Post covid syndrome and rheumatic diseases: focus on rheumatoid arthritis (own data)

Introduction. In modern reality postcovid syndrome (PCS) is characterized by clinical heterogeneity and multi-organ involvement, often presenting a differential diagnostic and therapeutic problem. However, in most studies of PCS, stratification of patients taking into account individual comorbid conditions was not performed. Thus, only an extremely small number of studies have been devoted to assessing the course of PCS in rheumatic diseases
Purpose. To characterize the features of the course of COVID-19 in patients with rheumatoid arthritis, as well as to conduct a comparative assessment of clinical and demographic parameters in groups of patients with rheumatoid arthritis, differentiated by the presence of PCS.
Materials and methods. The material of the questionnaire which contained questions regarding socio-demographic data of respondents, information on rheumatological history, comorbid diseases, data on past COVID-19, including cases of re-infection, and PCS.
Results.The study included 32 adult patients (29 women, 90%) with a reliable diagnosis of rheumatoid arthritis. Of the 32 patients who underwent COVID-19, in 23 cases it was possible to form a judgment about the presence or absence of PCS. To study PCS, 23 patients were stratified into two groups: 11 (47.8%) patients developed PCS (Group 1) and 12 patients had COVID-19 without consequences (Group 2). Both groups were represented predominantly by women (90.9% and 91.7%, respectively). In the general group 37.5% of patients with COVID-19 required inpatient treatment. The number of symptoms associated with COVID-19 did not correlate with RA activity, however, patients with higher RA activity were more likely to report increased arthralgia as a symptom of COVID-19. 47.8% of COVID-19 survivors experienced PCS. The average age, the number of comorbid diseases and the severity of RA symptoms at the time of COVID-19 were relatively higher in the group of patients with RA and PKS. Patients with PKS also noted a higher frequency of hospitalizations and a more severe course of COVID-19.
Conclusions. A quantitative assessment of the risk of developing PKS is needed, which will serve as a basis for developing a strategy aimed at prevention, timely diagnosis and treatment of this syndrome in patients with RS. To this end, further studies on larger cohorts of patients are required.

1. Fraser E. Long term respiratory complications of covid-19. BMJ. 2020;370:m3001. https://doi.org/10.1136/bmj.m3001.

2. Townsend L., Dyer A.H., Jones K., Dunne J., Mooney A., Gaffney F. et al. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS ONE. 2020;15(11):е0240784. https://doi.org/10.1371/journal.pone.0240784.

3. Hopkins C., Surda P., Vaira L.A., Lechien J.R., Safarian M., Saussez S., Kumar N. Six month follow-up of self-reported loss of smell during the COVID-19 pandemic. Rhinology. 2020;5(1):26–31. https://doi.org/10.4193/Rhin20.544.

4. Fjaeldstad A.W. Prolonged complaints of chemosensory loss after COVID-19. Dan Med J. 2020;67(8):A05200340. Available at: https://pubmed.ncbi.nlm.nih.gov/32741438.

5. Carfì A., Bernabei R., Landi F. Persistent symptoms in patients after acute COVID-19. JAMA. 2020;324(6):603–605. https://doi.org/10.1001/jama.2020.12603.

6. Jacobs L.G., Paleoudis E.G., Bari D.L., Nyirenda T., Friedman T, Gupta A. et al. Persistence of symptoms and quality of life at 35 days after hospitalization for COVID-19 infection. PLoS ONE. 2020;15:12:е0243882. https://doi.org/10.1371/journal.pone.0243882.

7. Huang C., Huang L., Wang Y., Li X., Ren L., Gu X. et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220–232. https://doi.org/10.1016/S0140-6736(20)32656-8.

8. Soriano J.B., Murthy S., Marshall J.C., Relan P., Diaz J.V. A clinical case definition of post COVID-19 condition by a Delphi consensus. 2021;S1473-3099(21)00703-9. https://doi.org/10.1016/S1473-3099(21)00703-9.

9. Bliddal S., Banasik K., Pedersen O.B., Nissen J., Cantwell L., Schwinn M. et al. Acute and persistent symptoms in non-hospitalized PCR-confirmed COVID-19 patients. Sci Rep. 2021;11(1):13153. https://doi.org/10.1038/s41598-021-92045-x.

10. Hausmann J.S., Kennedy K., Simard J.F., Liew J.W., Sparks J.A., Mon T.T. et al. Immediate effect of the COVID-19 pandemic on patient health, healthcare use, and behaviours: results from an international survey of people with rheumatic diseases. Lancet Rheumatol. 2021;3(10):e707–e714. https://doi.org/10.1016/S2665-9913(21)00175-2.

11. Davis H.E., Assaf G.S., McCorkell L., Wei H., Low R.J., Re’em Y. et al. Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact. EClinicalMedicine. 2021;38:101019. https://doi.org/10.1016/j.eclinm.2021.101019.

12. Cirulli E.T., Schiaboet Barrett K.M., Riffle S., Bolze A., Neveux I., Dabe S. al. Long-term COVID-19 symptoms in a large unselected population. Infect Dis (Lond). 2021;53(10):737–754. https://doi.org/10.1101/2020.10.07.20208702.

13. Sudre C.H., Murray B., Varsavsky T., Graham M.S., Penfold R.S., Bowyer R.C. et al. Attributes and predictors of long COVID. Nat Med. 2021;27(4):626–631. https://doi.org/10.1038/s41591-021-01292-y.

14. Thevarajan I., Nguyen T.H.O., Koutsakos M., Druce J., Caly L., van de Sandt C.E. et al. Breadth of concomitant immune responses prior to patient recovery: a case report of non-severe COVID-19. Nat Med. 2020;26(4):453–455. https://doi.org/10.1038/s41591-020-0819-2.

15. Goertz Y.M.J., van Herck M., Delbressine J.M., Vaes A.W., Meys R., Machado F.V. et al. Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome? ERJ Open Res. 2020;6(4):00542-2020. https://doi.org/10.1183/23120541.00542-2020.

16. Walsh-Messinger J., Manis H., Vrabec A., Sizemore J., Bishof K., Debidda M. et al. The Kids Are Not Alright: A Preliminary Report of Post-COVID Syndrome in University Students. J Am Call Health. 2021;1–7. https://doi.org/10.1101/2020.11.24.20238261.

17. Pavli A., Theodoridou M., Maltezou H.C. Post-COVID Syndrome: Incidence, Clinical Spectrum, and Challenges for Primary Healthcare Professionals. Arch Med Res. 2021;52(6):575–581. https://doi.org/10.1016/j.arcmed.2021.03.010.

18. Petersen M.S., Kristiansen M.F., Hanusson K.D., Danielsen M.E., Á Steig B., Gaini S. Long COVID in the Faroe Islands – a longitudinal study among non-hospitalized patients. Clin Infect Dis. 2021;73(11):e4058–e4063. https://doi.org/10.1093/cid/ciaa1792.

19. Lopez-Leon S., Wegman-Ostrosky T., Perelman C., Sepulveda R., Rebolledo P.A., Cuapio A., Villapol S. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep. 2021;11(1):16144. https://doi.org/10.1038/s41598-021-95565-8.

20. Brito-Zerón P., Sisó-Almirall A., Flores-Chavez A., Retamozo S., RamosCasals M. SARS-CoV-2 infection in patients with systemic autoimmune diseases. Clin Exp Rheumatol. 2021;39(3):676–687. Available at: https://pubmed.ncbi.nlm.nih.gov/34001305.

21. Nasonov E.L., Belov B.S., Lila A.M., Aronova E.S., Gridneva G.I., Kudryavtseva A.V. et al. Course and outcomes of COVID-19 in patients with immunoinflammatory rheumatic diseases: Preliminary data from the NIIR/APP-COVID-19 registry and literature review. Rheumatology Science and Practice. 2021;(6):666–675. (In Russ.) https://doi.org/10.47360/1995-4484-2021-666-675.

22. Halpin S.J., Mclvor C., Whyatt G., Adams A., Harwey O., McLean L. et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J Med Virol. 2021;93(2):1013–1022. https://doi.org/10.1002/jmv.26368.

23. Pepys M.B. C-reactive protein predicts outcome in COVID-19: is it also a therapeutic target? Eur Heart J. 2021;42(23):2280–2283. https://doi.org/10.1093/eurheartj/ehab169.

24. Smilowitz N.R., Kunichoff D., Garshick M., Shah B., Pillinger M., Hochman J.S., Berger J.S. C-reactive protein and clinical outcomes in patients with COVID-19. Eur Heart J. 2021;42(23):2270–2279. https://doi.org/10.1093/eurheartj/ehaa1103