Objective To describe clinical characteristics of patients with rheumatic and musculoskeletal diseases (RMDs) and immunosuppressive therapies with Coronavirus disease 2019 (COVID-19) at an academic rheumatology center in Madrid and to identify baseline variables associated with a severe infection requiring hospitalization. Methods We identified SARS-CoV-2 positive cases by polymerase chain reaction performed at our center within an updated RMDs database in our clinic. Additional RMDs patients were identified when they contacted the clinic because of a positive infection. Data extraction included diagnosis, demographics, immunosuppressive treatment, comorbidities, and laboratory tests. Comparisons between patients with or without hospitalization were performed. Multivariate logistic regression was used to analyze associations between baseline variables and need for hospitalization. Results A total of 62 patients with COVID-19 and underlying RMDs were identified by April 24, 2020. Median age was 60.9 years, and 42% men. Forty-two patients required hospitalization; these were more frequently men, older and with comorbidities. There were no statistically significant between-group differences for rheumatologic diagnosis and for baseline use of immunosuppressive therapy except for glucocorticoids that were more frequent in hospitalized patients. Total deaths were 10 (16%) patients. In multivariate analysis, male sex (odds ratio [OR], 8.63; p = 0.018), previous lung disease (OR, 27.47; p = 0.042), and glucocorticoids use (> 5 mg/day) (OR, 9.95; p = 0.019) were significantly associated to hospitalization. Conclusion Neither specific RMD diagnoses or exposures to DMARDs were associated with increased odds of hospitalization. Being male, previous lung disease and exposure to glucocorticoids were associated with higher odds of hospitalization in RMDs patients.

Objective. To our knowledge, the impact of the COVID-19 pandemic on fibromyalgia (FM) patients has not been studied before. FM patients often experience clinical impairment with stress. The aim of this study was to determine whether severity of FM increases because of confinement by the COVID-19 pandemic. Methods. This prospective study includes patients from the Combined Index of Severity of Fibromyalgia (ICAF) cohort who met the 2010 ACR FM criteria. In this cohort, all patients have a periodical evaluation of their quality of life through two questionnaires, the ICAF, which assesses the ability to perform daily living activities, anxiety and depression, and through the Patient Global Impression of Change (PGIC), which assesses overall change after a therapeutical intervention. Pre-and post-confinement measurements were analysed. Inferential statistical analysis and ANOVA for repeated measurements were used. Results. A total of 93 patients received a phone consultation, (95.5% females), mean (SD) age of 48.23 (8.38) years. Four patients were excluded as presenting COVID-19 and 51 (57%) completed the post-confinement ICAF. Following confinement, 25 (49%) patients got worse (group-worse) and 26 (51%) patients experienced no change or improved (group-stable). Comparisons between pre-and post-confinement ICAF did not show significant differences in both groups. Passive coping was significantly different in groupworse in pre-confinement evaluation. In the 80% of patients with passive coping predominance there were no changes in coping strategy. Conclusion. No clinical impairment due to COVID-19 confinement oc-curred. The perceived worsening among FM patients relies primarily on how patients cope with their disease, without a real impact on clinical manifestations.

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Objectives To determine the prevalence and characteristics of post-COVID-19 (PC) in fibromyalgia (FM) patients. Methods Retrospective, multi-centric, observational study, comparing a group of FM patients (FM group) with another group of patients with other rheumatic diseases (RD group). COVID-19 diagnosis was established by positive polymerase chain reaction or antigen during acute infection or by positive antibodies thereafter. We considered PC diagnosis when symptoms remain after COVID-19. We collected the principal characteristics of COVID-19, the severity of fatigue, waking unrefreshed and cognitive impairment, and persistent symptoms. The American College of Rheumatology (ACR) criteria and the Combined Index of Severity in Fibromyalgia (ICAF) were collected in the FM group. Results RD group (n = 56) had more pneumonia (p = 0.001) and hospital admissions (p = 0.002), but the FM group (n = 78) had a higher number of symptoms (p = 0.002). The percentage of patients with PC was similar between groups (FM group 79.5%; RD group 66.1%, p = 0.081). FM group had more PC symptoms (p = 0.001), more impairment after COVID-19 (p = 0.002) and higher severity of fatigue, waking unrefreshed and cognitive impairment (p <  0.0001). Only loss of smell was more frequent in the FM group (p = 0.005). The FM group with PC (n = 29) showed more severity of the Combined Index of Severity in Fibromyalgia (ICAF) total score and physical factor after COVID-19, while emotional, coping factors and the ACR criteria did not change. Conclusions The prevalence of PC in FM patients is similar to RD patients. In FM patients, the presence of PC does not appear to impact the severity of FM.

BackgroundImaging recommendations for primary large vessel vasculitis (LVV) were developed in 2018. Several new studies have emerged since then, and an update of the original statements was required.ObjectivesTo update the recommendations for the use of imaging in LVV.MethodsA systematic literature review update was performed to retrieve new evidence on ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT) and [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) for diagnosis, monitoring and outcome prediction in LVV. The task force consisted of 24 physicians, health professionals and patients from 14 countries.ResultsThree overarching principles and eight recommendations were agreed (Table 1). Compared to the 2018 version, US is now recommended as first line imaging test in all patients with suspected GCA, and axillary arteries should be included in the standard examination. As an alternative to US, cranial and extracranial arteries can be examined by FDG-PET or MRI. For Takayasu arteritis, MRI is the preferred imaging modality; CT or FDG-PET are alternatives. Although imaging is not routinely recommended for follow-up, US, FDG-PET or MRI may be used for assessing vessel abnormalities in LVV patients with suspected relapse, particularly when laboratory markers of inflammation are unreliable. MRA, CTA or US may be used for long-term monitoring of structural damage, particularly at sites of preceding vascular inflammation.ConclusionThe 2023 recommendations provide up-to-date guidance for the role of imaging in the diagnosis and assessment of patients with (suspected) LVV.Table 1.Recommendations for the use of imaging in large vessel vasculitis in clinical practiceOverarching principlesA. In patients with suspected GCA, an early imaging test is recommended to support the clinical diagnosis of GCA, assuming high expertise and prompt availability of the imaging technique. Imaging should not delay initiation of treatment.B. Imaging examination should be done by a trained specialist using appropriate equipment, standardized operational procedures and settings.C. In patients in whom there is a high clinical suspicion of GCA and a positive imaging result, the diagnosis of GCA may be made without an additional test (biopsy or further imaging). In patients with a low clinical probability and a negative imaging result, the diagnosis of GCA can be considered unlikely. In all other situations (including the case of an inconclusive imaging result), additional efforts towards a diagnosis are necessary.Recommendations1. Ultrasound of temporal and axillary arteries should be considered as the first imaging modality to investigate mural inflammatory changes in patients with suspected GCA.2. High resolution MRI or FDG-PET can be used as alternatives to ultrasound for the assessment of cranial arteries in patients with suspected GCA.3. FDG-PET, alternatively MRI or CT, can be used for the detection of mural inflammation or luminal changes of extracranial arteries in patients with suspected GCA.4. In patients with suspected TAK, MRI to investigate mural inflammation or luminal changes should be used as the first imaging test to make a diagnosis of TAK.5. FDG-PET, CT or ultrasound may be used as alternative imaging modalities in patients with suspected TAK. Ultrasound is of limited value for assessment of the thoracic aorta.6. Conventional angiography is not recommended for the diagnosis of GCA or TAK as it has been superseded by the previously mentioned imaging modalities.7. In case of a suspected relapse of GCA or TAK, particularly when laboratory markers of disease activity are unreliable, ultrasound, FDG-PET or alternatively MRI may be considered for the assessment of vessel abnormalities. Imaging is not routinely recommended for patients in clinical and biochemical remission.8. In patients with GCA or TAK, MRA, CTA or ultrasound of extracranial vessels may be used for long-term monitoring of structural damage, particularly at sites of preceding vascular inflammation. The frequency of screening as well as the imaging method applied should be decided on an individual basis.ReferencesNIL.AcknowledgmentsFunding provided by EULAR (Project number: QoC13). We would like to thank Louise Falzon for her help with the literature search strategy. We also thank Lorna Neill, Luca Cimino and Fabrizio Gozzi for their help with the update of the PICO questions.Disclosure of InterestsChristian Dejaco Consultant of: AbbVie, Novartis, Janssen, Sanofi, Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos and Sanofi, Grant/research support from: AbbVie, Sofia Ramiro Consultant of: AbbVie, Eli Lilly, Galapagos, MSD, Novartis, Pfizer, Sanofi, UCB, Speakers bureau: AbbVie, Eli Lilly, Galapagos, MSD, Novartis, Pfizer, Sanofi, UCB, Grant/research support from: AbbVie, Eli Lilly, Galapagos, MSD, Novartis, Pfizer, Sanofi, UCB, Milena Bond Consultant of: AbbVie, Philipp Bosch Speakers bureau: Janssen, Grant/research support from: Pfizer, Cristina Ponte Consultant of: AbbVie, Sanofi, Novartis, Vifor, AstraZeneca, GlaxoSmithKline, and Roche, Speakers bureau: Vifor, AstraZeneca, GlaxoSmithKline, and Roche, Sarah Mackie Consultant of: Roche/Chugai, Sanofi, AbbVie, AstraZeneca, Sanofi, GSK, Sparrow, Speakers bureau: Roche/Chugai, Vifor, Pfizer and Novartis, Torsten Bley Consultant of: BioTel Research, Chugai, Guerbet, Novartis, Roche and Siemens Healthineers, Speakers bureau: BioTel Research, Chugai, Guerbet, Novartis, Roche, Sanofi and Siemens Healthineers, Daniel Blockmans Consultant of: Roche and GSK, Sara Brolin Grant/research support from: Novartis, Ertugrul Cagri Bolek: None declared, Rebecca Cassie: None declared, Maria C. Cid Consultant of: GSK, SCL-Vifor, AbbVie, AstraZeneca and Janssen, Grant/research support from: Kiniksa Pharmaceuticals, Juan Molina Collada Consultant of: Abbvie, Lilly, Janssen, Novartis, Pfizer, UCB, MSD, Speakers bureau: Abbvie, Lilly, Janssen, Novartis, Pfizer, UCB, MSD, Bhaskar Dasgupta Consultant of: Novartis, Abbvie,Roche,Chugai,Sanofi, Grant/research support from: Novartis, Abbvie,Roche,Chugai,Sanofi, Berit Dalsgaard NIelsen Consultant of: Roche and Novartis, Speakers bureau: Roche and Novartis, Eugenio de Miguel Consultant of: Novartis, AbbVie, Pfizer, Janssen, Lilly, Speakers bureau: Abbvie, Novartis, Pfizer, Roche, Janssen, Lilly, MSD, BMS, UCB, Grunental and Sanofi, Grant/research support from: Novartis, AbbVie, Pfizer, Janssen, Lilly, Haner Direskeneli Consultant of: Abbvie and Novartis, Grant/research support from: Pfizer, Amgene, Celltrion, UCB and Roche, Christina Duftner Consultant of: Abbvie, AOP Orphan, Astra-Zeneca, Bristol-Myers-Squibb, Eli-Lilly, Janssen, Galapagos, Merck-Sharp-Dohme, Novartis, Pfizer, Roche, Sandoz, UCB, Vifor, Speakers bureau: Abbvie, AOP Orphan, Astra-Zeneca, Bristol-Myers-Squibb, Eli-Lilly, Janssen, Galapagos, Merck-Sharp-Dohme, Novartis, Pfizer, Roche, Sandoz, UCB, Vifor, Grant/research support from: Eli-Lilly, Pfizer, UCB, ALOJZIJA HOCEVAR: None declared, Anna Moltó Consultant of: AbbVie, BMS, Biogen, Eli Lilly, Galapagos, Janssen, MSD, Novartis, and UCB, Grant/research support from: AbbVie, BMS, Biogen, Eli Lilly, Galapagos, Janssen, MSD, Novartis, and UCB, Valentin Schäfer: None declared, Luca Seitz Grant/research support from: iQone and Sandoz, Riemer Slart Grant/research support from: Siemens Healtineers and Pfizer, Wolfgang Schmidt Consultant of: Abbvie, Chugai, GlaxoSmithKline, Medac, Novartis, Roche, and Sanofi, Speakers bureau: Abbvie, Chugai, GlaxoSmithKline, Medac, Novartis, Roche, and Sanofi.