Introducción: El efecto de la dexametasona en la fase inicial de la infección por SARS-CoV-2 y su influencia sobre la COVID-19 no está bien definido. Describimos las características clínico-radiológicas, los parámetros de tormenta de citoquinas y la evolución clínica de una serie de pacientes tratados con dexametasona en la fase inicial de la enfermedad. Método: Estudio de 8 pacientes que recibieron dexametasona previo al desarrollo de la COVID-19. Evaluamos variables clínicas, pruebas de imagen, parámetros de liberación de citoquinas, el tratamiento empleado y su evolución. Resultados: Todos los pacientes recibieron una dosis de 6mg/día con una duración media de 4,5 días previos al ingreso. La mayoría de los pacientes presentaron una extensión grave en TCAR y una elevación leve de los parámetros de liberación de citoquinas; tres pacientes requirieron ONAF por insuficiencia respiratoria, y ningún paciente requirió intubación orotraqueal ni falleció. Conclusión: La dexametasona en las fases iniciales de la infección por SARS-CoV-2 parece asociarse con una COVID-19 grave.

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BackgroundIt is estimated that rheumatoid arthritis (RA) increases the risk of cardiovascular disease (CVD) by 50% compared to the general population [1,2]. Non-HDL cholesterol (non-HDL CT) has become an innovative marker of cardiovascular risk (CVR). According to the recommendations of the ESC of 2022 [2], patients with RA start from an intermediate CVR and recommend non-HDL TC levels <130mg/dL.ObjectivesTo evaluate long-term risk of CVD according to nonHDL CT levels in a cohort of patients with recently diagnosed RA who started biological therapy and describe its characteristics.Methods71 patients with RA under biological treatment were reviewed. Demographic, clinical, and analytical data were obtained at the time of diagnosis. To estimate the risk of CVD in the long term, we applied the model developed by Brunner F. J. et al. [3] -Figure 1-. Based on this, the patients were stratified into 5 CVR groups according to the non-HDL CT and grouped into three age ranges. Statistical analysis was carried out using IBM-SPSS Statistics version 26.ResultsThe demographic, clinical, laboratory characteristics and CVR groups are indicated in Table 1. Regarding the mean age according to the CVR group: in the 8 patients of group 1 it was 38.13 ± 15.28 years - 7 with age < 45 years and one > 60 years -, in group 2 it was 42.93 ± 11.76 years - 17 patients < 45 years, 10 between 45 and 59 years and 2 ≥ 60 years -, in the 31 patients of group 3 it was 51.45 ± 11.49 years - 8 < 45 years, 15 between 45-59 years and 8 ≥ 60 years -. In the 2 patients in group 4 it was 52.5 years (45-59) and the patient in group 5 was 36 years old at diagnosis.No significant correlations were found between CRP, ESR, RF, ACPAs levels and presence of radiographic erosions with nonHDL CT values. Significant differences (p value < 0.01) were observed between the youngest individuals (age < 45 years) in groups 1 and 2 with respect to individuals older than 60 years in risk groups 3 or 4. The application of the current model -Figure 1- estimated a mean probability of CVD of 9.7% at 75 years with a reduction to 3.54% after a 50% decrease in non-HDL TC. A single fatal cardiovascular event was recorded in an obese, hypertensive, and diabetic man, classified in risk group 3.ConclusionIn our cohort of patients with new-onset RA, the majority (46%) were classified as CVR group 3 (nonHDL CT 145-184 mg/dL), despite approximately 50% being <45 years of age. Exposure from an early age to a moderate increase in non-HDL CT induces an increase in long-term CVR, not captured by the 10-year CVR estimate. For all this, emphasis should be placed on the establishment of measures to reduce CVR guided by non-HDL CT levels in patients diagnosed with RA.References[1]https://doi.org/10.1136/annrheumdis-2016-209775[2]https://doi.org/10.1016/j.rec.2022.04.003[3]https://doi.org/10.1016/s0140-6736(19)32519-xTable 1.N%DEMOGRAPHICTotal number of patients71SexM1115.5%W6084.5%Median age at diagnosis46,28 ± 12,73CLINICALRadiographic erosions2433.8%Corticosteroid therapy4563.38%LABORATORYRF (+)4766.19%ACPA (+)4664.78%MeanMedianCRP13.35 ± 19.066.74 IQR 15.90ESR25.06 35 ± 16.5620 IQR 17.00Total CT203Non-HDL CT144Colesterol LDL121.5N%CVRPrevious CVD0Statins22.81%Active smoking2129.57%Hypertension1318.30%IMC > 301521.12%Diabetes22.81%CVR group according to nonHDL CT1 (<100 mg/dL)811.3%2 (100-144 mg/dL)2940.8%3 (145-184 mg/dL)3143.7%4 (185-219 mg/dL)22.8%5 (≥ 220 mg/dL)11.4%Figure 1.Acknowledgements:NIL.Disclosure of InterestsNone Declared.