Background: Reports describing post-vaccine autoimmune phenomena, in previously healthy individuals, increased the concerns regarding the risk of disease flare-ups in patients with immune diseases. We aimed to assess the potential risk of disease flare-up, after receiving the COVID-19 (Coronavirus disease 2019) vaccine, during a follow-up period of 6 months. Methods: We performed a prospective cohort study, enrolling the patients with autoimmune- and immune-mediated diseases who voluntarily completed our questionnaire, both online and during hospital evaluations. Based on their decision to receive the vaccine, the patients were divided into two groups (vaccinated and non-vaccinated). Participants who chose not to receive the vaccine served as a control group in terms of flare-ups. Results: A total of 623 patients, 416 vaccinated and 207 non-vaccinated, were included in the study during hospital evaluations (222/623) and after online (401/623) enrolment. There was no difference concerning the risk of flare-up between vaccinated and non-vaccinated patients (1.16, versus 1.72 flare-ups/100 patients-months, p = 0.245). The flare-ups were associated with having more than one immune disease, and with a previous flare-up during the past year. Conclusions: We did not find an increased risk of flare-up following COVID-19 vaccination in patients with autoimmune-/immune-mediated diseases, after a median follow-up of 5.9 months. According to our results, there should not be an obvious reason for vaccine hesitancy among this category of patients.
Background: During the COVID-19 pandemic, patients with immune diseases are a vulnerable population. We aimed to evaluate their access to medical care, as well as their awareness and willingness to obtain the vaccine after a year of the SARS-CoV-2 pandemic. Methods: A cross-sectional, multicenter study was conducted on a questionnaire basis, handled both online as well as in person. Results: 651 patients with autoimmune or immune mediated diseases were enrolled. More than half (339/641 [53%]) reported difficulties in obtaining medical care throughout the pandemic and 135/651 ([21%]) of them were confirmed with COVID-19; 442/651, ([68%]) expressed their willingness to be vaccinated against SARS-CoV-2. The factors associated with an increased probability of vaccination were the male gender (OR = 2.01, CI95% 1.2–3.7, p = 0.001), the patient’s opinion that she/he was well informed (OR = 3.2, CI 95% 2.1–6.01, p < 0.001), physician’s advice (OR = 2.1, CI 95% 1.3–3.5, p < 0.001), and flu vaccination in the past (OR = 1.5, CI 95% 1.1–2.3, p < 0.001), while those associated with a decreased probability of vaccination were COVID-19 disease in the past medical history (OR = 0.7, CI 95% 0.3-0.95, p = 0.02), and the opinion that patients with autoimmune diseases are at increased risk for adverse reactions (OR = 0.7, CI95% 0.53–0.89, p = 0.001). Conclusions: Given the fact that considering themselves informed regarding vaccination is the most important factor in order to be immunized against SARS-CoV-2, effective information campaigns would substantially increase willingness.
Eosinophilic fasciitis (EF), defined as diffuse fasciitis with eosinophilia by Shulman in 1974, is a disease with unknown etiology and whose pathogenesis is still being researched. The diagnosis is based on the clinical aspects (skin induration with an “orange peel” appearance), the lab results (eosinophilia, increased inflammatory markers), the skin biopsy with the pathognomonic histopathological result, as well as the typical MRI changes. The treatment includes glucocorticoids and immunosuppressive drugs. Due to severe refractory cases, the treatment remains a challenge. EF is still a disease with potential for further research.
We sought to determine the prevalence of antiphospholipid antibodies (aPLs) and their correlation with COVID-19 severity (in terms of clinical and laboratory parameters) in patients without thrombotic events during the early phase of infection. This was a cross-sectional study with the inclusion of hospitalized COVID-19 patients from a single department during the COVID-19 pandemic (April 2020–May 2021). Previous known immune disease or thrombophilia along with long-term anticoagulation and patients with overt arterial or venous thrombosis during SARS-CoV-2 infection were excluded. In all cases, data on four criteria for aPL were collected, namely lupus anticoagulant (LA), IgM and IgG anticardiolipin antibodies (aCL), as well as IgG anti-β2 glycoprotein I antibodies (aβ2GPI). One hundred and seventy-nine COVID-19 patients were included, with a mean age of 59.6 (14.5) years and a sex ratio of 0.8 male: female. LA was positive in 41.9%, while it was strongly positive in 4.5%; aCL IgM was found in 9.5%, aCL IgG in 4.5%, and aβ2GPI IgG in 1.7% of the sera tested. Clinical correlation: LA was more frequently expressed in severe COVID-19 cases than in moderate or mild cases (p = 0.027). Laboratory correlation: In univariate analysis, LA levels were correlated with D-dimer (p = 0.016), aPTT (p = 0.001), ferritin (p = 0.012), C-reactive protein (CRP) (p = 0.027), lymphocyte (p = 0.040), and platelet (p < 0.001) counts. However, in the multivariate analysis, only the CRP levels correlated with LA positivity: OR (95% CI) 1.008 (1.001–1.016), p = 0.042. LA was the most common aPL identified in the acute phase of COVID-19 and was correlated with infection severity in patients without overt thrombosis.
BackgroundCalcinosis cutis (CC) is a rare disorder characterized by the abnormal deposition of calcium salts in the subcutaneous tissues of patients with normal calcium metabolism. Dystrophic calcinosis is a common and potentially debilitating manifestation in systemic sclerosis (SSc) patients. The CC was described to appear more frequently in newly diagnosed SSc patients with Raynaud’s phenomenon, with ischemic ulcer or telangiectasia and in areas related to repeated trauma, but current data remains inconclusive 1,2.ObjectivesOur objective was to analyze the prevalence, clinical features, and biological associations of CC in SSc patients.MethodsA retrospective analysis of patients hospitalized in the Rheumatology Department of the Colentina Clinical Hospital, Bucharest, Romania. Data of the patients fulfilling the 2013 American College of Rheumatology/ European League Against Rheumatism (ACR/EULAR) SSc classification criteria were collected. In all patients, clinical examination, including evaluation of the cutaneous involvement by the modified Rodnan skin score (mRSS) was performed. A CC diagnosis was sustained by radiographic and/ or ultrasound imaging.Results44 SSc patients were included with female predominance (39 patients - 88.6%), and with mean (SD) age 58.8±11.3 years old, CC was found in 11(25.0%) of these patients, all feminine gender. Elbow (36.4%), hands and forearms (27.3%) were the most frequent sites affected by CC.Overall, CC was not related to the SSc subtype, when comparing limited (lc) with diffuse cutaneous (dc) involvement (27.3% vs. 48.5%, p=0.219). However, patients with CC had more often lc SSc, 72.7% vs. 27.3%. Accordingly, SSc patients with CC had a significant lower mRSS score, 6 (1;7) vs. 9 (5; 15.5) points, p=0.001 and more frequently expressed positives anti-centromere antibodies (ACA), 72.7% vs. 57.1%, p=0.036. CC was also found not to be related to sclerodactyly, 54.5% vs. 75.8%, p=0.038. Regarding the nailfold capillaroscopy (NFC) exam, the CC was more often described in patients with late NFC pattern, 45.5% of cases.In SSc patients with CC, there was reported more often intestinal transit disturbances 45.5% vs. 3.0%, p=0.015, even if overall there was no gastrointestinal involvement, 72.7% vs. 63.6%, p=0.582.Regarding inflammation, the level of erythrocyte sedimentation rate (ESR) was lower in patients with CC 18 (13;33) vs. 33 (17.0; 58.5) mm/h, p=0.040, but not the C-reactive protein level 2.4 (1.7; 6.7) vs. 3.3 (1.2; 8.5) mg/L, p=0.866.When comparing SSc patients with or without CC we did not found any significant difference regarding the presence of anti-Scl70 antibodies, p=0.432, rheumatoid factor, p=0.067, lupus anticoagulant or antiphospholipid antibodies, p=0.835. Also, no significant correlations were identified for CC in SSc and the following parameters: smoking, p=0.162, obesity, p=0.812, hypertension, p=0.371, diabetes, p=0.403, Raynaud phenomenon, p=0.539, telangiectasia, p=0.28, pulmonary hypertension, p=0.777, lung interstitial disease, p=0.315, digital ulcers, p=0.723, or digital starry scars, p=0.223.ConclusionThe CC prevalence in SSc consecutive patients was 25.0%, more frequently with elbow localization. We’ve also found more frequent CC in patients with positive ACA serology and defined relations with many other SSc-related parameters.References[1]Pearson DR, et al. Systemic sclerosis: Current concepts of skin and systemic manifestations. Clin Dermatol. 2018 Jul-Aug;36(4):459-474.[2]Bartoli F, et al. Calcinosis in systemic sclerosis: subsets, distribution and complications. Rheumatology (Oxford). 2016 Sep;55(9):1610-4.Disclosure of InterestsNone declared
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