THE COURSE OF COVID-19 IN A COHORT OF SPONDYLOARTHRITIS PATIENTS: A CASE-CONTROL PROSPECTIVE STUDY

BackgroundWith the outbreak of the SARS-CoV-2 pandemic, the rheumatologists’ attention was directed at understanding whether infected patients could have a less favorable outcome. Available data seem to indicate that the course in rheumatic patients is not dissimilar from that in the general population. However, data on the outcome of COVID-19 in patients with spondyloarthritis (SpA) are scant.ObjectivesTo describe the outcome of COVID-19 in patients with SpA in terms of hospitalization, need of oxygen therapy, and symptoms compared to a control group. The variation in disease activity before and after COVID-19 was also assessed.MethodsWe enrolled adult patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS) classified according to standard criteria, that received a diagnosis of COVID-19 through molecular or rapid antigen swab tests between September 2020 and January 2022. Demographic and clinical data, including age, body mass index (BMI), smoking habit, comorbidities, rheumatic treatment at diagnosis of COVID-19, date of COVID-19 diagnosis, symptoms and additional therapy during the infection and vaccination status were collected through a questionnaire and recorded on an electronic database. Disease activity, assessed by DAPSA in PsA patients and by BASDAI and ASDAS in AS patients, was evaluated before and at the first visit after the infection. As controls, individuals with COVID-19 but with no known diagnosis of rheumatic/autoimmune disease were recruited using the “best friend” system.ResultsSixty-two patients were enrolled [43 with PsA and 19 with AS; F:M=40:22; median age 51 years, 25th-75th percentile 39.5-61; median BMI 25.5, 25th-75th percentile 21.75-28; median disease duration 90 months, 25th-75th percentile 36-192; 6 (9.7%) smokers, 37 (59.7%) non-smokers, 19 (30.6%) past smokers; 15 (24.2%) only treated with one conventional DMARD, 27 (43.5%) with bDMARDs and 20 (32.3%) with both; 44 (71%) had received no vaccine, 18 (29%) one or more doses of vaccine]. Forty-eight controls were also recruited [F:M=29:19; median age 48 years, 25th-75th percentile 41.5-57; median BMI 23.86, 25th-75th percentile 20.69-28.03; 10 (20.83%) smokers, 28 (58.33%) non-smokers, 10 (20.83%) past smokers; 43 (89.6%) had received no vaccine, 5 (10.4%) one or more doses of vaccine]. Among patients, 10 (16.1%) were hospitalized, of whom 8 (80%) required noninvasive oxygen therapy. Among controls, 7 (14.5%) were hospitalized, of whom 5 (71.4%) required noninvasive oxygen therapy. No differences were observed compared to the control group in terms of hospitalization and need for oxygen support. Likewise, the two groups did not bear any statistically significant difference in terms of symptoms (fever, dysgeusia, dyspnoea) and cardiovascular and respiratory comorbidities. BMI and smoking habit did not influence the outcome of COVID-19 in SpA patients, while a BMI of 25 or above was associated with hospitalization in the control group (p=0.0004, RR 3.417). Baseline treatment with immunosuppressants did not influence the disease outcome. DAPSA, ASDAS, and BASDAI did not significantly change after the infection (Table 1). We did not record any COVID-19-related death in either group.Table 1.Disease activity before and after COVID-19Last visit before COVID-19First visit after COVID-19*PsA (n=43)AS (n=19)PsA (n=43)AS (n=19)Remission/low disease activity, n (%)19 (44.2%)17 (89.5%)23 (53.5%)14 (73.7%)Moderate/high disease activity, n (%)11 (25.6%)0 (0%)7 (16.3%)1 (5.3%)NA 13 (30.2%)NA 2 (10.5%)NA 13 (30.2%)NA 4 (21%)* Reassessment of patients was performed 2 months (median) after COVID-19, 25th-75th percentile 1-4 monthsPsA, psoriatic arthritis; AS, ankylosing spondylitis; NA, not availableConclusionOur data show that patients with SpA do not face a worse prognosis of COVID-19 than subjects without rheumatic/autoimmune diseases and that demographic and clinical features did not influence the course of the disease.Disclosure of InterestsNone declared