Aksiyel spondiloartritli hastalarda COVİD-19 sıklığı ve ilişkili faktörler

Yıl 2023, Cilt: 16 Sayı: 3, 404 - 411, 01.07.2023

Mete Pekdiker , Mete Kara , Emrah Koç , Gezmiş Kimyon

https://doi.org/10.31362/patd.1223660

Öz

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.

Anahtar Kelimeler

COVID-19, aksiyel spondiloartrit, ankilozan spondilit, radyografik olmayan aksiyel spondiloartrit, şeker hastalığı

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

Yok

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

Öz

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.

Anahtar Kelimeler

COVID-19, axial spondyloarthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, diabetes mellitus

Proje Numarası

Yok

Kaynakça

• 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