LONG-TERM CONSEQUENCES OF COVID-19 AMONG PATIENTS WITH RHEUMATIC DISEASES

Abstract

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: To estimate long-term effects of COVID-19 infection in patients with rheumatic diseases. METHODS: A telephone/online survey of COVID-19 patients with rheumatic diseases has been conducted to detect lung and other organ damage 40 days or more after the coronavirus infection. The inclusion criterion was the laboratory confirmation of SARS-CoV-2 virus and/or hospitalization in COVID-19 hospitals. Out of 42 patients interviewed 25 had ANCA-associated vasculitis (AAV), 10 - systemic sclerosis, 5 – rheumatoid arthritis (RA), 1 – systemic lupus erythematosus and 1– giant cell arteritis. Additional examination was carried out when necessary: chest computed tomography (CT);examination of blood serum (CRP, ANCA, ANA, RF, biochemical tests);cerebrospinal fluid analysis;clinical analysis of blood and urine. RESULTS: Long-term complications of COVID-19 after 40 or more days have been detected in 8 patients;seven of them had AAV (4- granulomatosis with polyangiitis, GPA;2- eosinophilic granulomatosis with polyangiitis, EGPA;1- microscopic polyangiitis, MPA) and one - RA. Six patients were examined in a hospital. In four patients with AAV long-term consequences of COVID-19 included lung involvement (CT 25-75% of lung involvement, noted 70-150 days after acute COVID-19, 4/4 - ground-glass opacity, 2/4 - fibrosis), in one patient with MPA - Guillain–Barre syndrome and ground-glass opacity on chest CT with 45% of lung involvement (42 days after COVID-19), in one patient with GPA - severe dermatitis (60 days after COVID-19), in one patient with RA - headache (30 days and more after COVID-19). Three AAV patients had myalgias. Sudden death occurred 6 months later in the patient with GPA without a history of heart disease. In all cases other infections were excluded, and there was no detected activity of the main disease. All AAV patients had rituximab-induced remission. In two EGPA patients hypersensitivity pneumonitis development cannot be excluded, considering the polypharmacy (analgesics, antibacterial and antifungal agents). CONCLUSIONS: The results may suggests the existence of the synergy of the pathological mechanisms of COVID-19 and autoimmune rheumatic diseases (primarily AAV), which can lead to the development of long-term consequences of COVID-19. In modern understanding, the mechanisms underlying severe COVID-19 are immune disorders with the development of occlusive microangiopathy (immunothrombosis), together with high inflammatory activity. The complications of COVID-19 have developed primarily in patients with AAV, which is characterized by damage to small vessels, the mechanisms of AAV and severe COVID-19 are similar. CLINICAL IMPLICATIONS: It seems evident that patients with rheumatic diseases after COVID-19 (or after coronavirus vaccination) need long-term monitoring. DISCLOSURES: No relevant relationships by Valeriya Babak, source=Web Response No relevant relationships by Tatiana Beketova, source=Web Response No relevant relationships by Mariia Beketova, source=Web Response No relevant relationships by Aleksandr Kulikov, source=Web Response No relevant relationships by Marina Suprun, source=Web Response