BackgroundThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) raised many questions and concerns about the safety of different immunosuppressive agents in patients (pts) with rheumatic diseases during the pandemic. There is some data that anti-B-cell depletion strategies could lead to more severe disease course. Rituximab (RTM) is one of the most effective, safe and well tolerated agents in IgG4-related disease (IgG4-RD) treatment. Information about the course of COVID-19 in pts with IgG4-RD is lacking.ObjectivesTo examine clinical course of COVID-19 in pts with IgG4-RD treated with anti-CD20 monoclonal antibody (RTM).MethodsSingle center observational study. We searched in our clinical base from 2019 to 2021 years for pts with IgG4-RD, treated with RTM within this period. Diagnosis of IgG4-RD was based on comprehensive diagnostic criteria (H. Umehara, 2011). COVID-19 infection was registered when PCR test results were positive. RTM was administered in two 1000 mg infusions 14 days apart for the 1st course, then 500 mg every 6 months. We used mean ± standard deviation and median values with interquartile range of 25 - 75 percentile to characterize quantitative data.ResultsFifteen pts, 6 women and 9 men, mean age 53.2 ± 12 years, receiving RTM monotherapy were included. The majority of patients (80%) had multiple organ involvement, mean number 2,3 (from 1 to 5): dacryadenitis – 11 pts, sialadenitis – 10 pts, AIP 1 – 4 pts, lung disease – 3 pts, sclerosing cholangiris – 2 pts, kidney disease – 2 pts, retroperitoneal fibrosis – 1 pt, aortitis – 1 pt, prostatitis – 1 pt. Median duration of IgG4-RD before COVID-19 onset was 48 [27;72] months, median duration of RTM treatment was 22 [11,5;30,5] months and median time from the last dose of RTM was 2 [1;4,5] months. Three pts had arterial hypertension or coronary heart disease anamnesis, 4 pts had asthma, 2 pts were overweight and 1 had class 3 obesity. No pts were vaccinated against SARS-CoV-2. Six patients (40%) required hospitalization and 4 of them received IL-6 inhibitors, only 1 required mechanical lung ventilation, 6 patients (40%) had only minor symptoms and didn’t require any specific treatment, glucocorticoids were administered to 8 patients. All patients, except one, were older than 50, but they didn’t have severe comorbidities. One patient, a 46 year-old man with a long anamnesis of IgG4-related dacryo- and sialadenitis, bronchial asthma, arterial hypertension class 3 and class 3 obesity, died. Due to small number of studied pts no statistical correlations could be established.ConclusionThe proportion of hospitalized pts with IgG4-RD and RTM treatment was surprisingly high. The worst course was in patient with severe comorbidity. It appears that RTM can have negative impact on susceptibility to COVID-19 and its disease course.Disclosure of InterestsNone declared
BackgroundApart from anti-Ro and/or anti-La positive primary Sjögren’s syndrome (pSS), there is a unique subtype of pSS with anticentromere antibodies (ACA). At the present time salivary gland ultrasonography (SGUS) is widely used to assess the structure of the salivary glands in pSS, but there are few publications about SGUS changes in ACA-positive patients [1].ObjectivesTo investigate SGUS changes in ACA (ACA+) positive pSS patients and compare with ACA-negative (ACA–).MethodsWe examined 141 patients with pSS, including 103 ACA– patients (pSS-ACA–) with the mean age 49,8 ± 14,1 years and 38 ACA+ positive (pSS-ACA+) with the mean age 59,1 ± 10,2 years. All patients underwent standard examination for the diagnosis of pSS (stomatological, ophthalmological, immunological), and SGUS performed using GE LOGIQ 9 of two parotid and two submandibular glands. Ultrasound images were evaluated with the OMERACT SGUS scoring system (SGUS SS) from grades 0 to 3 [2]. Statistical analyses (chi-squared test, p <0.05) were performed using STATISTICA version 12.ResultsCharacteristics of patients with pSS-ACA+ and pSS-ACA– are presented in Table 1.Table 1.ParametersACA–ACA+N%N%Oral dryness8683,53694,7Ocular dryness7673,83078,9Enlargement of parotid salivary glands3634,9718,4Recurrent parotitis2322,3760,5ANA ≥1:32010310038100Stimulated saliva flow test < 2.5 ml/5 min6563,13078,9Sialectasia on parotid sialography10310038100Stimulated Schirmer’s test <10 mm/5 min6765,02668,4Tear breakup time <10 seconds5957,32052,6Focus score ≥ 1foci/4 mm29491,312/1392,3MALT-lymphomas87,7513,1Characteristics of SGUS SS in pSS-ACA+ and pSS-ACA– are shown in Figure 1.Figure 1.We did not find significant differences when comparing SGUS SS in patients with pSS-ACA+ and pSS-ACA–.ConclusionWe did not find significant differences in SGUS and SGUS SS in patients with pSS-ACA+ and pSS-ACA–.ReferencesFURS-2022-003[1]Min HK, Kim SH, Park Y, et al. Ultrasonographic characteristics of major salivary glands in anti-centromere antibody-positive primary Sjögren’s syndrome. PLoS One. 2021;16(11):e0259519. Published 2021 Nov 3. doi:10.1371/journal.pone.0259519[2]Jousse-Joulin, Sandrine et al. “Video clip assessment of a salivary gland ultrasound scoring system in Sjögren’s syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise.” Annals of the rheumatic diseases vol. 78,7 (2019): 967-973. https://doi:10.1136/annrheumdis-2019-215024Disclosure of InterestsNone declared
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