Characteristics and evolution of 38 patients with rheumatic diseases and COVID-19 under DMARD therapy
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LETTERS OF BIOMEDICAL AND CLINICAL RESEARCH
Characteristics and evolution of 38 patients with rheumatic diseases and COVID-19 under DMARD therapy Dionicio Ángel Galarza-Delgado 1 & Griselda Serna-Peña 1 & Jesús Eduardo Compeán-Villegas 1 & Jesus Alberto Cardenas-de la Garza 1 & Rita Angélica Pineda-Sic 1 & Iris Jazmín Colunga-Pedraza 1 & David Vega-Morales 1 & Lorena Pérez-Barbosa 1 & Cassandra Michelle Skinner-Taylor 1 & Diana Elsa Flores-Alvarado 1 Received: 22 September 2020 / Revised: 11 November 2020 / Accepted: 15 November 2020 # International League of Associations for Rheumatology (ILAR) 2020
To date, we still have questions about the outcomes of patients with rheumatic inflammatory diseases who develop COVID19 on disease-modifying antirheumatic drugs (DMARDs) therapy; consequently, efforts to reach conclusions continue. According to the review by Ladani et al. [1], autoimmune rheumatic diseases have not been identified as a risk factor for COVID-19. In like manner, it is expected that some patients with poorly controlled disease may be at increased risk of contracting SARS-CoV-2 infection; hence, they must be encouraged to continue their usual medication. On the other hand, although some therapies used by rheumatologists could potentially confer protection or even limit the serious manifestations of SARS-CoV-2, there is insufficient evidence to establish their safety while the patient is infected [1]. In this study, we report the characteristics and evolution of 38 patients with autoimmune rheumatic diseases from an outpatient rheumatology clinic in Monterrey, Mexico, who developed SARS-CoV-2 infection while on immunosuppressive therapy during July and August 2020. Most of the patients were female (n = 33, 86.84%) and the mean age was 43.47 years (SD 14.58). The most frequent diagnosis was rheumatoid arthritis (RA) with 15 patients (39.47%), followed by systemic lupus erythematosus (SLE) with 13 (34.21%), spondylarthritis with 4 (8.5%), psoriatic arthritis with 3 (6.9%), and systemic sclerosis, Sjogren’s syndrome, and systemic vasculitis with one patient each. Diagnosis of COVID-19 was confirmed by reverse
* Dionicio Ángel Galarza-Delgado [email protected] 1
Servicio de Reumatología, Hospital Universitario, Universidad Autónoma de Nuevo León, Av. Gonzalitos No. 235 Nte. Col. Mitras Centro, C.P. 64460 Monterrey, NL, México
transcription polymerase chain reaction (RT-PCR) in all patients. Regarding immunosuppressive therapy, 29 patients were treated with csDMARDs (76.31%), eleven with bDMARDs (28.94%), and 3 (7.89%) with tsDMARDs (Table 1). Most of the patients developed mild COVID-19, defined as no requirement of hospitalization or oxygen (n = 31, 81.57%); five (13.15%) developed moderate disease (need of hospitalization) of which 3 (7.89%) of them required supplemental oxygen; and two patients (5.26%) had severe COVID-19 (mechanical ventilation or death). None of the patients was treated with antiviral therapy. Among the treatments widely used in Mexico, seventeen patients (44.73%) were treated
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