Prevalence Of Covid-19 Among Patients With Rheumatic Diseases: An Observational Survey During The Two Waves In Italy

Background: The new coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) is a source of concern for the management of patients suffering from rheumatic and musculoskeletal diseases (RMDs) treated with immunomodulatory therapies (1). Objectives: We aimed to analyze the prevalence of SARS-CoV-2 infection in patients with RMDs living in Italy. Methods: During the first wave (March-May 2020) and during the second wave (October-December 2020) of COVID-19, we conducted a survey to investigate the incidence of SARS-CoV-2 infection in patients with RMDs followed at the Rheumatology Unit of the University of Campania, Italy. The demographic data, medication use, the frequency of respiratory symptoms and the incidence of COVID-19 confirmed by nasopharyngeal swab were collected with questionnaires administered by phone. The prevalence of COVID-19 of our cohort was compared to that of the general population (2). Results: During the first wave, we collected data from 900 patients with RMDs (Table 1): 320 patients with rheumatoid arthritis (RA), 295 patients with spondyloarthropathies (SpA), 283 patients with systemic lupus erythematosus (SLE), 2 patients with vasculitis. 546 (60%) were treated with bDMARD/tsDMARDs. Overall, a total of 11/900 (1%) cases were tested for COVID-19 due to compatible symptoms. 2 (0.2%) adult patients treated with bDMARDs were registered as swab test positive by PCR for COVID-19. 2 patients without confirmed COVID-19 developed pneumonia that required admission to hospital. No deaths occurred among the patients with confirmed COVID-19. During the second wave, data were collected from 470 patients who accepted to take part of the study (Table 1). 49 presented with symptoms that were compatible with COVID-19. 139 patients were tested whereas 30 patients (6%) had a swab confirmation of SARS-CoV-2 infection. Among them, 16 (53%) were treated with bDMARDs and a patient was treated with tofacitinib. we found no increase in COVID-19 prevalence in patients treated with bDMARD/tsDMARDs (p>0.05). A patient with SLE developed pneumonia that required admission to hospital and died. Lacking distinct prevalence data between first and second waves, we found no differences in total COVID-19 prevalence between general population living in Campania (215.752/5.802.000; 3.7%) and patients with RMDs (32/900; 3.5%). However, we had a significant increase in COVID-19 prevalence in our cohort during the second wave compared to the first. Nevertheless, no increase in mortality or hospitalization was recorded, confirming the safety of immunomodulatory therapies in patients with RMDs. Conclusion: In this cohort of patients with RMDs in a geographical region with a high prevalence of COVID-19, the risk of SARS-CoV-2 infection does not appear different from that observed in the general population. References: [1]Wang L., Wang Y., Ye D. Int J Antimicrob Agents. 2020:105948. [2]http://www.protezionecivile.gov.it/ (accessed 28.01.21) Table 1. Demographics and clinical characteristics of 900 patients with rheumatic diseases during the COVID-19 Pandemic. First wave Second wave Women, n 660 (73 %) 366(77%) Age, years, median (range) 56 (54-57) 53 (51-55) Rheumatoid Arthritis 320 (35.5%) 143 (30%) Spondyloarthritis 295 (32%) 110 (23%) Systemic Lupus Erythematosus 283 (31%) 217 (46 %) Vasculitis 2 (0.2%) 1 (0.2%) Prior ILD 56 (6%) 22 (4.6%) Smokers 220 (24%) 118 (25%) Hydroxychloroquine 215 (23%) 155 (32%) Steroids 337 (37%) 194 (41%) Prednisone equivalent dose, median (range) 5 (0-75) 5 (0-50) bDMARD/tsDMARDs 546 (60%) 247 (52%) csDMARDS 387 (43%) 185 (39%) Angiotensin-converting enzyme (ACE) inhibitors 178 (19.8%) 101 (21%) Angiotensin II receptor blockers(ARBs) 153 (17%) 61 (13%) Fever 64 (7%) 30 (6.3%) Cough 83 (9%) 36 (7%) Shortness of breath 34 (3%) 15 (3%) Sore throat 32 (3%) 11 (2.3%) Rhinorrhoea 36 (3%) 11 (2.3%) Headache 5 (0.5%) 2 (0.4%) Anosmia 10 (1%) 24 (5%) Myalgia 2 (0.2%) 1 (0.2%) Gastrointestinal symptoms 24 (2.6%) 3 (0.6%) Pneumonia 2 (0.2%) 2 (0.4%) Admission to hospital 2 (0.2%) 9 (1.9%) Swab confirmation of SARS-CoV-2 infection 2 30 Disclosure of Interests: None declared.