COVID-19 in patients with rheumatological diseases in the Eastern Province of Saudi Arabia

Abstract

The severity of the 2019 coronavirus disease (COVID-19) and its effects remain unpredictable. Certain factors, such as obesity, hypertension, and type 2 diabetes mellitus, may increase the severity of the disease. Rheumatology experts suggest that patients with active autoimmune conditions and controlled autoimmune diseases on immunosuppressive therapy may be at higher risk of developing severe COVID-19. In this retrospective observational study, we aimed to examine the patterns of COVID-19 in patients with underlying rheumatological diseases and their association with disease severity and hospital outcomes. A total of 34 patients with underlying rheumatological diseases who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by polymerase chain reaction (PCR) were included between March 2020 and April 2021 at King Fahd Hospital of the University. The study population consisted of 76.47% female and 23.53% male patients, with a mean age ranging from 20 to 40 years. Female gender (p=0.0001) and younger age (p=0.004) were associated with milder disease. The most frequent rheumatological disease was systemic lupus erythematosus (SLE) (38.24%), which was associated with a milder infection (p=0.045). Patients treated with mycophenolate mofetil (MMF) had a milder disease course (p=0.0037). Hypertension was significantly associated with severe COVID-19 disease (p=0.037). There was no significant relationship between SLE and the need for ICU admission. Patients on hydroxychloroquine and MMF tended to develop milder disease, and there was no association between the severity of the infection and the treatment with steroids.

Keywords: ACE2: Angiotensin-converting enzyme 2; ANA: Antinuclear antibody; AOR: Adjusted odds ratio; ARDS: Acute respiratory distress syndrome; AT2: Type 2 alveolar cells; AZA: Azathioprine; BMI: Body mass index; CI: Confidence intervals; CK: Creatine kinase; CKD: Chronic kidney disease; COPD: Chronic obstructive pulmonary disease; COVID-19 infection; COVID-19: Coronavirus disease 2019; CRP: C-reactive protein; CT: Computed tomography scan; CTD: Connective tissue disease; DM: Diabetes mellitus; DMARDs: Disease-modifying antirheumatic drugs; ESR: Erythrocyte sedimentation rate; GI: Gastrointestinal; GPA: Granulomatosis with polyangiitis; HCQ: Hydroxychloroquine; ICU: Intensive Care Unit; IFN: Interferon; IL: Interleukin; ILD: Interstitial lung disease; IQR: Interquartile range; LDH: Lactate dehydrogenase; LOH: Length of hospitalization; MMF: Mycophenolate mofetil; MTX: Methotrexate; ORs: Odds ratios; PAN: Polyarteritis nodosa; PsA: Psoriatic arthritis; RA: Rheumatoid arthritis; SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2; SD: Standard deviations; SLE: Systemic lupus erythematosus; SLEDAI: Systemic Lupus Erythematosus Disease Activity Index; SpO2: Oxygen saturation; TNF inhibitor: Tumor necrosis factor inhibitor; WHO: World Health Organization; disease outcome; disease severity; mortality; rheumatological disease.