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Scientific Abstracts
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COVID-19
POS1246 COVID-19 IN ITALIAN PATIENTS WITH RHEUMATIC AUTOIMMUNE SYSTEMIC DISEASES: RESULTS OF A NATIONWIDE SURVEY STUDY
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  1. C. Ferri1,
  2. D. Giuggioli2,
  3. V. Raimondo3,
  4. L. Dagna4,
  5. V. Riccieri5,
  6. E. Zanatta6,
  7. S. Guiducci7,
  8. A. Tavoni8,
  9. R. Foti9,
  10. G. Cuomo10,
  11. R. De Angelis11,
  12. F. Cozzi12,
  13. G. Murdaca13,
  14. I. Cavazzana14,
  15. N. Romeo15,
  16. V. Codullo16,
  17. F. Ingegnoli17,
  18. R. Pellegrini18,
  19. G. Varcasia19,
  20. A. Della Rossa20,
  21. M. De Santis21,
  22. G. Abignano22,
  23. M. Colaci23,
  24. M. Caminiti24,
  25. M. L’andolina25,
  26. E. Lubrano26,
  27. A. Spinella2,
  28. F. Lumetti2,
  29. G. De Luca4,
  30. S. Bellando Randone7,
  31. E. Visalli9,
  32. S. Bilia8,
  33. F. Masini10,
  34. G. Pellegrino5,
  35. E. Pigatto12,
  36. E. Generali21,
  37. F. Franceschini14,
  38. G. Pagano Mariano24,
  39. S. Barsotti20,
  40. G. Pettiti15,
  41. G. Zanframundo16,
  42. R. Brittelli27,
  43. V. Aiello27,
  44. D. Scorpiniti27,
  45. T. Ferrari19,
  46. R. Caminiti27,
  47. C. Campochiaro4,
  48. P. Gigliotti28,
  49. R. Cecchetti29,
  50. D. Olivo30,
  51. F. Ursini31,
  52. V. Brusi31,
  53. R. Meliconi31,
  54. F. Caso32,
  55. R. Scarpa32,
  56. S. D’angelo22,
  57. F. Iannone33,
  58. M. Matucci-Cerinic7,
  59. A. Doria6,
  60. M. Miccoli34,
  61. S. R. Paparo35,
  62. F. Ragusa34,
  63. G. Elia34,
  64. S. M. Ferrari34,
  65. P. Fallahi36,
  66. A. Antonelli37
  1. 1Rheumatology Unit, University of Modena & RE., School of Medicine, Modena, Italy; Rheumatology Clinic ‘Madonna dello Scoglio’ Cotronei, Crotone, Italy, Rheumatology Department, Modena; Cotronei, Italy
  2. 2Rheumatology Unit, University of Modena & RE., School of Medicine, Modena, Italy, Rheumatology Department, Modena, Italy
  3. 3Rheumatology Clinic ‘Madonna dello Scoglio’ Cotronei, Rheumatology Department, Cotronei, Italy
  4. 4Ospedale S. Raffaele, Milano, Italy, Rheumatology Department, Milano, Italy
  5. 5Rheumatology, Sapienza-University of Rome, Italy, Rheumatology Department, Roma, Italy
  6. 6Rheumatology, University of Padova, Italy, Rheumatology Department, Padova, Italy
  7. 7Rheumatology, University of Florence, Italy, Rheumatology Department, Firenze, Italy
  8. 8Clinical Immunology, University of Pisa, Pisa, Italy, Immunology, Pisa, Italy
  9. 9AOU Policlinico Vittorio Emanuele, Catania, Italy, Rheumatology Department, Catania, Italy
  10. 10University of Campania, Luigi Vanvitelli, Napoli, Italy, Rheumatology Department, Napoli, Italy
  11. 11Rheumatology Clinic, Marche Polytechnic University, Ancona. Italy, Dpt Clinical & Molecular Sciences, Ancona, Italy
  12. 12Ospedale “Villa Salus” Mestre, Italy, Rheumatology Department, Mestre, Italy
  13. 13Ospedale Policlinico S. Martino-University of Genova, Italy, Rheumatology Department, Genova, Italy
  14. 14Rheumatology, Spedali Civili di Brescia, Italy, Rheumatology Department, Brescia, Italy
  15. 15ASO S. Croce e Carle, Cuneo, Italy, Rheumatology Department, Cuneo, Italy
  16. 16Rheumatology, Policlinico San Matteo, Pavia, Italy, Rheumatology Department, Pavia, Italy
  17. 17Rheumatology, University of Milano, Italy, Rheumatology Department, Milano, Italy
  18. 18U.O.C. Medicina Interna “M.Valentini” P.O. Annunziata Cosenza, Italy, Medicine, Cosenza, Italy
  19. 19U.O.S. Reumatologia, Ospedale Castrovillari, Cosenza, Italy, Rheumatology Department, Castrovillari, Italy
  20. 20Rheumatology, University of Pisa, Pisa, Italy, Rheumatology Department, Pisa, Italy
  21. 21Istituto Clinico Humanitas, Rozzano, Milano, Italy, Rheumatology Department, Milano, Italy
  22. 22AOR San Carlo di Potenza, Potenza, Italy, Rheumatology Department, Potenza, Italy
  23. 23Rheumatology, University of Catania, Catania Italy, Rheumatology Department, Catania, Italy
  24. 24UOD Reumatologia- Grande Ospedale Metropolitano, Reggio Calabria, Italy, Rheumatology Department, Reggio Calabria, Italy
  25. 25Rheumatology Outpatient Clinic, ASP- Vibo Valentia–Tropea Hospital, Italy, Rheumatology Department, Tropea, Italy
  26. 26Rheumatology, Università del Molise, Campobasso, Italy, Rheumatology Department, Campobasso, Italy
  27. 27Rheumatology Clinic ‘Madonna dello Scoglio’ Cotronei, Crotone, Italy, Rheumatology Department, Cotronei, Italy
  28. 28U.O.T. Specialistica Ambulatoriale ASP 201, Cosenza, Italy, Rheumatology Department, Cosenza, Italy
  29. 29Ospedale di Portoferraio, Livorno, Italy, Rheumatology Department, Livorno, Italy
  30. 30Rheumatology Outpatient Clinic, San Giovanni di Dio Hospital, Crotone, Italy, Rheumatology Department, Crotone, Italy
  31. 31University of Bologna, Rizzoli Orthopaedic Institute Bologna, Bologna, Italy, Rheumatology Department, Bologna, Italy
  32. 32Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy, Rheumatology Department, Napoli, Italy
  33. 33UO Reumatologia – DETO, Università di Bari, Italy, Rheumatology Department, Bari, Italy
  34. 34University of Pisa, School of Medicine, Pisa, Italy, Department of Clinical and Experimental Medicine, Pisa, Italy
  35. 35University of Pisa, School of Medicine, Pisa, Italy, Department of Translational Research & New Technologies in Medicine and Surgery, Pisa, Italy
  36. 36University of Pisa, School of Medicine, Pisa, Italy, Translational Research and New Technologies in Medicine and Surgery, Pisa, Italy
  37. 37University of Pisa, School of Medicine, Pisa, Italy, Clinical and Experimental Medicine, Pisa, Italy

Abstract

Background: SARS-CoV-2 infection poses a serious challenge for patients with rheumatic autoimmune systemic diseases (ASD), characterized by marked immune-system dysregulation and frequent visceral organ involvement.

Objectives: To evaluate the impact of Covid-19 pandemic in a large series of Italian patients with ASD.

Methods: Our multicenter telephone survey (8-week period, March-April 2020) included a large series of 2,994 patients (584 M, 2,410 F, mean age 58.9±13.4SD years) with ASD followed at 34 tertiary referral centers of 14 regions of northern, central, and southern Italian macro areas, characterized by different prevalence of SARS-CoV-2 infection. According to currently used criteria, Covid-19 was classified as definite Covid-19 (signs or symptoms of Covid-19 confirmed by positive oral/nasopharyngeal swabs at PCR testing) or highly suspected Covid-19 (signs or symptoms highly suggestive of Covid-19, but not confirmed by PCR testing due to limited availability of virological tests in that period). The results were analyzed performing the Odds Ratio by Java-Stat 2-way Contingency Table Analysis.

Results: The main findings of the survey study revealed a significantly increased prevalence of Covid-19 in:

a.the whole series of ASD patients (definite Covid-19: 22/2994, 0.73%; p=0.0007;

definite Covid-19 plus highly suspected Covid-19: 74/2,994, 2.47%; p<0.0001) when compared to Italian general population of Covid-19 infected individuals (349/100000 = 0.34%; data from Italian Superior Institute of Health;

https://www.epicentro.iss.it/en/coronavirus/sars-cov-2-national-surveillance-system).

b.the subgroup of patients with connective tissue diseases or systemic vasculitis (n = 1,901) compared to the subgroup of inflammatory arthritis (n = 1,093), namely rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis (definite Covid-19: 19/1,901, 0.99%, vs 3/1,093, 0.27%; p=0.036; definite Covid-19 plus highly suspected Covid-19: 69/1,901, 3.6%, vs 5/1,093, 0.45%; p<0.0001)

c.the subgroup of patients with pre-existing interstitial lung involvement (n = 526) compared to those without (n = 2,468) (definite Covid-19: 10/526, 1.90%, vs 12/2,468, 0.48%; p=0.0015; definite Covid-19 plus highly suspected Covid-19: 33/526, 6.27%, vs 41/2,468, 1.66%; p<0.0001).

Of interest, the prevalence of Covid-19 did not correlate with presence/absence of different comorbidities, mainly diabetes, cardio-vascular and/or renal disorders, as well as of ongoing treatments with biological DMARDs; while patients treated with conventional DMARDs showed a significantly lower prevalence of Covid-19 compared to those without. Covid-19 was more frequently observed in the patients’ populations from northern and central compared to southern Italian macro area with lower diffusion of pandemic. Clinical manifestations of Covid-19, observed in 74 patients, were generally mild or moderate; 4/9 individuals requiring hospital admission died for severe pneumonia.

Conclusion: The prevalence of Covid-19 observed in ASD patients during the first wave of pandemic was significantly higher than that observed in Italian general population; moreover, the actual prevalence of Covid-19 might be underestimated due to the high number of mild variants as well as the possible clinical overlapping between these two conditions. Patients with ASD should be invariably regarded as ‘frail patients’ during the pandemic course, considering the risk of worse outcome in the acute phase of Covid-19, as well as the potential long-term effects of viral infection.

The statistically significant association of Covid-19 with connective tissue diseases/systemic vasculitis, as well as with pre-existing interstitial lung involvement, suggests the presence of distinct clinico-pathological ASD subsets, characterized by markedly different patients’ vulnerability to SARS-CoV-2 infection.

Disclosure of Interests: None declared

https://doi.org/10.1136/annrheumdis-2021-eular.3493

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