key: cord-0692682-kcqm52ty authors: Martinez, O.; Ibanez, S.; Valenzuela, F. title: Clinical characteristics of Chilean patients with rheumatic diseases and COVID-19: data from the Covid-19 Global Rheumatology Alliance physician-reported registry date: 2021-12-08 journal: nan DOI: 10.1101/2021.12.07.21267429 sha: c076bc5f78c77e0bbdeef59efaec131950464736 doc_id: 692682 cord_uid: kcqm52ty Objective: The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), has registered more than 234 million confirmed cases and more than 4.7 million deaths throughout the world until October 2, 2021. During the last few months, a significant number of reports of COVID-19 in patients with rheumatic diseases have been published. In this study the objective is to report the clinical characteristics of Chilean patients with rheumatic diseases and COVID-19 reported in the Global Rheumatology Alliance (GRA) physician registration platform. Methods: Chilean patients with rheumatic diseases and COVID-19 were included in the Covid-19 GRA physician-reported registry. Results: 54 patients were included. The most common primary rheumatic disease was rheumatoid arthritis (RA) with 28 cases (51.9%). 30 patients (55.6%) used corticosteroids, of which 20 (66.7%) used a dose of 10 mg or less. 33 patients (61.1%) only used conventional DMARDs, 4 (7.4%) only biological, and 6 (11.1%) the combination. A total of 35 patients (64.8%) had to be hospitalized. 2 patients (3.7%) died. 26 patients of the 35 hospitalized (74.2%) required some type of ventilatory support, of which 5 (19.2%) required non-invasive and 8 (30.8%) invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO). Discussion: Most of included Chilean rheumatic patients were hospitalized, with a low mortality rate but with a high percentage of patients requiring at least non-invasive mechanical ventilation. Key Points: -The most common primary rheumatic disease was rheumatoid arthritis (RA) followed by lupus (LES) -Most of the included Chilean rheumatic patients were hospitalized, with a high percentage of patients requiring at least non-invasive mechanical ventilation, but with a low mortality rate. -Worsening of arthralgias or activation of the rheumatic disease was not reported. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), has registered more than 234 million confirmed cases and more than 4.7 million deaths throughout the world until October 2, 2021, according to data published by the Johns Hopkins University (1). In Latin America, according to the World Health Organization, by October 2, 2021, almost 47 million cases had been registered, with approximately 1.5 million deaths (2) , while Chile reported a total of 1.6 million cases with 37 thousand deaths from COVID-19 (3). COVID-19 can generate a severe and aggressive illness, requiring hospitalization and ventilatory support, and potentially resulting in death. During the last few months, a significant number of case series and reports of COVID-19 in patients with rheumatic diseases have been published; one of the most important being the registry of the "COVID-19 Global Rheumatology Alliance" (GRA), the response of the rheumatology community to the global pandemic of COVID-19 (4). Since its launch in March 2020, more than 19,000 cases have been reported worldwide through its European and World-wide registries. In this study the objective is to report the clinical characteristics of Chilean patients with rheumatic diseases and COVID-19 reported in the GRA physician registration platform. Chilean patients with rheumatic disease and COVID-19 were included in the physician registry of the GRA between April 2020 and August 2021. COVID-19 diagnostic method as well as sociodemographic information, including age, sex, smoking status, rheumatic diagnosis, disease activity, comorbidities, and pre-COVID-. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Since the COVID-19 pandemic began, the question has arisen as to whether patients with pre-existing inflammatory diseases mediated by the immune system, such as rheumatic diseases, are at increased risk of SARS CoV2 infection or severe COVID-19 outcomes. The first GRA report was published in may 2020 (5), where the factors associated with hospitalization were examined in 600 rheumatic patients with COVID-19 from 40 countries, of which 46% (277 patients) required hospitalization. Both, advanced age and the presence of previous comorbidities (arterial hypertension, previous lung disease, diabetes mellitus), were factors associated with hospitalization (as in the general population). The most frequent underlying rheumatic disease was rheumatoid arthritis followed by systemic lupus erythematosus. The use of high-dose glucocorticoids (≥10 mg per day of prednisone equivalent) was associated with an increased risk of hospitalization. The study also included a preliminary analysis of biological DMARD exposure and found that compared to patients who were not receiving biological DMARDs, they were less likely to be hospitalized, regardless of the presence of other risk factors. In the Chilean registry, the inclusion of hospitalized patients was favored, and the number of registered cases was low, so performing analysis of associations of risk for hospitalization and worse outcome of infection did not seem appropriate to us. The median of days from onset to resolution of symptoms was 13 days in the global report, while in Chilean patients it was 21 days. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted December 8, 2021. ; https://doi.org/10.1101/2021.12.07.21267429 doi: medRxiv preprint In September 2020 another GRA study was published comparing the characteristics of 74 patients with rheumatic diseases and COVID-19 reported in Latin America with 583 from the rest of the world. The most frequent rheumatic diseases in both publications were rheumatoid arthritis and systemic lupus erythematosus, and mortality was similar in both groups (12% in Latin America vs 11% in the rest of the world). However, the Latin American registry included a higher percentage of hospitalized patients (61% in Latin America vs 45% in the rest of the world) and a high percentage needed at least non-invasive ventilation. This was similar to our Chilean report, but the reported mortality was higher in the Latin American cohort. In January 2021, a publication derived from the GRA (7) registry determined the factors associated with death related to COVID-19 in people with rheumatic disease. Of 3729 patients, 1739 (49%) was hospitalized, 187 (6.2%) required invasive ventilation and 390 (10.5%) died. Death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights. Caution may be required with rituximab, sulfasalazine, glucocorticoid dosages and some immunosuppressants. Mortality was higher, but the percentage of hospitalized patients was lower in this study than that reported in the Chilean registry (10.5% vs 3% deaths, 49% vs 64% hospitalized patients). A more recent publication from the GRA (8), with a total of 1,324 patients, concluded that African American, Latinos, and Asian patients were more likely to require hospitalization compared to white patients. Latino patients were also 3 times more likely to require ventilatory support. We think these differences may be due in large part to a bias in the registry, clearly in Chile the registry of hospitalized patients was favored. No differences in mortality were found based on race / ethnicity. The . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted December 8, 2021. ; https://doi.org/10.1101/2021.12.07.21267429 doi: medRxiv preprint results of this study are similar to the Chilean data in terms of mortality and the use of at least non-invasive mechanical ventilation reported, despite the fact that in Chile the registration of hospitalized patients was favored (64% Chile vs 36% Global). This study had some limitations, such as the difficulty in collecting data, due to medical exhaustion, the increase in the care burden in health centers, constant changes in the treatment paradigm, therefore, the number of patients included is low compared to those affected by COVID-19 in Chile. Therefore, we did not carry out other association analyzes, as they would not reflect the reality of what happened. It is evident that the median of symptoms is higher than that reported in other studies, this may be because the patients with more days of symptoms were those who attended health centers and were hospitalized. In Chilean rheumatic patients, COVID-19 symptoms were the classic symptoms described for the disease, a low percentage manifested arthralgia, and activation of the rheumatic disease was not reported. Less use of corticosteroids and greater use of biological DMARDS are evidenced in rheumatic patients from the rest of the world compared to Chilean patients, possibly related to accessibility given by economic factors and health policies of each region. Regarding the specific treatment for COVID 19, some patients were treated with therapies that were initially believed to work, but later evidence showed that they did not, such as hydroxychloroquine or azithromycin. Only one patient received tocilizumab, probably because of the time of registration (early in the pandemic). It is not mentioned whether the patients were vaccinated because when the data collection began, it was not yet available, and Chile began the vaccination process in patients with comorbidities in February 2021, and very few patients were registered after that. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) conventional synthetic disease-modifying antirheumatic drugs. The "other" rheumatic disease category included polymyalgia rheumatica, vasculitis, psoriasic arthritis, antiphospholipid syndrome, other inflammatory arthritis, undifferentiated connective tissue disease . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted December 8, 2021. ; https://doi.org/10.1101/2021.12.07.21267429 doi: medRxiv preprint World Health Organization. Global Health Observatory Data Rheumatic disease and COVID-19: initial data from the COVID-19 Global Rheumatology Alliance provider registry Characteristics associated with hospitalization for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry Characteristics associated with Covid-19 in patients with Rheumatic Disease in Latin America: data from the Covid-19 Global Rheumatology Alliance physician-reported registry. Global rheumatology by PANLAR Factors associated with COVID-19 related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry Association of Race and ethnicity with COVID-19 outcomes in rheumatic disease: data from the COVID-19 Global rheumatology Alliance physician-registry It is concluded that most of the Chilean rheumatic patients included were hospitalized with a low mortality rate, although with a high percentage of patients requiring at least non-invasive mechanical ventilation . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted December 8, 2021. ; https://doi.org/10.1101/2021.12.07.21267429 doi: medRxiv preprint It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) PCR Based on symptoms 4 (7.4) Fever 29 (53.7). CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted December 8, 2021. ; https://doi.org/10.1101/2021.12.07.21267429 doi: medRxiv preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted December 8, 2021. ; https://doi.org/10.1101/2021.12.07.21267429 doi: medRxiv preprint