COVID 19 Infection in Patients with Rheumatic Immune-mediated Diseases in a Single University Hospital: Matched Case-control Study

BackgroundCOVID19 may present different degrees of severity. It is generally thought that viral infections in patients with rheumatic inflammatory diseases (R-IMID) or receiving immunosuppressive treatment tend to present more severe disease. However, data comparing the severity of the disease between R-IMID and the general population are scarce.ObjectivesTo assess the predisposing factors, clinical-analytical features and severity of COVID-19 infection in R-IMID compare to patients without R-IMID.MethodsCase-control study in a single University Hospital. We included all consecutive patients with a diagnosis of a R-IMID and a positive test for COVID-19 up to March 31st, 2021.A total of 274 controls were selected for each case, and matched by sex, age (± 5 years), and without previous diagnosis of R-IMID or use of immunosuppresive therapy.Confirmed infection was defined if the patient had a positive nasopharyngeal swab for SARS-CoV-2.COVID-19 case severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) COVID-19 guidelines (1). Mild/moderate COVID19 was compared with critical.ResultsWe included 274 patients (185 women/89 men), mean age 59.1 18 years.More frequent R-IMID were: Rheumatoid arthritis (RA) (n=87, 31.8%), Axial spondyloarthritis/ Psoriatic arthritis (SpA/PsA) (n=90, 32.8%), Polymyalgia Rheumatica (PMR) (n=22, 8%) and Systemic Lupus Erythematosus (SLE) (n=22, 8%)We also included 274 age and matched controls. Main characteristics of patients with R-IMID and controls are shown in Table 1.Table 1.Main clinical and analytical features of patients with R-IMID and matched controlsR-IMID patients (n=274)Controls (n=274)PAge59.1±1858.8±17.30.842Sex F/M, n, (%)185/89 (67.5/32.5)185/89 (67.5/32.5)1Comorbidities (n,%)Hypertension119 (43.4)84 (30.7)0.0026*Dyslipidemia119 (43.4)79 (28.8)0.0005*Diabetes mellitus36 (13.1)37 (13.5)1Pulmonary disease29 (10.6)32 (11.7)0.79Cardiovascular disease45 (16.4)33 (12)0.18Severity of the disease (n, %)Mild209 (76.3)204 (74.5)0.69Moderate35 (12.8)47 (17.2)0.19Severe9 (3.3)14 (5.1)0.39Critical21 (7.7)9 (3.3)0.04*Deaths17 (6.2)7 (2.6)0.0076*Analytical values, median [25-75th IQR]CRP4.7 [2-9.3]3.9 [1-7.3]0.176Lymphocytes (x103 /µL)1 [0.6-1.5]1.1 [0.8-2.5]0.711Platelets (x103 /µL)179 [141-237]174 [155-211]0.722D-Dimer (ng/mL)999 [342-1417]548 [336-997]0.032*CRP: C-reactive protein.Concerning comorbidities, hypertension and dyslipidemia were more frequent in patients with R-IMID (p< 0.05).COVID-19 symptoms’ distribution is shown in Figure 1.Figure 1.Symptoms in R-IMID patients and matched controls*: p < 0.05Cough and dyspnoea were more frequent and headache, odynophagia and diarrhea were less frequent in the R-IMID group.The only analytical difference was D-Dimer that was significantly higher in patients with R-IMID.Although most of the cases were mild, critical cases and deaths were more frequent in R-IMID (p <0.05).ConclusionMost of the patients present a mild COVID-19. However, a more severe syndrome was observed in R-IMIDReferences[1]COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/. Accessed [insert date].Disclosure of InterestsDavid Martínez-López: None declared, Diana Prieto-Peña: None declared, Fabricio Benavides-Villanueva: None declared, Lara Sanchez-Bilbao: None declared, Cristina Corrales-Selaya: None declared, Alba Herrero-Morant: None declared, Carmen Álvarez-Reguera: None declared, Martin Trigueros-Vazquez: None declared, Reinhard Wallman: None declared, Miguel A González-Gay Speakers bureau: Consultation fees/participation in company-sponsored speaker´s bureau from Abbvie, Pfizer, Roche, and MSD., Grant/research support from: Dr. Miguel A. Gonzalez-Gay received grants/research supports from Abbvie, MSD, and Roche., Ricardo Blanco Speakers bureau: Consultation fees/participation in company-sponsored speaker´s bureau from Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, and MSD., Grant/research support from: Dr. Ricardo Blanco received grants/research supports from Abbvie, MSD, and Roche