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Aksiyel spondiloartritli hastalarda COVİD-19 sıklığı ve ilişkili faktörler

Year 2023, Volume: 16 Issue: 3, 404 - 411, 01.07.2023
https://doi.org/10.31362/patd.1223660

Abstract

Amaç: Kronik hastalığa sahip bireylerde COVİD-19’un ağır seyri romatolojik hastalıkların tedavisinde endişeye yol açmıştır. Bu yüzden çalışmamızda aksiyel spondiloartritli (aSpa) hastalarda COVİD-19 sıklığı ve şiddeti ile ilişkili faktörleri tanımlamayı amaçladık.
Gereç ve yöntem: Üç tersiyer merkezde izlenen ve en az altı aydır tedavilerini düzenli kullanan aSpa’lı hastalar çalışmaya dahil edildi. Hastalık süresi, radyolojik şiddet ve tedavi gibi aSpa ilişkili değişkenler ile COVİD-19 sonuçları arasındaki ilişkiyi değerlendirdik.
Bulgular: Ortalama hastalık süresi 109 ay olan toplam 833 hasta analiz edildi; %64,5’inde ankilozan spondilit ve %35,5’inde non-radyografik aSpa tanısı mevcutken hastaların %59,4’ü biyolojik ajanlarla tedavi edilmekteydi. Çalışma grubumuzda COVİD-19 sıklığı %23 (n:192) olup sadece beş olguda (%0,5) yoğun bakım ünitesi öyküsü vardı. İleri yaş, hipertansiyon (HT) ve diabetes mellitus (DM) yüksek çözünürlüklü bilgisayarlı tomografisinde (YÇBT) tutulum olan hastalarda anlamlı olarak daha fazlaydı (p:0,02, p:0,01 ve p<0,001). Hastaneye yatış gerektiren hastalarda ise ileri yaş, HT, DM ve 10 yıldan uzun hastalık süresi anlamlı olarak daha fazlaydı (p:0,03, p:0,011, p<0,001 ve p:0,014). Çok değişkenli regresyon analizinde sadece DM hem YÇBT’de akciğer tutulumu (p:0,029) hem de hospitalizasyon (p:0,001) için bağımsız bir risk faktörü olarak bulundu.
Sonuç: Homojen bir hasta grubu ile yaptığımız çalışmamızın sonuçları biyolojik ajanların COVİD-19 ilişkili kötü sonuçlar üzerine etkisini olmadığını göstermiştir; çalışmamızda sadece DM, aSpa’lı hastalarda daha ciddi COVİD-19 sonuçları ile ilişkiliydi.

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References

  • 1. World Health Organization (WHO) https://www.who.int (World Health Organization official website)
  • 2. Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet 2017;390:73-84. https://doi.org/10.1016/S0140-6736(16)31591-4
  • 3. Lopez Medina C, Molto A. Update on the epidemiology, risk factors, and disease outcomes of axial spondyloarthritis. Best Pract Res Clin Rheumatol 2018;32:241-253. https://doi.org/10.1016/j.berh.2018.10.006
  • 4. Van der Heijde D, Ramiro S, Landewé R, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 2017;76:978-991. https://doi.org/10.1136/annrheumdis-2016-210770
  • 5. Evangelatos G, Bamias G, Kitas GD, Kollias G, Sfikakis PP. The second decade of anti-TNF a therapy in clinical practice: new lessons and future directions in the COVID-19 era. Rheumatol Int 2022;42:1493-1511. https://doi.org/10.1007/s00296-022-05136-x
  • 6. Aparicio M, Guillén Astete CA, López Medina C, Sastre C, Rodríguez Martínez FJ. Evidence for the use of secukinumab in patients with radiographic and non-radiographic axial spondyloarthritis in the last 5 years. Rheumatol Ther 2022;9:73-94. https://doi.org/10.1007/s40744-021-00400-1
  • 7. Sun WT, He YH, Dong MM, et al. The comparative safety of biological treatment in patients with axial spondylarthritis: a meta-analysis of randomized controlled trials with placebo. Eur Rev Med Pharmacol Sci 2020;24:9824-9836. https://doi.org/10.26355/eurrev_202010_23192
  • 8. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984;27:361-368. https://doi.org/10.1002/art.1780270401
  • 9. Rudwaleit M, van der Heijde D, Landewe R, et al. The development of assessment of spondyloarthritis international society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009;68:777-783. https://doi.org/10.1136/ard.2009.108233
  • 10. The guidelines published by the Turkish Ministry of Health’s Scientific Committee. URL: https://covid19.saglik.gov.tr
  • 11. Tahamtan A, Ardebili A. Real-time RT-PCR in COVID-19 detection: issues affecting the results. Expert Rev Mol Diagn 2020;20:453-454. https://doi.org/10.1080/14737159.2020.1757437
  • 12. De Smet K, De Smet D, Ryckaert T, et al. Diagnostic performance of Chest CT for SARS-CoV-2 infection in individuals with or without COVID-19 symptoms. Radiology 2020;298:30-37. https://doi.org/10.1148/radiol.2020202708
  • 13. Raiker R, Pakhchanian H, Kavadichanda C, Gupta L, Kardes S, Ahmed S. Axial spondyloarthritis may protect against poor outcomes in COVID 19: propensity score-matched analysis of 9766 patients from a nationwide multi centric research network. Clin Rheumatol 2022;41:721-730. https://doi.org/10.1007/s10067-021-05979-y
  • 14. Rosenbaum JT, Weisman MH, Hamilton H, et al. The interplay between COVID-19 and spondyloarthritis or its treatment. J Rheumatol 2022;49:225-229. https://doi.org/10.3899/jrheum.210742
  • 15. Türk SM, Öztürk Z, Karataş D, Erkorkmaz Ü, Gönüllü E. Evaluation of the frequency and intensity of COVID-19 in patients with ankylosing spondylitis under anti-TNF therapy. Turk J Med Sci 2022;52:522-523. https://doi.org/10.55730/1300-0144.5341
  • 16. Santos CS, Férnandez XC, Moriano Morales C, et al. Biological agents for rheumatic diseases in the outbreak of COVID-19: friend or foe? RMD Open 2021;7:e001439. https://doi.org/10.1136/rmdopen-2020-001439
  • 17. Gianfrancesco M, Hyrich KL, Al Adely S, et al. Characteristics associated with hospitalization for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020;79:859-866. https://doi.org/10.1136/annrheumdis-2020-217871
  • 18. Pehlivan Ö, Aydın T. Clinical outcomes of patients with COVID-19 and inflammatory rheumatic diseases receiving biological/targeted therapy. Ann Saudi Med 2022;42:155-164. https://doi.org/10.5144/0256-4947.2022.155
  • 19. Favalli EG, Monti S, Ingegnoli F, Balduzzi S, Caporali R, Montecucco C. Incidence of COVID-19 in patients with rheumatic diseases treated with targeted immunosuppressive drugs: what can we learn from observational data? Arthritis Rheumatol 2020;72:1600-1606. https://doi.org/10.1002/art.41388
  • 20. Wang Q, Liu J, Shao R, Han X, Su C, Lu W. Risk and clinical outcomes of COVID 19 in patients with rheumatic diseases compared with the general population: a systematic review and meta analysis. Rheumatol Int 2021;41:851-861. https://doi.org/10.1007/s00296-021-04803-9
  • 21. Hasseli R, Mueller Ladner U, Hoyer BF, et al. Older age, comorbidity, glucocorticoid use, and disease activity are risk factors for COVID-19 hospitalization in patients with inflammatory rheumatic and musculoskeletal diseases. RMD Open 2021;7:e001464.
  • 22. Eder L, Croxford R, Drucker AM, et al. COVID-19 hospitalizations, intensive care unit stays, ventilation, and death among patients with immune-mediated inflammatory diseases compared to controls. J Rheumatol 2022;49:523-530. https://doi.org/10.3899/jrheum.211012
  • 23. Haberman RH, Castillo R, Chen A, et al. COVID-19 in patients with inflammatory arthritis: a prospective study on the effects of comorbidities and disease-modifying antirheumatic drugs on clinical outcomes. Arthritis Rheumatol 2020;72:1981-1989. https://doi.org/10.1002/art.41456
  • 24. Izadi Z, Gianfrancesco MA, Aguirre A, et al. Development of a prediction model for COVID-19 acute respiratory distress syndrome in patients with rheumatic diseases: results from the global rheumatology alliance registry. ACR Open Rheumatol 2022;4:872-882. https://doi.org/10.1002/acr2.11481
  • 25. Gallo Marin B, Aghagoli G, Lavine K, et al. Predictors of COVID-19 severity: a literature review. Rev Med Virol 2021;31:1-10. https://doi.org/10.1002/rmv.2146
  • 26. Pablos JL, Galindo M, Carmona L, et al. Clinical outcomes of hospitalized patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study. Ann Rheum Dis 2020;79:1544-1549. https://doi.org/10.1136/annrheumdis-2020-218296
  • 27. Robinson PC, Richards D, Tanner HL, Feldmann M. Accumulating evidence suggests anti-TNF therapy needs to be given trial priority in COVID-19 treatment. Lancet Rheumatol 2020;2:653-655. https://doi.org/10.1016/S2665-9913(20)30309-X
  • 28. Fara A, Mitrev Z, Rosalia RA, Assas BM. Cytokine storm and COVID-19: a chronicle of pro-inflammatory cytokines. Open Biol 2020;10:200160. https://doi.org/10.1098/rsob.200160
  • 29. Bachiller Corral J, Boteanu A, Garcia Villanueva MJ, et al. Risk of severe COVID-19 infection in patients with inflammatory rheumatic diseases. J Rheumatol 2021;48:1098-1102. https://doi.org/10.3899/jrheum.200755
  • 30. Ortolan A, Lorenzin M, Cosma C, et al. SARS-CoV-2 infection in spondyloarthritis patients treated with biotechnological drugs: a study on serology. Front Immunol 2021;12:682850. https://doi.org/10.3389/fimmu.2021.682850

Factors associated with frequency and severity of COVID-19 in patients with axial spondyloarthritis

Year 2023, Volume: 16 Issue: 3, 404 - 411, 01.07.2023
https://doi.org/10.31362/patd.1223660

Abstract

Purpose: The severe course of COVID-19 in individuals with chronic diseases has led to concerns in managing rheumatic diseases during the pandemic; therefore, we aimed to define the factors associated with the frequency and severity of COVID-19 in patients with axial spondyloarthritis (axSpa) in this study.
Materials and methods: Patients with axSpa who were followed up in three tertiary hospitals and used their treatment regularly for at least six months were included. We assessed the relationship between axSpa-associated variables such as disease duration time, radiological severity, treatment and COVID-19 outcomes.
Results: A total of 833 patients with a mean disease duration of 109 months were analyzed; 64.5% of them had ankylosing spondylitis, 35.5% had non-radiographic axSpa, and 59.4% of patients were treated with a biologic agent. The frequency of COVID-19 was 23% (n:192); only five patients (0.5%) had a history of intensive care unit. Advanced age, hypertension (HT), and diabetes mellitus (DM) were found to be significantly more common in those with involvement in high-resolution computed tomography (HRCT) (p:0.02, p:0.01, and p<0.001). In hospitalized individuals, female gender, HT, DM, and disease lasting longer than 10 years were significantly higher (p:0.03, p:0.011, p<0.001, and p:0.014). Only DM was found as an independent risk factor for both pulmonary involvement in HRCT (p:0.029) and hospitalization (p:0.001).
Conclusion: We conducted our study with a homogenous study population and our results suggested that biological agents did not affect poor COVID-19 outcomes; only DM was associated with a more severe COVID-19 course in patients with axSpa.

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References

  • 1. World Health Organization (WHO) https://www.who.int (World Health Organization official website)
  • 2. Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet 2017;390:73-84. https://doi.org/10.1016/S0140-6736(16)31591-4
  • 3. Lopez Medina C, Molto A. Update on the epidemiology, risk factors, and disease outcomes of axial spondyloarthritis. Best Pract Res Clin Rheumatol 2018;32:241-253. https://doi.org/10.1016/j.berh.2018.10.006
  • 4. Van der Heijde D, Ramiro S, Landewé R, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 2017;76:978-991. https://doi.org/10.1136/annrheumdis-2016-210770
  • 5. Evangelatos G, Bamias G, Kitas GD, Kollias G, Sfikakis PP. The second decade of anti-TNF a therapy in clinical practice: new lessons and future directions in the COVID-19 era. Rheumatol Int 2022;42:1493-1511. https://doi.org/10.1007/s00296-022-05136-x
  • 6. Aparicio M, Guillén Astete CA, López Medina C, Sastre C, Rodríguez Martínez FJ. Evidence for the use of secukinumab in patients with radiographic and non-radiographic axial spondyloarthritis in the last 5 years. Rheumatol Ther 2022;9:73-94. https://doi.org/10.1007/s40744-021-00400-1
  • 7. Sun WT, He YH, Dong MM, et al. The comparative safety of biological treatment in patients with axial spondylarthritis: a meta-analysis of randomized controlled trials with placebo. Eur Rev Med Pharmacol Sci 2020;24:9824-9836. https://doi.org/10.26355/eurrev_202010_23192
  • 8. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984;27:361-368. https://doi.org/10.1002/art.1780270401
  • 9. Rudwaleit M, van der Heijde D, Landewe R, et al. The development of assessment of spondyloarthritis international society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009;68:777-783. https://doi.org/10.1136/ard.2009.108233
  • 10. The guidelines published by the Turkish Ministry of Health’s Scientific Committee. URL: https://covid19.saglik.gov.tr
  • 11. Tahamtan A, Ardebili A. Real-time RT-PCR in COVID-19 detection: issues affecting the results. Expert Rev Mol Diagn 2020;20:453-454. https://doi.org/10.1080/14737159.2020.1757437
  • 12. De Smet K, De Smet D, Ryckaert T, et al. Diagnostic performance of Chest CT for SARS-CoV-2 infection in individuals with or without COVID-19 symptoms. Radiology 2020;298:30-37. https://doi.org/10.1148/radiol.2020202708
  • 13. Raiker R, Pakhchanian H, Kavadichanda C, Gupta L, Kardes S, Ahmed S. Axial spondyloarthritis may protect against poor outcomes in COVID 19: propensity score-matched analysis of 9766 patients from a nationwide multi centric research network. Clin Rheumatol 2022;41:721-730. https://doi.org/10.1007/s10067-021-05979-y
  • 14. Rosenbaum JT, Weisman MH, Hamilton H, et al. The interplay between COVID-19 and spondyloarthritis or its treatment. J Rheumatol 2022;49:225-229. https://doi.org/10.3899/jrheum.210742
  • 15. Türk SM, Öztürk Z, Karataş D, Erkorkmaz Ü, Gönüllü E. Evaluation of the frequency and intensity of COVID-19 in patients with ankylosing spondylitis under anti-TNF therapy. Turk J Med Sci 2022;52:522-523. https://doi.org/10.55730/1300-0144.5341
  • 16. Santos CS, Férnandez XC, Moriano Morales C, et al. Biological agents for rheumatic diseases in the outbreak of COVID-19: friend or foe? RMD Open 2021;7:e001439. https://doi.org/10.1136/rmdopen-2020-001439
  • 17. Gianfrancesco M, Hyrich KL, Al Adely S, et al. Characteristics associated with hospitalization for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020;79:859-866. https://doi.org/10.1136/annrheumdis-2020-217871
  • 18. Pehlivan Ö, Aydın T. Clinical outcomes of patients with COVID-19 and inflammatory rheumatic diseases receiving biological/targeted therapy. Ann Saudi Med 2022;42:155-164. https://doi.org/10.5144/0256-4947.2022.155
  • 19. Favalli EG, Monti S, Ingegnoli F, Balduzzi S, Caporali R, Montecucco C. Incidence of COVID-19 in patients with rheumatic diseases treated with targeted immunosuppressive drugs: what can we learn from observational data? Arthritis Rheumatol 2020;72:1600-1606. https://doi.org/10.1002/art.41388
  • 20. Wang Q, Liu J, Shao R, Han X, Su C, Lu W. Risk and clinical outcomes of COVID 19 in patients with rheumatic diseases compared with the general population: a systematic review and meta analysis. Rheumatol Int 2021;41:851-861. https://doi.org/10.1007/s00296-021-04803-9
  • 21. Hasseli R, Mueller Ladner U, Hoyer BF, et al. Older age, comorbidity, glucocorticoid use, and disease activity are risk factors for COVID-19 hospitalization in patients with inflammatory rheumatic and musculoskeletal diseases. RMD Open 2021;7:e001464.
  • 22. Eder L, Croxford R, Drucker AM, et al. COVID-19 hospitalizations, intensive care unit stays, ventilation, and death among patients with immune-mediated inflammatory diseases compared to controls. J Rheumatol 2022;49:523-530. https://doi.org/10.3899/jrheum.211012
  • 23. Haberman RH, Castillo R, Chen A, et al. COVID-19 in patients with inflammatory arthritis: a prospective study on the effects of comorbidities and disease-modifying antirheumatic drugs on clinical outcomes. Arthritis Rheumatol 2020;72:1981-1989. https://doi.org/10.1002/art.41456
  • 24. Izadi Z, Gianfrancesco MA, Aguirre A, et al. Development of a prediction model for COVID-19 acute respiratory distress syndrome in patients with rheumatic diseases: results from the global rheumatology alliance registry. ACR Open Rheumatol 2022;4:872-882. https://doi.org/10.1002/acr2.11481
  • 25. Gallo Marin B, Aghagoli G, Lavine K, et al. Predictors of COVID-19 severity: a literature review. Rev Med Virol 2021;31:1-10. https://doi.org/10.1002/rmv.2146
  • 26. Pablos JL, Galindo M, Carmona L, et al. Clinical outcomes of hospitalized patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study. Ann Rheum Dis 2020;79:1544-1549. https://doi.org/10.1136/annrheumdis-2020-218296
  • 27. Robinson PC, Richards D, Tanner HL, Feldmann M. Accumulating evidence suggests anti-TNF therapy needs to be given trial priority in COVID-19 treatment. Lancet Rheumatol 2020;2:653-655. https://doi.org/10.1016/S2665-9913(20)30309-X
  • 28. Fara A, Mitrev Z, Rosalia RA, Assas BM. Cytokine storm and COVID-19: a chronicle of pro-inflammatory cytokines. Open Biol 2020;10:200160. https://doi.org/10.1098/rsob.200160
  • 29. Bachiller Corral J, Boteanu A, Garcia Villanueva MJ, et al. Risk of severe COVID-19 infection in patients with inflammatory rheumatic diseases. J Rheumatol 2021;48:1098-1102. https://doi.org/10.3899/jrheum.200755
  • 30. Ortolan A, Lorenzin M, Cosma C, et al. SARS-CoV-2 infection in spondyloarthritis patients treated with biotechnological drugs: a study on serology. Front Immunol 2021;12:682850. https://doi.org/10.3389/fimmu.2021.682850
There are 30 citations in total.

Details

Primary Language English
Subjects Rheumatology and Arthritis
Journal Section Research Article
Authors

Mete Pekdiker 0000-0003-3089-1564

Mete Kara 0000-0003-4690-610X

Emrah Koç 0000-0002-7889-3051

Gezmiş Kimyon 0000-0003-3775-639X

Project Number Yok
Early Pub Date June 23, 2023
Publication Date July 1, 2023
Submission Date December 23, 2022
Acceptance Date March 22, 2023
Published in Issue Year 2023 Volume: 16 Issue: 3

Cite

AMA Pekdiker M, Kara M, Koç E, Kimyon G. Factors associated with frequency and severity of COVID-19 in patients with axial spondyloarthritis. Pam Med J. July 2023;16(3):404-411. doi:10.31362/patd.1223660

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