Clinical profile and management of COVID-19 in unvaccinated patients with rheumatoid arthritis: A single-center study

Abstract

Aim. The present study aimed primarily to assess COVID-19 (COronaVIrus Disease 2019) course and management in unvaccinated patients with rheumatoid arthritis (RA). Secondary objectives included an analysis of the impact of RA disease activity, age, comorbidities, and DMARD treatment on COVID-19 course. Materials and methods. We performed a prospective observational study on RA patients in the 1st Rheumatology Clinic of the Clinical Rehabilitation Hospital between February and July 2021. The criteria for inclusion in the study cohort were: confirmed RA diagnosis and SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection confirmed by rapid antigen test and/or RT-PCR (Real-Time Polymerase Chain Reaction) during hospitalization in our department. We excluded the patients who were vaccinated against SARS-CoV-2 and those with incomplete data regarding COVID-19 clinical features and management. Demographic characteristics, DAS28 (Disease Activity Score 28) and the treatment prior to SARS-CoV-2 infection, as well as the patients’ comorbidities were taken from the subjects’ charts completed on presentation in the 1st Rheumatology Clinic. COVID-19-related data were collected from the patients’ release forms from specialized departments. Results. The study group included 28 unvaccinated patients with RA who tested positive for SARS-CoV-2. All patients over 65 years of age were symptomatic for COVID-19. Moreover, this subgroup had an increased risk of pneumonia (p = 0.047) and a 217% risk increase for desaturation. Comorbid type 2 diabetes mellitus was associated with COVID-19 pneumonia (p = 0.048). Women needed less antiaggregant and anticoagulant medication (p = 0.029), antitussives (p = 0.014) and oxygen therapy (p = 0.044) compared to men. Patients with comorbid heart failure, valvulopathies and cardiac ischemia were more likely to require antiaggregant or anticoagulant medication during hospitalization for COVID-19 (p = 0.003, p= 0.013, and p < 0.001). DAS28 ≥ 5.1 prior to infection was associated with Tocilizumab therapy for COVID-19 pneumonia, results approaching statistical significance in this respect. Conclusions. In the present study group, we found significant associations between COVID-19-related changes and advanced age, as well as certain comorbidities. Large comprehensive longitudinal studies may provide a more accurate representation of COVID-19 outcomes in unvaccinated patients with RA.

Keywords

• rheumatoid arthritis
• covid-19
• sars-cov-2
• pneumonia
• obesity
• diabetes mellitus
• systemic hypertension