COVID-19 in rheumatoid arthritis cases: an Iranian referral center experience

Abstract

Coronavirus infections, known as COVID-19, can induce a fatal respiratory system infection and also affect other organs, such as the kidney and heart. The mortality rate has been estimated between 1 and 5% in previous reports; however, the mortality and morbidity can be higher in patients with the immune-deficiency condition. Rheumatoid arthritis (RA) is one of the most rheumatoid disorders, and it is important to report their clinical and paraclinical data when affected with COVID-19. Evidence about their laboratory and radiologic findings is limited. In this case series, 10 cases of chronic and approved rheumatoid arthritis (RA) affected by COVID-19 are presented. Only 40% had dry cough, but myalgia and weakness as the general first presentation of infections was reported in most cases (80%). Gastrointestinal symptoms, including nausea/vomiting, diarrhea, anorexia, and abdominal pain, were reported in 50% of individuals. In blood cell count, 30% of cases had thrombocytopenia, and ESR in all cases was positive. Abnormal CRP and elevated LDH were seen in 90% of cases. In HRCT assessment, all cases had an abnormal parenchymal pattern, and 90% of cases presented the usual pattern of COVID-19 (bilateral multifocal GGO/consolidation). Although it is a limited report, these findings are helpful for comparison of clinical and paraclinical cases in RA cases with normal cases.

Outcomes of coronavirus disease 19 patients with a history of rheumatoid arthritis: A retrospective registry‐based study in Iran

“…15 Although initial publications warned about increasing mortality rates in immune-suppressed cases, a recent analysis indicated that immune-suppressed patients had similar or even lower mortality rates than the general population. 16 Moreover, data about the pathophysiology of COVID-19 infection shows that some anti-rheumatoid medicines can manage COVID-19. 7 A major strength of this study is that it considered a large, highquality COVID-19 registry that allowed us to adjust for several important confounding factors, such as age, gender, oxygen saturation, and several comorbidities.…”

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“…Recent research conducted in Iran reported 10 cases of RA who had COVID-19. Of these patients, those receiving corticosteroids had a more severe form of the disease (38,39).…”

“…It has been suggested that the risk of infection may be increased by disease flares and corticosteroid use (37). Patients with SLE using glucocorticoids at a dose >10 mg per day were found to be at higher risk of severe COVID-19 (38,40,41).…”

Atención por Teleconsulta para el Personal de Salud y Pacientes con Artritis Reumatoide, en la Emergencia Sanitaria por Covid-19: Análisis Cualitativo

“…En el contexto de la pandemia por COVID-19 la Artritis Reumatoide (AR) es una patología vulnerable por inmunosupresión o uso de corticosteroides (Shadmanfar et al, 2020). Para evitar que la AR se exacerbe o tenga un deterioro acelerado y progresivo, se implementaron programas de teleconsulta para minimizar los riesgos de contagio de la población vulnerable y para garantizar su control y seguimiento.…”