Peculiarities of COVID-19 clinical course in patients with various rheumatic diseases

Patients with immunoinflammatory rheumatic diseases are forming the risk group for COVID-19 severe clinical course.

The aim: to study the peculiarities of clinical course and outcomes of a novel coronavirus infection (NCI) in patients with rheumatic diseases (RD).

Material and methods. From March 2020 to February 2022 in the study were included 293 patients (77 males and 216 females) with significant RD and a history of COVID-19: 193 patients with rheumatoid arthritis (RA), 46 with ankylosing spondylitis (AS), 38 with psoriatic arthritis (PsA), 16 – with systemic connective tissue disease (SCTD). Average age of patients was 61,32 [55,25; 69], duration of RD at the moment of NCI – 14,06 [8; 17,5] years.

Results. Asymptomatic COVID-19 clinical course was fixed in 92 (31,4%), mild in 121 (41,3%), moderate in 59 (20,1%), severe in 21 (7,16%) patients. 201 patient had pulmonary damage of varying severity: CT-1 – in 94 (52,1%), CT-2 – in 69 (26,0%), CT-3 – in 22 (11,1%), CT-4 – in 16 (10,7%) cases. The study revealed the significant influence of coronary artery disease (post-infarction cardiosclerosis) and CHF at the increase in the volume of lung damage, as well as paroxysmal atrial fibrillation at the development of pulmonary fibrosis in COVID-19 case. From 293 patients, 37,1% required hospitalization in an infectious diseases hospital; 4,43% of NCI cases resulted in death. An increased risk of an unfavorable course of COVID-19 was associated with female gender, the presence of comorbid conditions and excess body weight, and the degree of activity of the underlying disease before infection with NCI.

Conclusion. The course of COVID-19 in RD patients is heterogeneous. A more severe course (CT-3–4) was more common in patients with CTD and RA. The type of RD therapy did not affect the severity of NCI, with the exception of rituximab use. High activity of RD before NCI and concomitant cardiovascular pathology play a significant role in the development of an unfavorable outcome of COVID-19.