Should Patient with Autoimmune Inflammatory Rheumatic Diseases (AIIRD) be vaccinated with COVID-19 Vaccines?

Vaccination is a very important measure for the prevention of various infections worldwide including the recent COVID-19 disease. However, until now the COVID-19 vaccine with various platforms has not been clinically tested on autoimmune inflammatory rheumatic disease (AIIRD) patients, due to caution against possible side effects and unknown efficacy. Several recent studies proved that there is increased risk of SARS-CoV-2 infection in AIIRD patients and moreover, those patients also have worse COVID-19 outcomes. Thus, patients with AIIRD should be prioritized for vaccination because they have an increased burden of infections, including COVID-19. Many studies showed that inactivated/non-live vaccine is safe for AIIRD patients and do not cause disease exacerbations. We conclude that benefits of vaccination greatly outweigh the risks of infection and therefore, COVID-19 vaccines can also be administered safely in stable AIIRD patients.

AB0266 METHOTREXATE AND CARDIOVASCULAR RISK IN RHEUMATIC DISEASES:A COMPREHENSIVE REVIEW

Background:The management of inflammatory rheumatic disease has evolved in the last decade with the importance of the management of comorbidities. Methotrexate is the cornerstone of inflammatory rheumatic disease management, but its cardiovascular effects are still poorly understoodObjectives:To assess the cardiovascular impact of methotrexate in inflammatory rheumatic disease.Methods:A systematic review of the literature, following the prisma recommandations, was performed on the PubMed and Embase databases with the following keywords: (“Methotrexate”) AND (“cardiovascular”). We included papers written in English and including patients older than 18 years.Results:570 references were identified and, 36 articles were kept for analysis.The mechanism of action of methotrexate lies mainly on the antagonism of purines. It reduces systemic inflammation, oxidative stress.In Rheumatoid arthritis, the use of methotrexate was associated with a decreased incidence of high blood pressure, an improvement of the lipid profile and of the insulin resistance. Major adverse cardiovascular events were decreased with methotrexate. The effects of methotrexate on the endothelial function were more controversial and available data did not argue for a direct vascular effect of MTX in RA.In psoriatic arthritis, evidences were more scarce. A meta-analysis showed that methotrexate was associated with a reduction of cardiovascular events in patients with psoriatic arththritis. In psoriatic arthritis, methotrexate did not improve the endothelial function.In plaque psoriasis, available data were rare. The use of methotrexate in this condition was not associated with a reduction of cardiovascular events. Nevertheless, a decrease in circulating VCAM-1 and in E selectin levels was described with the use of methotrexate.In HIV infection, a model of pro inflammatory state, the use of methotrexate did not change the endothelial function and thus the cardiovascular events.Finally, in general population, the use of methotrexate did not decrease the occurrence of cardiovascular events after a myocardial infarction.Conclusion:The cardiovascular effects of methotrexate are poorly understood at this time. Nevertheless, it seems clear that methotrexate can reduce the occurrence of cardiovascular events in inflammatory disease. The mechanisms explaining this good issue are poorly understood, but it seems possible that the essential effect of methotrexate lies in the reduction of the inflammatory syndrome without a direct vascular impact.Disclosure of Interests:None declared

AB0699 RETROSPECTIVE ANALYSIS OF 52 SARS-COV2 POSITIVE PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASE: A SINGLE CENTER EXPERIENCE

Background:It is a generally accepted opinion that autoimmune and inflammatory rheumatic diseases or drugs used in the treatment of these conditions increase the risk of infection. During the pandemic period, the follow-up and treatment of patients who were diagnosed with rheumatic disease and used corticosteroid, immunosuppressive, biological or synthetic DMARDs and disease management during sars-cov2 infection still remain a problem.Objectives:In this study, it was aimed to share the demographic data of 52 patients with inflammatory rheumatic disease diagnosed with SARS-COV2 who were followed up and treated in the Rheumatology Department of Private Doruk Hospital during the SARS-COV2 pandemic. Additionally, it is aimed to examine the primary rheumatological diseases of the patients, their biological and conventional DMARD treatments, their comorbidities and the course of SARS-COV2.Methods:Fifty-two patients who were diagnosed with SARS-COV2 by PCR method while being followed up and treated in the rheumatology center between May 2020 and November 2020 and get COVID treatment in the same center were included in the study. All patients diagnosed with SARS-COV2 and required hospitalization were hospitalized in the same center and followed up and treated. The files and electronic records of the patients were retrospectively recorded by the rheumatologist who followed the patients.Results:In this retrospective study conducted from a single center, 52 patients whose diagnosis of SARS-COV2 was confirmed by PCR were included. Distribution of primary rheumatic diseases of the patients; 19 rheumatoid arthritis (RA), 14 Ankylosing spondylitis (AS), 4 Psoriatic Arthritis (PsA), 4 Systemic lupus erythematosus (SLE), 5 Behcet’s Disease (BD), 4 Familial Mediterranean Fever (FMF), 2 Sjögren’s syndrome. 76.8% of the patients were female, 22.2% male, their mean age was 47 ± 18. Biological drug use rate of 37 patients in RA, AS and PsA groups was 83.7% (monotherapy or combination 31/37).Moreover, 16.2% (6/37) of the patients were using synthetic DMARD combination (MTX+SLZ +HCQ) and 40.5% (15/37) of the patients were using a combination of biological and synthetic DMARDs. While 73% (38/52) of 52 patients had a mild course, 27% (14/52) had severe SARS-COV2 requiring hospitalization. 14 patients who had severe SARS-COV2 infection and required hospitalization, 10 were followed up with the diagnosis of RA, 2 with AS and 2 with SLE. Hospitalization of patients using monotherapy biological drugs (TNF inhibitor, Tocilizumab, IL 17-A) due to severe SARS-COV2 was found to be lower than the group using combined synthetic DMARDs with steroids (MTX+SSZ+HCQ) (p <0.05). The corticosteroid dose of the RA patients was in the range of 5-10 mg/day. The rate of having severe SARS-COV2 was found to be higher in the combination group using biological or synthetic DMARD and low dose corticosteroids compared to group using monotherapy biologicals (p <0.05). The rate of having severe SARS-COV2 was found to be significantly higher in the group using 10/mg or more at the time of diagnosis (p <0.05). Two patients with SLE multiple organ involvement had severe SARS-COV2 while using rituximab, and hospitalization was required. In terms of comorbidities, hypertension was the most common comorbidity with 64.2% (9/14) in the group with severe SARS-COV2, followed by obesity with 21.4% (3/14).Conclusion:In patients with inflammatory rheumatic disease, SARS-COV-2 infection and the drugs used for the treatment of primary disease are still considered to be a difficult situation in terms of prognosis. In our study with limited cases, data suggesting that there is no increased risk of SARS-COV2 requiring hospitalization in patients using TNF inhibitors, tocilizumab and IL17-A blockers. It was thought that there might be a drug-induced increased risk due to the severe SARS-COV2 infection that developed in our two patients who used rituximab, but the disease-related risk increase was not ignored because the patients were SLE patients with active multi-organ involvement.Disclosure of Interests:None declared

Incidence and severeness of COVID-19 hospitalisation in patients with inflammatory rheumatic disease: a nationwide cohort study from Denmark

Objectives To estimate the incidence of COVID-19 hospitalisation in patients with inflammatory rheumatic disease (IRD); in patients with rheumatoid arthritis (RA) treated with specific DMARDs; and the incidence of severe COVID-19 infection among hospitalised patients with RA. Methods A nationwide cohort study from Denmark between 1 March to 12 August 2020. The adjusted incidence of COVID-19 hospitalisation was estimated for patients with RA; spondyloarthritis including psoriatic arthritis; connective tissue disease; vasculitides; and non-IRD individuals.Further, the incidence of COVID-19 hospitalisation was estimated for patients with RA treated respectively non-treated with TNF-inhibitors, hydroxychloroquine, or glucocorticoids.Lastly, the incidence of severe COVID-19 infection (intensive care, acute respiratory distress syndrome, or death) among hospital-admitted patients was estimated for RA and non-IRD individudals. Results Patients with IRD (n = 58,052) had an increased partially adjusted incidence of hospitalisation with COVID-19 compared with the 4.5 million people in the general population (HR 1.46, 95%CI 1.15 to 1.86) with strongest associations for patients with RA (n = 29,440, HR 1.72, 95%CI 1.29 to 2.30) and vasculitides (n = 4072, HR 1.82, 95%CI 0.91 to 3.64). There was no increased incidence of COVID-19 hospitalisation associated with TNF-inhibitor, hydroxychloroquine nor glucocorticoid use. COVID-19 admitted patients with RA had a HR of 1.43 (95% CI 0.80 to 2.53) for a severe outcome. Conclusion Patients with IRD were more likely to be admitted with COVID-19 than the general population, and COVID-19 admitted patients with RA could be at higher risk of a severe outcome. Treatment with specific DMARDs did not affect the risk of hospitalisation.

The psychological impact of the COVID-19 pandemic on Dutch people with and without an inflammatory rheumatic disease

Objectives To determine the psychological impact of the COVID-19 pandemic on people with and without an inflammatory rheumatic disease and establish whether psychological flexibility buffers this impact. Methods From online surveys in the general Dutch population in 2018 and during the peak of the COVID-19 pandemic in 2020, we analysed data of people with (index group, n = 239) and without (control group, n = 1821) an inflammatory rheumatic disease. Worry, stress, mental well-being (SF-36) and psychological flexibility levels were subjected to covariate-adjusted analyses of variance or linear regression analyses. Results During the peak of the COVID-19 pandemic in 2020, as compared with the control group, the index group was more worried about getting infected with the virus (partial η2=0.098; medium effect) and more stressed (partial η2= 0.040; small effect). However, as compared with data acquired in 2018, the level of mental well-being during the COVID-19 pandemic peak was not lower in both groups. Levels of psychological flexibility did not moderate associations of group or year with mental well-being. Conclusions Although patients with an inflammatory rheumatic disease were more worried and stressed during the peak of the COVID-19 pandemic, their level of mental well-being was not reduced, which may have prevented us from finding a buffering effect of psychological flexibility. Overall, our results suggest that the psychological impact of the COVID-19 pandemic in patients with inflammatory rheumatic disease is modest, which could imply that common education and health care will do for most patients.