COVID-19 was not associated or trigger disease activity in spondylarthritis patients: ReumaCoV-Brasil cross-sectional data

Abstract

Objectives To evaluate the disease activity before and after COVID-19 and risk factors associated with outcomes, including hospitalization, intensive care unit (ICU) admission, mechanical ventilation (MV) and death in patients with spondylarthritis (SpA). Methods ReumaCoV Brazil is a multicenter prospective cohort of immune-mediated rheumatic diseases (IMRD) patients with COVID-19 (case group), compared to a control group of IMRD patients without COVID-19. SpA patients enrolled were grouped as axial SpA (axSpA), psoriatic arthritis (PsA) and enteropathic arthritis, according to usual classification criteria. Results 353 SpA patients were included, of whom 229 (64.9%) were axSpA, 118 (33.4%) PsA and 6 enteropathic arthritis (1.7%). No significant difference was observed in disease activity before the study inclusion comparing cases and controls, as well no worsening of disease activity after COVID-19. The risk factors associated with hospitalization were age over 60 years (OR = 3.71; 95% CI 1.62–8.47, p = 0.001); one or more comorbidities (OR = 2.28; 95% CI 1.02–5.08, p = 0.001) and leflunomide treatment (OR = 4.46; 95% CI 1.33–24.9, p = 0.008). Not having comorbidities (OR = 0.11; 95% CI 0.02–0.50, p = 0.001) played a protective role for hospitalization. In multivariate analysis, leflunomide treatment (OR = 8.69; CI = 95% 1.41–53.64; p = 0.023) was associated with hospitalization; teleconsultation (OR = 0.14; CI = 95% 0.03–0.71; p = 0.01) and no comorbidities (OR = 0.14; CI = 95% 0.02–0.76; p = 0.02) remained at final model as protective factor. Conclusions Our results showed no association between pre-COVID disease activity or that SARS-CoV-2 infection could trigger disease activity in patients with SpA. Teleconsultation and no comorbidities were associated with a lower hospitalization risk. Leflunomide remained significantly associated with higher risk of hospitalization after multiple adjustments.

The impact of SARS-CoV-2 infection and vaccination on inflammatory arthritis: a cohort study

“…However, there was no difference in the rate of flare within the different IA subsets. At multivariate analysis, the only predictive risk factor for a flare-up was SARS-CoV-2 infection, thus confirming previous findings in the literature ( 9 , 10 ). Only 7.5% of patients who experienced flares needed a therapy switch.…”

“…Furthermore, we fail to demonstrate any impact of the different anti-rheumatic drugs on SARS-CoV-2 infection and/or COVID-19 course, in particular as it pertains to three recently reported aspects: the potential protective role of TNFi ( 43 , 44 ) and the negative effect of corticosteroids and rituximab, the more severe forms of COVID-19 in patients with immune-mediated rheumatic diseases ( 5 , 43 , 44 ), and sulfasalazine. The effect of TNFi may stem from the fact that most of our patients suffering from seronegative SpA which presents some pathophysiological differences vs. RA, such as T17/T1 pathway balance ( 10 ). We did not find a negative effect of RTX, SSZ or steroids, as previously reported ( 5 , 43 , 44 ), likely due to the low frequency of this treatment in our cohort.…”

“…Several studies have indicated a similar or slightly increased severity of COVID-19 and risk of hospitalization in patients with inflammatory joint disease, and more widely in rheumatic diseases, vs. the general population ( 2 – 8 ). There was no association between SARS-CoV-2 infection and joint disease exacerbation ( 9 , 10 ). The serological response in patients with IA was surprisingly higher than expected based on reported symptoms ( 11 ), despite immunosuppressive therapy.…”