COVID-19 in patients with rheumatological diseases in the Eastern Province of Saudi Arabia
Safi Alqatari, Ameera Nemer, Manal Hasan, Raed Bukhari, Reem Al Argan, Dania Al Khafaji, Abrar Alwaheed, Alaa Alzaki, Marwan Al-Wazza, Sara Al Warthan, Abir Al Saeed, Feda Albeladi, Hashim Almeer, Reem Alsulaiman, Ahmed Abu Quren
doi:10.25122/jml-2023-0037
The severity of the 2019 coronavirus disease (COVID-19) and its effects remain unpredictable. Certain factors, such as obesity, hypertension, and type 2 diabetes mellitus, may increase the severity of the disease. Rheumatology experts suggest that patients with active autoimmune conditions and controlled autoimmune diseases on immunosuppressive therapy may be at higher risk of developing severe COVID-19. In this retrospective observational study, we aimed to examine the patterns of COVID-19 in patients with underlying rheumatological diseases and their association with disease severity and hospital outcomes. A total of 34 patients with underlying rheumatological diseases who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by polymerase chain reaction (PCR) were included between March 2020 and April 2021 at King Fahd Hospital of the University. The study population consisted of 76.47% female and 23.53% male patients, with a mean age ranging from 20 to 40 years. Female gender (p=0.0001) and younger age (p=0.004) were associated with milder disease. The most frequent rheumatological disease was systemic lupus erythematosus (SLE) (38.24%), which was associated with a milder infection (p=0.045). Patients treated with mycophenolate mofetil (MMF) had a milder disease course (p=0.0037). Hypertension was significantly associated with severe COVID-19 disease (p=0.037). There was no significant relationship between SLE and the need for ICU admission. Patients on hydroxychloroquine and MMF tended to develop milder disease, and there was no association between the severity of the infection and the treatment with steroids.
Conflict of interest The authors declare no conflict of interest.
Ethical approval This study was approved by the ethics committee of the institutional review board (IRB), Imam Abdulrahman Bin Faisal University (IRB-2021-01-049).
Consent to participate Written informed consent was obtained from the participants. The data does not contain any identifiable data, and the confidentiality of the included patients is fully maintained.
Authorship SAQ is the first author who was in charge of conceptulization, supervision of data collection and manuscript preparation and revision. REAS the corresponding author and contributed in manuscript preparation and revision. AN, MH, RB, RAA, DK, and AAW contributed in manuscript preparation and data collection supervision. AAZ, MAW, SAW, and AAS contributed in manuscript revision and data analysis. FA, HA, and AAQ contributed in literature review searching, data collection and data analysis.
References
Abualfadl, Ismail, Shereef, Hassan, Impact of COVID-19 pandemic on rheumatoid arthritis from a Multi-Centre patient-reported questionnaire survey: influence of gender, rural-urban gap and north-south gradient, Rheumatol Int,
doi:10.1007/s00296-020-04679-xAlzahrani, Alghamdi, Almaqati, Clinical characteristics and outcome of COVID-19 in patients with rheumatic diseases, Rheumatol Int,
doi:10.1007/s00296-021-04745-0Avouac, Airó, Carlier, Matucci-Cerinic, Allanore, Severe COVID-19-associated pneumonia in 3 patients with systemic sclerosis treated with rituximab, Ann Rheum Dis,
doi:10.1136/annrheumdis-2020-217864Bui, Winters, Chung, Joseph, Chronic lung diseases are associated with gene expression programs favoring SARS-CoV-2 entry and severity, Nat Commun,
doi:10.1038/s41467-021-26384-4Dahan, Segal, Katz, Hellou, Ferritin as a Marker of Severity in COVID-19 Patients: A Fatal Correlation, Isr Med Assoc J
Fernandez-Ruiz, Paredes, Niewold, COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease, Transl Res,
doi:10.1016/j.trsl.2021.03.004Gianfrancesco, Hyrich, Al-Adely, Carmona, Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry, Ann Rheum Dis
Gianfrancesco, Hyrich, Al-Adely, Carmona, Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry, Ann Rheum Dis,
doi:10.1136/annrheumdis-2020-217871Grainger, Machado, Robinson, Novel coronavirus disease-2019 (COVID-19) in people with rheumatic disease: Epidemiology and outcomes, Best Pract Res Clin Rheumatol,
doi:10.1016/j.berh.2021.101657Hasseli, Mueller-Ladner, Hoyer, Krause, Older age, comorbidity, glucocorticoid use and disease activity are risk factors for COVID-19 hospitalisation in patients with inflammatory rheumatic and musculoskeletal diseases, RMD Open,
doi:10.1136/rmdopen-2020-001464Hassen, Almaghlouth, Hassen, Daghestani, Impact of COVID-19 outbreak on rheumatic patients' perceptions and behaviors: A cross-sectional study, Int J Rheum Dis,
doi:10.1111/1756-185X.13979Hsu, Ko, Wang, Hsu, Lin, Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: a nationally representative cohort study, Arthritis Res Ther,
doi:10.1186/s13075-019-1925-7Huang, Chen, Wang, Han, Clinical characteristics of 17 patients with COVID-19 and systemic autoimmune diseases: a retrospective study, Ann Rheum Dis,
doi:10.1136/annrheumdis-2020-217871Juge, Hachulla, Richez, Drumez, Impact of a pre-existing interstitial lung disease on severity of COVID-19 in patients with rheumatic and musculoskeletal diseases, Ann Rheum Dis,
doi:10.1136/annrheumdis-2021-eular.4066Kastritis, Kitas, Vassilopoulos, Giannopoulos, Systemic autoimmune diseases, anti-rheumatic therapies, COVID-19 infection risk and patient outcomes, Rheumatol Int,
doi:10.1007/s00296-020-04633-xLoarce-Martos, García-Fernández, López-Gutiérrez, García-García, High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study, Rheumatol Int,
doi:10.1007/s00296-020-04699-xNg, Tipih, Makoah, Vermeulen, Comorbidities in SARS-CoV-2 Patients: a Systematic Review and Meta-Analysis, mBio,
doi:10.1128/mBio.03647-20Nuñez, Leon, Mucientes, Rodriguez-Rodriguez, Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases, Ann Rheum Dis,
doi:10.1136/annrheumdis-2020-218479Nuño, Navarro, Bonilla, Clinical course, severity and mortality in a cohort of patients with COVID-19 with rheumatic diseases, Ann Rheum Dis,
doi:10.1136/annrheumdis-2020-218641Ouédraogo, Tiendrébéogo, Kaboré, Ntsiba, COVID-19, chronic inflammatory rheumatic disease and anti-rheumatic treatments, Clin Rheumatol,
doi:10.1007/s10067-020-05176-8Ramírez-De-Arellano, Gutiérrez-Franco, Sierra-Diaz, Pereira-Suárez, The role of estradiol in the immune response against COVID-19, Hormones,
doi:10.1007/s42000-020-00263-xShah, Danda, Kavadichanda, Das, Autoimmune and rheumatic musculoskeletal diseases as a consequence of SARS-CoV-2 infection and its treatment, Rheumatol Int,
doi:10.1007/s00296-020-04644-8Silva, Serling-Boyd, Wallwork, Hsu, Clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and rheumatic disease: a comparative cohort study from a US 'hot spot, Ann Rheum Dis,
doi:10.1136/annrheumdis-2020-217888Tharwat, Mohamed, Nassar, Challenges of Egyptian patients with systemic lupus erythematosus during the COVID-19 pandemic, Reumatologia,
doi:10.5114/reum.2021.109165Vahidy, Pan, Ahnstedt, Munshi, Sex differences in susceptibility, severity, and outcomes of coronavirus disease 2019: Cross-sectional analysis from a diverse US metropolitan area, PLoS One,
doi:10.1371/journal.pone.0245556Yasuda, Tsukune, Watanabe, Sugimoto, Persistent COVID-19 Pneumonia and Failure to Develop Anti-SARS-CoV-2 Antibodies During Rituximab Maintenance Therapy for Follicular Lymphoma, Clin Lymphoma Myeloma Leuk,
doi:10.1016/j.clml.2020.08.017Zhou, Yu, Du, Fan, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet,
doi:10.1016/S0140-6736(20)30566-3
