Impact of COVID-19 on patients with rheumatic diseases: Experience of the department of rheumatology of the university hospital of IBN rochd of casablanca

El Moutaouakil, H.; El Ouali, Z.; Nassar, K.; Janani, S.

Background: The COVID-19 outbreak has been a source of major concern for the management of rheumatic patients, particularly those under immunosuppressants. It is generally admitted that patients followed for autoimmune diseases have an increased risk of infectious complications compared to the general population (1). However, to date, there is no established relationship between autoimmune diseases and an increased risk of infection with SARS-CoV-2 (2). Objectives: The primary objective was to assess the severity of COVID-19 in patients followed in our department. The secondary objective was to assess the subgroup of patients on immunosuppressants. Methods: We conducted a descriptive retrospective study of patients followed in the Department of Rheumatology of the University Hospital of Ibn Rochd, Casablanca. The patients who presented with COVID-19 between 08/2020 and 12/2020 were included. Epidemiological, clinical, therapeutic, and evolutionary data were collected and analyzed. Results: Our series included 30 patients, with a sex ratio M/F of 0.3. The mean age of the patients was 46.4 years (±16.3), with a mean follow-up time of 8.1 years. 7 patients had a metabolic syndrome. Patients were followed for rheumatoid arthritis (n = 4), spondyloarthritis (n = 10), systemic lupus erythematosus (n = 5), scleroderma (n = 2), polymyalgia rheumatica (n = 1), adult onset Still'sdisease (n = 1), polyosteoarthritis (n = 6), benign osteopathy (n = 1). 17 patients were in low disease activity when they presented the COVID-19. 8 patients presented moderate to high activity, of which 2 (25%) developed a form requiring hospitalization. 7 patients were under NSAIDs, 13 under corticosteroids, 19 under csDMARD, 7 under bDMARD. The COVID-19 disease was symptomatic in 83% of cases, with fatigue (68%), cough (52%), back pain (48%), anosmia (48%), ageusia (44%), arthritis (44%), fever (36%). The diagnosis was made with polymerase chain reaction (83%), serology (10%), CT scan (23%). The CT lung lesions reached 25-50% in 2 lupus patients with a moderate disease activity, under corticosteroids and hydroxychloroquine. The involvement was > 75% in 2 patients, who admitted to intensive care: one was followed for polyarthrosis and was hypertensive and poorly balanced diabetic, and the other was followed for Horton's disease. The treatment was administered on an outpatient basis in 77.4% of cases, in an intensive care unit in 16% of cases. 30 patients fully recovered from infection, one patient died secondary to pulmonary embolism. The subgroup of patients on immunosuppressants consisted of 23 patients (76%), of whom 5 (22%) developed a moderate to severe form of COVID-19 requiring hospitalization. Among these hospitalized patients, 2 (40%) had moderate to high disease activity of their rheumatism. Conclusion: Most of the patients in our series presented a mild form of COVID-19, including those under immunosuppressants. Patients who were under hydroxychloroquine were not spared from COVID-19, but developed a mild form. The disease activity of the chronic rheumatism did not appear to influence the severity of the COVID-19.