patients without comorbidities and in patients treated with csDMARDs
Summary
The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) runs a variable clinical course including asymptomatic infection, flu-like symptoms, isolated anosmia or hyposmia, mild to severe pneumonia, involvement of various organs or a cytokine storm, which may eventually prove fatal [1].All age groups and patient populations can be affected by COVID-19, individuals with an older age, and those with co-morbidities have a higher risk for more severe disease [2]. Hydroxychloroquine (HQ), chloroquine and baricitinib were suggested to have antiviral effects and patients on these drugs were proposed to be less likely to have severe COVID-19 outcomes due to reduced viral replication during the early phase [6]. Physicianreported COVID-19 Global Rheumatology Alliance (GRA) registry suggested that biologic disease-modifying antirheumatic drugs (bDMARDs), which are used for the treatment of cytokine storm that is responsible for tissue damage and multiple organ failure in COVID-19, may prevent this condition in patients with IRDs who are already using bDMARDs, if infected by SARS-CoV-2 [7]. The course of novel coronavirus disease 2019 (COVID-19) has been of special concern in patients with inflammatory rheumatic diseases (IRDs) due to the immune dysregulation that may be associated with these diseases and the medications used for IRDs, that may affect innate immune responses
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
