RESUMO
Background: In Argentina we have witnessed two COVID 19 waves between 2020 and 2021. The frst wave occurred during the spring of 2020 and it was related to the wild type of the virus, the second occurred during the fall/winter of 2021 when the gamma variant showed a clear predominance. During the frst wave, patient with rheumatic diseases showed a higher frequency of hospitaliza-tion and mortality (4% vs 0.26%) when compared to the general population1;at that time, however, vaccination was not yet available. Objectives: To compare sociodemographic and disease characteristics, course and outcomes of SARS-CoV-2 infection in patients with immune-mediated/auto-infammatory diseases (IMADs) during the frst and second waves in Argentina. Methods: SAR-COVID is a national, multicenter, longitudinal and observational registry, in which patients ≥18 years of age, with a diagnosis of a rheumatic disease who had confrmed SARS-CoV-2 infection (RT-PCR or positive serol-ogy) were consecutively included since August 2020. For the purpose of this report, only patients with IMADs who had SARS-CoV-2 infection during the frst wave (defned as cases occurred between March 2020 and March 2021) and the second wave (cases occurred between April and August 2021) were examined. Sociodemographic characteristics, disease diagnosis and activity, comorbidities, immunosuppressive treatment and COVID 19 clinical characteristics, complications and outcomes: hospitalization, intensive care unit (ICU) admission, use of mechanical ventilation and death were compared among groups. Descriptive statistical analysis was performed. Variables were compared with Chi squared test and Student T test or Mann Whitney test. Multivariable logistic regression models with forward and backward selection method, using hospitalization, ICU admission and death as dependent variables were carried out. Results: A total of 1777 patients were included, 1342 from the frst wave and 435 of the second one. Patients had a mean (SD) age of 50.7 (14.2) years and 81% were female. Both groups of patients were similar in terms of socio-de-mographic features, disease diagnosis, disease activity, the use of glucocorti-coids ≥ 10 mg/day and the immunosuppressive drugs (Table 1 below). Patients infected during the frst wave have higher frequency of comorbidities (49% vs 41%;p= 0.004). Hospitalizations due to COVID 19 (31% vs 20%;p <0.001) and ICU admissions (9% vs 5%;p= 0.009) were higher during the frst wave. No differences in the use of mechanical ventilation (16% vs 16%;p= 0.97) nor in the mortality rate (5% vs 4%;p= 0.41) were observed. In the multivariable analysis, after adjusting for demographics, clinical features and immunosup-pressive treatment, patients infected during the second wave were 40% less likely to be hospitalized (OR= 0.6, IC95% 0.4-0.8) and to be admitted to the ICU (OR= 0.6, IC95% 0.3-0.9). Conclusion: The impact of COVID 19 in Argentina, in terms of mortality in patients with IMADs was still higher compared to the general population during the second wave. However, the frequency of hospitalizations and ICU admissions was lower. These fndings could be explained by the introduction of the SARS COV 2 vaccination and, probably, by the cumulative knowledge and management improvement of this infection among physicians.
RESUMO
Background: Comorbidities, particularly cardio-metabolic disorders, are highly prevalent in patients with psoriatic arthritis (PsA) and they were associated with an increased risk of atherosclerotic cardiovascular disease, which have been associated with higher morbidity and mortality. Whether PsA enhances the risk of SARS-CoV-2 infection or affects the disease outcome remains to be ascertained. Objectives: To describe the sociodemographic, clinical and treatment characteristics of patients with PsA with confrmed SARS-CoV-2 infection from the SAR-COVID registry and to identify the variables associated with poor COVID-19 outcomes, comparing them with those with rheumatoid arthritis (RA). Methods: Cross-sectional observational study including patients ≥18 years old, with diagnosis of PsA (CASPAR criteria) and RA (ACR/EULAR 2010 criteria), who had confrmed SARS-CoV-2 infection (RT-PCR or serology) from the SAR-COVID registry. Recruitment period was between August 13, 2020 and July 31, 2021. Sociodemographic variables, comorbidities, and treatments were analyzed. To assess the severity of the infection, the ordinal scale of the National Institute of Allergy and Infectious Diseases (NIAID)1 was used, and it was considered that a patient met the primary outcome, if they presented criteria of categories 5 or higher on the severity scale. For this analysis, Chi2 test, Fisher's test, Student's test or Wilcoxon test, and binomial logistic regression using NIAID>=5 as dependent variable were performed. Results: A total of 129 PsA patients and 808 with RA were included. Clinical characteristics are shown in Table 1. Regarding PsA treatment, 12.4% of PsA were receiving IL-17 inhibitors, 5.4% IL12-23 inhibitors, one patient apremilast and one abatacept. The frequency of NIAID≥5 was comparable between groups (PsA 19.5% vs RA 20.1%;p=0.976). (Figure 1). PsA patients with NIAID≥5 in comparison with NIAID<5 were older (58.6±11.4 vs 50±12.5;p=0.002), had more frequently hypertension (52.2% vs 23%;p=0.011) and dyslipidemia (39.1% vs 15%;p=0.017). In the multivariate analysis, age (OR 1.06;95% CI 1.02-1.11) was associated with a worse outcome of the COVID-19 (NIAID≥5) in patients with PsA, while those who received methotrexate (OR 0.34;95% CI 0.11-0.92) and biological DMARDs (OR 0.28;95% CI 0.09-0.78) had a better outcome. Conclusion: Although PsA patients have a higher frequency of cardiovascular and metabolic comorbidities than those with RA, the COVID-19 severity was similar. Most of the patients had mild SARS-CoV-2 infection and a low death rate.
RESUMO
Objectives: To evaluate adherence to treatment and the impact of isolation in patients with rheumatic diseases Methods: Observational and cross-sectional study, using an electronic survey (Google form®) in participants of the virtual congress of patients in 2020 over 18 years of age. Demographic data, diagnosis and factors associated with the life of the people in this period of restriction were recorded. Results: 558 patients answered the survey (95.34%women). 494 patients from Argentina (164 were from the province of Buenos Aires). 75 of the survey participants were between 40 and 70 years old. Most of the patients had rheumatoid arthritis 45%, Fibromyalgia 31%and Osteoarthritis 16%. 70% were followed in the private environment. 65% considered themselves within the risk group of suffering from COVID-19 and 23% were unsure of their risk. The majority of the population knew the necessary measures of prevention. 83% were able to connect with their doctor during this period, the most common way was in person and via Whats App, only 18% had access through tele consultation. 79.2% continued with the treatment for their disease, 14.2% had difficulties and 6.4% did not succeed. Of these two groups, lack of access to medication and lack of communication with their doctor was the cause. During this period, 50% were able to do physical activity at home. Of the surveyed population, 35 people (6.4%) had a diagnosis of COVID-19;of these only 6 (15%) required hospitalization, the rest only isolation at home. Anxiety 63% anguish 48% and sadness 42.6%were the emotions that predominated in the vast majority of people with rheumatic diseases. Regarding vaccines, 51% thought that they would be vaccinated if recommended by their rheumatologist and 28 .6% had doubts. Only 9% would not be vaccinated. These data are depincted in Figures 1 and 2. Conclusion: From this survey, we obtained information on how the pandemic impacted people's daily lives during the restriction. Although the vast majority were able to comply with their treatment and indications, a percentage could not comply with their treatment and did not have access to their rheumatologist. There is a great emotional impact from the restrictions on this group of people. Additionally, patients expressed trust in their rheumatologist, and the recommendation for COVID-19 vaccination.