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

Iorio, Michael Di; Cook, Claire; Vanni, Kathleen M M; Patel, Naomi J; D’Silva, Kristin M; Fu, Xiaoqing; Wang, Jiaqi; Prisco, Lauren; Kowalski, Emily; Zaccardelli, Alessandra; Martin, Lily; Qian, Grace; Hsu, Tiffany; Wallace, Zachary S

doi:10.1016/j.semarthrit.2022.152025

Cited by 44 publications

(47 citation statements)

References 36 publications

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“…A recent study performed in Boston, Massachusetts, USA surveyed 174 people with SARDs who survived confirmed COVID-19 (82% as outpatient) and reported a median symptom duration of 25 days. 10 That study found that a higher proportion of patients (45%) met the CDC definition for prolonged symptom duration than our current study (26.0%). Unlike the present study, they had data on specific post-COVID-19 symptoms; fatigue, pain, dyspnoea, dysgeusia and anosmia were common.…”

Section: Discussioncontrasting

confidence: 64%

“…Unlike the present study, they had data on specific post-COVID-19 symptoms; fatigue, pain, dyspnoea, dysgeusia and anosmia were common. 10 That study also found a high proportion of DMARD disruption and SARD flares after COVID-19, emphasising that COVID-19 may also impact the underlying SARD activity. Another study found that SARD status was not associated with risk for ‘long-haul’ COVID-19 (defined in that study as 3 months or longer) compared with people without SARDs seen in a New York City academic rheumatology practice.…”

Section: Discussionmentioning

confidence: 57%

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Prolonged COVID-19 symptom duration in people with systemic autoimmune rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey

et al. 2022

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ObjectiveWe investigated prolonged COVID-19 symptom duration, defined as lasting 28 days or longer, among people with systemic autoimmune rheumatic diseases (SARDs).MethodsWe analysed data from the COVID-19 Global Rheumatology Alliance Vaccine Survey (2 April 2021–15 October 2021) to identify people with SARDs reporting test-confirmed COVID-19. Participants reported COVID-19 severity and symptom duration, sociodemographics and clinical characteristics. We reported the proportion experiencing prolonged symptom duration and investigated associations with baseline characteristics using logistic regression.ResultsWe identified 441 respondents with SARDs and COVID-19 (mean age 48.2 years, 83.7% female, 39.5% rheumatoid arthritis). The median COVID-19 symptom duration was 15 days (IQR 7, 25). Overall, 107 (24.2%) respondents had prolonged symptom duration (≥28 days); 42/429 (9.8%) reported symptoms lasting ≥90 days. Factors associated with higher odds of prolonged symptom duration included: hospitalisation for COVID-19 vs not hospitalised and mild acute symptoms (age-adjusted OR (aOR) 6.49, 95% CI 3.03 to 14.1), comorbidity count (aOR 1.11 per comorbidity, 95% CI 1.02 to 1.21) and osteoarthritis (aOR 2.11, 95% CI 1.01 to 4.27). COVID-19 onset in 2021 vs June 2020 or earlier was associated with lower odds of prolonged symptom duration (aOR 0.42, 95% CI 0.21 to 0.81).ConclusionMost people with SARDs had complete symptom resolution by day 15 after COVID-19 onset. However, about 1 in 4 experienced COVID-19 symptom duration 28 days or longer; 1 in 10 experienced symptoms 90 days or longer. Future studies are needed to investigate the possible relationships between immunomodulating medications, SARD type/flare, vaccine doses and novel viral variants with prolonged COVID-19 symptoms and other postacute sequelae of COVID-19 among people with SARDs.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 57%

Prolonged COVID-19 symptom duration in people with systemic autoimmune rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey

et al. 2022

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“…PASC affects a high proportion of individuals who are infected with SARS-CoV-2( 27, 28 ). Over 40% of COVID-19-recovered individuals have persistent symptoms 90 days later ( 29 ) Further in individuals with pre-existing rheumatic disease, up to 45% of COVID-19 recovered individuals have persistent symptoms 28-days later( 30 ). ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

“…Understanding the mechanisms that lead to the development of PASC is challenging due to its broad syndromic definition likely with multiple endotypes each with distinct pathophysiologic mechanisms. SARS-CoV-2 can induce the production of autoantibodies( 34, 35 ), cause exacerbated tissue/organ damage( 2 ), lead to neurologic inflammatory complications( 36, 37 ), exacerbate pre-existing SARDS symptoms( 30 ), and cause the new onset of SARDs ( 38, 39 ). To focus in on a single endotype, here we used systems serology to profile a cohort of COVID-19 rheumatic patients months after initial COVID infection who were clinically evaluated for PASC.…”

Section: Discussionmentioning

confidence: 99%

“…We analyzed patients recovered from COVID-19 with pre-existing rheumatic disease due to their propensity for inflammation and autoantibody production, which could make them more vulnerable to PASC and enrich for specific inflammatory-driven endotypes. Since March 1, 2020, all SARD participants with PCR-or antigen-confirmed SARS-CoV-2 were identified in the Massachusetts General Brigham (MGB) HealthCare system, supplemented by referrals from rheumatologists of participants who were diagnosed with COVID-19 outside of the MGB system (30,(59)(60)(61)(62)(63). Only individuals who did not require hospitalization for COVID-19 were included in our study.…”

Section: Methodsmentioning

confidence: 99%

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Impact of cross-coronavirus immunity in post-acute sequelae of COVID-19

Herman

Atyeo

Zur

et al. 2022

Preprint

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Beyond the unpredictable acute illness caused by SARS-CoV-2, one-fifth of infections unpredictably result in long-term persistence of symptoms despite the apparent clearance of infection. Insights into the mechanisms that underlie post-acute sequelae of COVID-19 (PASC) will be critical for the prevention and clinical management of long-term complications of COVID-19. Several hypotheses have been proposed that may account for the development of PASC, including persistence of virus or the dysregulation of immunity. Among the immunological changes noted in PASC, alterations in humoral immunity have been observed in some patient subsets. To begin to determine whether SARS-CoV-2 or other pathogen specific humoral immune responses evolve uniquely in PASC, we performed comprehensive antibody profiling against SARS-CoV-2 and a panel of endemic pathogens or routine vaccine antigens using Systems Serology in a cohort of patients with pre-existing rheumatic disease who either developed or did not develop PASC. A distinct humoral immune response was observed in individuals with PASC. Specifically, individuals with PASC harbored less inflamed and weaker Fc-receptor binding anti-SARS-CoV-2 antibodies and a significantly expanded and more inflamed antibody response against endemic Coronavirus OC43. Individuals with PASC, further, generated more avid IgM responses and developed an expanded inflammatory OC43 S2-specific Fc-receptor binding response, linked to cross reactivity across SARS-CoV-2 and common coronaviruses. These findings implicate previous common Coronavirus imprinting as a marker for the development of PASC.

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The Evolving Role of the Rheumatology Practitioner in the Care of Immunocompromised Patients in the COVID‐19 Era

Calabrese

Kirchner

et al. 2022

Arthritis & Rheumatology

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

Cited by 44 publications

References 36 publications

Prolonged COVID-19 symptom duration in people with systemic autoimmune rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey

Prolonged COVID-19 symptom duration in people with systemic autoimmune rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey

Impact of cross-coronavirus immunity in post-acute sequelae of COVID-19

The Evolving Role of the Rheumatology Practitioner in the Care of Immunocompromised Patients in the COVID‐19 Era

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