DMARD disruption, disease flare, and prolonged symptom duration after acute COVID-19 among participants with rheumatic disease: A prospective study

Abstract

Objective: To describe disease-modifying antirheumatic drug (DMARD) disruption, rheumatic disease flare/activity, and prolonged COVID-19 symptom duration among COVID-19 survivors with systemic autoimmune rheumatic diseases (SARDs). Methods: We surveyed patients with SARDs after confirmed COVID-19 at Mass General Brigham to investigate post-acute sequelae of COVID-19. We obtained data on demographics, clinical characteristics, COVID-19 symptoms/course, and patient-reported measures. We examined baseline predictors of prolonged COVID-19 symptom duration (defined as lasting ≥28 days) using logistic regression. Results: We analyzed surveys from 174 COVID-19 survivors (mean age 52 years, 81% female, 80% White, 50% rheumatoid arthritis) between March 2021 and January 2022. Fifty-one percent of 127 respondents on any DMARD reported a disruption to their regimen after COVID-19 onset. For individual DMARDs, 56-77% had any change, except for hydroxychloroquine (23%) and rituximab (46%). SARD flare after COVID-19 was reported by 41%. Global patient-reported disease activity was worse at the time of survey than before COVID-19 (mean 6.6, SD 2.9 vs. 7.6, SD 2.3, p<0.001). Median time to COVID-19 symptom resolution was 14 days (IQR 9,29). Prolonged symptom duration of ≥28 days occurred in 45%. Hospitalization for COVID-19 (OR 3.54, 95%CI 1.27-9.87) and initial COVID-19 symptom count (OR 1.38 per symptom, 95%CI 1.17-1.63) were associated with prolonged symptom duration. Respondents experiencing prolonged symptom duration had higher RAPID3 scores (p=0.007) and more pain (p<0.001) and fatigue (p=0.03) compared to those without prolonged symptoms. Conclusion: DMARD disruption, SARD flare, and prolonged symptom duration were common in this prospective study of COVID-19 survivors, suggesting substantial impact on SARDs after acute COVID-19.

The Flare of Rheumatic Disease After SARS-CoV-2 Vaccination: A Review

“…As shown above, the vaccine showed no direct association with flare, while SARS-CoV-2 infection was reported as an independent risk factor for RD flare in some studies (52)(53)(54). The flare rate of RD after SARS-CoV-2 infection presented a vastly higher flare risk than that after vaccination (52)(53)(54)(55)(56)(57)(58), with most flare rates being higher than 20% and some even higher than 40%. This may also encourage RD patients to receive the COVID-19 vaccination.…”

COVID-19 and rheumatic diseases: A mini-review

“…It is important understanding the potential pathways and manifestations leading to rheumatic illnesses that could be triggered due to COVID-19. In a prospective study, Di Iorio et al ( 44 ) describe a sequela of worse events after COVID-19 in patients with systemic autoimmune RD, possibly related to underlying condition leading to altered immunity, propensity for hyperinflammation, immunosuppression, organ damage, and comorbidities.…”

A Flare of Hepatitis C Virus-Associated Cryoglobulinemic Vasculitis After COVID-19

“…While coronavirus disease 2019 (COVID- 19) is thought to be involved in the development of various autoimmune diseases since the early phases of the pandemic, COVID-19 may cause autoimmune disease flare-ups and worsening of disease activity [3,4]. However, few previous case reports suggest a relationship between CV and COVID-19.…”