Severity of COVID-19 infection in rheumatic immune-mediatedinflammatory diseases. study in a Single University Hospital

Martínez-López, D.; Prieto-Peña, D.; Sanchez-Bilbao, L.; Herrero-Morant, A.; Álvarez-Reguera, C.; Trigueros-Vazquez, M.; González-Gay, M. A.; Blanco, R.

Background: Immune-mediated inflammatory diseases (IMID) may have a global increased risk of infections due to the disease itself, and/or immunosuppressive therapy. The severity and characteristics of COVID-19 in patients with rheumatic IMID (R-IMID) remain unknown. Objectives: To analyze the severity of COVID-19 infection in R-IMID. Methods: Cross-sectional study in a single University Hospital. We included all consecutive patients with a diagnosis of a R-IMID and a positive test for COVID-19 up to November 6th, 2020. Confirmed infection was defined if the patient had a positive nasopharyngeal swab for SARS-CoV-2. Medical records of 11,199 patients with COVID-19 in our region, and 6891 with R-IMID from our hospital were reviewed. COVID-19 case severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) COVID-19 guidelines (1). Mild/moderate COVID19 was compared with critical. Results: We included 147 patients (96 women/51 men), mean age 60±18 years. Most cases were mild to moderate (n=123, 83.7%), 30 of them (20.4%) were asymptomatic. The remaining patients presented severe (n=5, 3.4%) or critical (n=19, 12.9%) disease (Table 1). Fatal outcome occurred in 12 patients (8.2%). More frequent underlying R-IMID were Rheumatoid Arthritis (n=36;24.5%), Psoriatic Arthritis (n=30;20.4%), axial spondyloarthritis (n=24;16.3%), conectivopathies (n=19;12.9%), polymyalgia rheumatica (n=16;10.9%) and vasculitis (n=9;6.1%) (Figure 1). Main comorbidities were hypertension (n=65, 44.2%), dyslipidemia (n=64, 43.5%), age higher than 65 years old (n=55, 37.4%), obesity (n=35, 23.8%), coronary vascular disease (CVD) (n=27, 18.4%) and diabetes mellitus (n=22, 15%). Comorbidities and R-IMID associated with critical disease (p<0.05) were hypertension, age higher than 65 years,CVD and Polymyalgia Rheumatica. Critical compared with mild/moderate disease showed significantly higher levels of creatinine and D-dimer, and lower level of lymphocytes and platelets (Table 1) and received more frequently systemic glucocorticoids. Tocilizumab and Anakinra were used only in critical patients, 2 cases each. Conclusion: Although most cases are mild, COVID-19 can be a severe life threatening disease in patients with R-IMID. Hypertension, older age, CVD and polymyalgia rheumatica were associated with critical disease.