Impact of a new coronavirus infection on the clinical course of immunoinflammatory rheumatic diseases

BACKGROUND: The COVID-19 pandemic poses a particular threat to patients suffering from immunoinflammatory rheumatic diseases. New coronavirus infection has been found to be accompanied by the development of a wide range of extrapulmonary clinical and laboratory manifestations, which are characteristic of a number of immunoinflammatory rheumatic diseases. AIM: To evaluate the features of the clinical course of immunoinflammatory rheumatic diseases in patients who underwent new coronavirus infection. MATERIALS AND METHODS: The clinical course of immunoinflammatory rheumatic diseases was analyzed in 324 patients who underwent new coronavirus infection from March 2020 to February 2021 and were treated at the Clinical Rheumatology Hospital No. 25, Saint Petersburg, for exacerbation of the underlying disease. RESULTS: Analysis showed that the risk factors for severe new coronavirus infection in patients with immunoinflammatory rheumatic diseases were: age over 60, comorbidities, use of prednisolone in a dose greater than 12,5 mg, and ESR values 40 mm/hour before the development of new coronavirus infection. There was no effect of immunosuppressive and biological therapy on the severity of the course of viral infection. There was no effect of immunosuppressive therapy and biological therapy on the severity of the course of viral infection in patients with immunoinflammatory rheumatic diseases. The development of the postinfectious syndrome was observed in 1/4 of patients, which was characterized by the formation of postinfectious arthritis in 3,6% of patients, transformation of undifferentiated arthritis into various rheumatic diseases in 49% of patients (more often into early rheumatoid arthritis), as well as exacerbation of the underlying disease in 83,4% of patients with an advanced stage of rheumatoid arthritis. In patients with mixed connective tissue disease, there was a significant increase in immunologic activity due to antinuclear factor (up to a maximum of 1:163 840). Clinical cases of the development of arthritis associated with viral infection and the debut of rheumatoid arthritis after an new coronavirus infection are presented. CONCLUSIONS: New coronavirus infection in the cohort of patients with immunoinflammatory rheumatic diseases observed in the Clinical Rheumatology Hospital No. 25, Saint Petersburg, proceeded in the variant of medium severity in half of patients, initiated the development of lung lesions in 68,6% of patients, arthritis associated with viral infection in 3,6% of patients, immunoinflammatory rheumatic diseases which transformed from undifferentiated arthritis in 49% of cases and exacerbation of the main disease in an overwhelming number of patients. Patients with immunoinflammatory rheumatic diseases have a high risk of adverse outcome of new coronavirus infection, especially in cases of unstable course of the disease or exacerbation of this group of diseases.

AB0237 INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH RITUXIMAB AND ANTI-TNF INHIBITOR

Background:Biological therapies have significantly improved the management of rheumatoid arthritis (RA). These molecules are very effective, but are known for their specific risks, especially infectious. It depends on several factors including the type of molecule used.Objectives:The objective of our study is to compare the rate of infection in RA patients treated with rituximab and anti-TNFα.Methods:Prospective, observational, monocentric study. Were included RA patients (ACR / EULAR 2010 criteria) treated with rituximab and anti-TNFα (adalimumab, infliximab and Etanercept) after inadequate response to DMARDs.Demographic characteristics, comorbidities, association with methotrexate and corticosteroids were collected and compared for each group.The number, type and severity of the infections in both cases were noted.SPSS (Statistical Package for Social Science) was used for data analysis.Results:40 RA patients treated with rituximab and 31 patients who received anti-TNFα were included.Patient characteristics and Comparison of rate of infection in RA patients between the two groups are summarized in Table 1Table 1.ParametersRituximabAnti-TNFαpNumber of patients4031Average age (years)56,2846,060,01Sexratio0,140,110,7Average duration of evolution (years)15,8313,740,3Patients under corticosteroid (%)97,587,10,08Average corticosteroid dose6,415,480,3patients under methotrexate (%)37,545,20,5Diabetes (%)2016,10,7Patients with infection (%)32,551,60,1Number of infections18240,4Number of serious infections500,04Conclusion:The rate of infections in patients with RA treated with rituximab or anti-TNF was similar. However, the infections observed were more serious in patients with RA treated with rituximabReferences:[1]Fabiola Atzeni MD PhD and al. Infections and Biological Therapy in Patients with Rheumatic Diseases. IMAJ . VOL 18. march-APRIL 2016.[2]Huifeng Yun and al. Comparative Risk of Hospitalized Infection Associated with Biologic Agents in Rheumatoid Arthritis Patients Enrolled in Medicare. ARTHRITIS & RHEUMATOLOGY. Vol. 68, No. 1, January 2016, pp 56–66.[3]Manjari Lahiri and al. Risk of infection with biologic antirheumatic therapies in patients with rheumatoid arthritis. Best Practice & Research Clinical Rheumatology (2015) 1-16.Disclosure of Interests:None declared

AB0188 COMPARISON OF COMPOSITE INDICES FOR DETECTING REMISSION ON ULTRASOUND

Background:Several studies have shown the greater sensitivity of ultrasound (US) to detect B-mode synovitis and synovial Doppler activity in a high percentage of rheumatoid Arthritis (RA) patients in clinical remission, assessed by different composite indices.Objectives:The aim of the study was to compare the accuracy of composite indices to detect remission in ultrasound B-mode and power Doppler (PD) in RA patients that are in remission according to the DAS28 ESR.Methods:Cross-sectional study including patients with RA in clinical remission defined by: DAS28ESR ≤ 2.6, without disease flare or changes in therapy in the previous 6 months. Each patient underwent B-mode and PD assessments of 36 joints and 20 tendons in the Rheumatology Department over a period of 6 month. B-mode and PD signal for synovitis and tenosynovitis were defined according to the Outcome Measures in Rheumatology Clinical Trials (OMERACT). A global score for B-mode and a global score for PD signal were calculated for each patient. The DAS28, CDAI, SDAI and the Boolean 2010 ACR/EULAR remission criteria were compared.Results:Thirty two patients were enrolled, the mean age was 53.7±13.4 and the sex ratio M/F was 0.3. The mean disease duration was 15.0 years ± 8.8. According to the SDAI, 68.8% of patients were in remission. These were lower for the CDAI (62.5%) and the Boolean criteria (23.3%). Synovial hypertrophy and tenosynovitis in B mode was detected in 100% with the Boolean remission criteria, in 93.8% with a DAS28, in 90.9% with a SDAI ≤ 3.3 and in 90% with a CDAI ≤ 2.8 (p>0.05). The PD signal was detected in 62.5% with a DAS28, in 59.1% with a SDAI ≤ 3.3, in 57.1% with the Boolean remission criteria and in 55.1% with a CDAI≤ 2.8 (p>0.05). The mean B-mode global score was higher for the DAS28 ESR (8.2±6) and lower for the Boolean remission criteria (6.2 ±5.4). For a CDAI ≤ 2.8, the mean global score for B-mode was 7.6 ±5.9 and for a SDAI ≤ 3.3, it was 7.4±5.7. The median PD global score was similar for the DAS28, SDAI≤ 3.3 and Boolean remission criteria (1[0-12]). It was higher for a CDAI ≤ 2.8 (1.5 [0-12]). The global score for PD signal was correlated with DAS28 ESR (r: 0.42 p: 0.02). There were no significant correlations between the other indices and the mode B and PD global scores.Conclusion:The CDAI least detected subclinical synovitis and tenosynovitis in B mode and in power Doppler signal but it showed higher scores of power Doppler.References:[1]Merve Ozata Olmez, Esen Kasapoglu Gunal, Sibel Bakirci Ureyen and al. Comparison of composite indices with global synovitis score on ultrasound for detecting remission. Clinical Rheumatology 2017. doi.org/10.1007/s10067-017-3925-xDisclosure of Interests:None declared