Title:COVID-19 in Patients with Systemic Inflammatory Diseases: Impact on
Disease Activity
Volume: 19
Issue: 3
Author(s): Saoussen Miledi, Sirine Bouzid*, Alia Fazaa, Mariem Sallemi, Hiba Bousaa, Kaouther Ben Abdelghani and Ahmed Laatar
Affiliation:
- Department of Rheumatology, Mongi Slim Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
Keywords:
COVID-19, systemic inflammatory diseases, disease activity, rheumatic diseases, ankylosing spondylitis disease, methotrexate.
Abstract:
Introduction: COVID-19 pandemic, an international emergency, raised concerns about
the interaction of this infection and disease-modifying drugs used in the treatment of Systemic inflammatory
diseases (SID). Understanding the relationship between COVID-19 and disease activity
is crucial to adapt the treatment.
Aim: The aim of our study was to determine the impact of COVID-19 on the disease activity of
rheumatic diseases.
Patients and Methods: We performed a cross-sectional study, including patients with SID (rheumatoid
arthritis (RA) and spondyloarthritis (SpA)). Disease activity was evaluated during the last
check-up before COVID-19 and within the period of 6 months after the infection. Activity scores
were assessed with Disease Activity Score (DAS28) for RA and Ankylosing Spondylitis Disease
Activity Score (ASDAS) for SpA. Correlation and regression coefficients were used to evaluate associations
among the variables.
Results and Discussion: Totally, thirty-two patients were included; twenty followed for RA and
twelve for axial SpA. The mean disease duration of the underlying rheumatic disease was 10.2 years
(2-30). RA was seropositive and erosive in 61% and 31%, respectively. Seventeen patients were on
csDMARDs: 14 were on Methotrexate and three patients were on Salazopyrine. Ten patients (31%)
were treated with bDMARDs; Tumor necrosis factor (TNF)-alpha inhibitors were used in eight cases.
Rituximab and secukinumab were prescribed for one patient each. In 70%, COVID-19 was
pauci-symptomatic. A severe form with a need for hospitalization was noted in 9%. Two patients
were admitted to the intensive care unit (ICU).
Overall, treatment with DMARDs was interrupted in all cases: when COVID-19 symptoms began
in 82% and when PCR was positive in 18%. Both RA and axial SpA were not active after a mean
period of 6 months after COVID-19 infection (p = 0.818 and p = 0.626, respectively).
Conclusion: Although our patients interrupted their DMARDs, our study demonstrates that disease
activity as assessed by ASDAS and DAS28 in SpA and RA remained unchanged after COVID-19.
