Impact of a new coronavirus infection on the clinical course of immunoinflammatory rheumatic diseases

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Abstract

BACKGROUND: The COVID-19 pandemic poses a particular threat to patients suffering from immunoinflammatory rheumatic diseases. New coronavirus infection has been found to be accompanied by the development of a wide range of extrapulmonary clinical and laboratory manifestations, which are characteristic of a number of immunoinflammatory rheumatic diseases.

AIM: To evaluate the features of the clinical course of immunoinflammatory rheumatic diseases in patients who underwent new coronavirus infection.

MATERIALS AND METHODS: The clinical course of immunoinflammatory rheumatic diseases was analyzed in 324 patients who underwent new coronavirus infection from March 2020 to February 2021 and were treated at the Clinical Rheumatology Hospital No. 25, Saint Petersburg, for exacerbation of the underlying disease.

RESULTS: Analysis showed that the risk factors for severe new coronavirus infection in patients with immunoinflammatory rheumatic diseases were: age over 60, comorbidities, use of prednisolone in a dose greater than 12,5 mg, and ESR values ≥40 mm/hour before the development of new coronavirus infection. There was no effect of immunosuppressive and biological therapy on the severity of the course of viral infection. There was no effect of immunosuppressive therapy and biological therapy on the severity of the course of viral infection in patients with immunoinflammatory rheumatic diseases. The development of the postinfectious syndrome was observed in 1/4 of patients, which was characterized by the formation of postinfectious arthritis in 3,6% of patients, transformation of undifferentiated arthritis into various rheumatic diseases in 49% of patients (more often into early rheumatoid arthritis), as well as exacerbation of the underlying disease in 83,4% of patients with an advanced stage of rheumatoid arthritis. In patients with mixed connective tissue disease, there was a significant increase in immunologic activity due to antinuclear factor (up to a maximum of 1:163 840). Clinical cases of the development of arthritis associated with viral infection and the debut of rheumatoid arthritis after an new coronavirus infection are presented.

CONCLUSIONS: New coronavirus infection in the cohort of patients with immunoinflammatory rheumatic diseases observed in the Clinical Rheumatology Hospital No. 25, Saint Petersburg, proceeded in the variant of medium severity in half of patients, initiated the development of lung lesions in 68,6% of patients, arthritis associated with viral infection in 3,6% of patients, immunoinflammatory rheumatic diseases which transformed from undifferentiated arthritis in 49% of cases and exacerbation of the main disease in an overwhelming number of patients. Patients with immunoinflammatory rheumatic diseases have a high risk of adverse outcome of new coronavirus infection, especially in cases of unstable course of the disease or exacerbation of this group of diseases.

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About the authors

Vadim I. Mazurov

North-West State Medical University named after I.I. Mechnikov; Clinical Rheumatology Hospital No. 25

Email: maz.nwgmu@yandex.ru
ORCID iD: 0000-0002-0797-2051
SPIN-code: 6823-5482
Scopus Author ID: 16936315400
ResearcherId: A-8944-2016

MD, Dr. Sci. (Med.), Professor, Honoured Science Worker, Academician of the RAS

Russian Federation, 41 Kirochnaya str., Saint Petersburg, 191015; Saint Petersburg

Irina B. Belyaeva

North-West State Medical University named after I.I. Mechnikov; Clinical Rheumatology Hospital No. 25

Author for correspondence.
Email: belib@mail.ru
ORCID iD: 0000-0002-7981-6349
SPIN-code: 3136-9062

MD, Dr. Sci. (Med.), Professor

Russian Federation, 41 Kirochnaya str., Saint Petersburg, 191015; Saint Petersburg

Lubov E. Sarantseva

North-West State Medical University named after I.I. Mechnikov; Clinical Rheumatology Hospital No. 25

Email: dr.liubovs@gmail.com
Russian Federation, 41 Kirochnaya str., Saint Petersburg, 191015; Saint Petersburg

Anton L. Chudinov

Clinical Rheumatology Hospital No. 25

Email: anton-chudinov@mail.ru
ORCID iD: 0000-0002-7675-5683
SPIN-code: 5771-8320

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Roman A. Bashkinov

North-West State Medical University named after I.I. Mechnikov; Clinical Rheumatology Hospital No. 25

Email: bashkinov-roman@mail.ru
ORCID iD: 0000-0001-9344-1304
SPIN-code: 5169-5066

MD, PhD student

Russian Federation, 41 Kirochnaya str., Saint Petersburg, 191015; Saint Petersburg

Evgeni A. Trofimov

North-West State Medical University named after I.I. Mechnikov

Email: evgeniy.trofimov@szgmu.ru
SPIN-code: 4358-1663

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, 41 Kirochnaya str., Saint Petersburg, 191015

Olga A. Smulskaya

Clinical Rheumatology Hospital No. 25

Email: olgasmul@yandex.ru

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Oksana V. Inamova

North-West State Medical University named after I.I. Mechnikov; Clinical Rheumatology Hospital No. 25

Email: b25@zdrav.spb.ru
ORCID iD: 0000-0001-9126-3639
SPIN-code: 8841-5496

MD, Cand. Sci. (Med.)

Russian Federation, 41 Kirochnaya str., Saint Petersburg, 191015; Saint Petersburg

Marianna S. Petrova

North-West State Medical University named after I.I. Mechnikov; Clinical Rheumatology Hospital No. 25

Email: podagra@bk.ru
ORCID iD: 0000-0001-5261-6614

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, 41 Kirochnaya str., Saint Petersburg, 191015; Saint-Petersburg

Evgeni S. Melnikov

North-West State Medical University named after I.I. Mechnikov; Clinical Rheumatology Hospital No. 25

Email: melnikovzhenya@mail.ru
ORCID iD: 0000-0002-8521-6542

MD, PhD student

Russian Federation, 41 Kirochnaya str., Saint Petersburg, 191015; Saint-Petersburg

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Supplementary files

Supplementary Files
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1. Fig. 4. X-ray of the hands of patient O., age 60

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2. Fig. 5. X-ray of the feet of patient O., 60 years old

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3. Fig. 1. Effect of glucocorticoid therapy on COVID-19 severity in immunoinflammatory rheumatic diseases (n = 324)

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4. Fig. 2. COVID-19 severity in patients with immunoinflammatory rheumatic diseases depending on the use of baseline therapy before COVID-19

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5. Fig. 3. Distribution by severity of new coronavirus infection in patients with rheumatic pathology who received biological therapy

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Copyright (c) 2021 Mazurov V.I., Belyaeva I.B., Sarantseva L.E., Chudinov A.L., Bashkinov R.A., Trofimov E.A., Smulskaya O.A., Inamova O.V., Petrova M.S., Melnikov E.S.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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