The course of COVID-19 infection in patients with arthritis receiving targeted dmards

Koltsova, E.; Lukina, G.; Shmidt, E.; Lytkina, K.; Rozochkina, E.; Zhilyaev, E.

Background: WHO declared the COVID-19 outbreak as a pandemic on March 12th, 2020. Assessing the risk of severe course in patients with rheumatic diseases, especially those who receive targeted immunosuppressive treatment, is an urgent problem for rheumatologists. Objectives: determine the relationship between used targeted biologic and synthetic DMARDs (tDMARDs) and the severity of course of COVID-19 infection. Methods: The analysis included the data of patients with chronic arthritis and COVID-19, used tDMARDs. COVID-19 infection was confirm by serology tests or immune system molecules (immunoglobulins/antibodies). The presence of symptoms, the need for hospitalization, and the need for oxygen therapy were considered as indicators of the severity of the infection. We also analyzed the spread of the lung involvement according to CT data, symptoms during the disease (fever, cough, anosmia, diarrhea). Results: Analyses included 78 patients, among them 32 patients has ankylosing spondylitis, 31 patients -rheumatoid arthritis, 12 patients has psoriatic arthritis, 3 patients -juvenile arthritis. The average age of the included patients was 51,8 ± 11,69. Most of patients used TNF inhibitors -43 (Adalimumab -10, Golimumab -4, Infliximab -4, Certolizumab pegol -3, Etanercept -22), JAK inhibitor tofacitinib used 13 patients, 5 patients each was treated with Abatacept and Tocilizumab, 3 patients used Rituximab and 2 patients each used Netakimab and Ustekinumab (Table 1). None of the patients included in the analysis required treatment in the ICU and/or mechanical ventilation. The course of the disease in patients treated with tDMARDs did not seem to be more severe than in 5 patients with arthritis who stopped treatment with tDMARDs before the onset of the pandemic. There was a direct correlation between the severity of the infection and the age of the patients (p=0.007). There were no significant differences in the severity of the infection depending on the drug, including when adjusting for age. Conclusion: COVID-19 does not look extremely dangerous in patients with rheumatic diseases, used target DMARDs. Used of tsDMARDs doesn't reliably increase the risk of COVID-19 severity. There is reliable correlation between age and COVID-19 severity.