Background and Aims:The National Multiple Sclerosis Society and other expert organizations recommended that all patients with multiple sclerosis (MS) should be vaccinated against COVID-19. However,...

Humoral immune response to COVID-19 mRNA vaccine in patients with multiple sclerosis treated with high-efficacy disease-modifying therapies

The COVID-19 pandemic has infected millions worldwide, leaving a global burden for long-term care of COVID-19 survivors. It is thus imperative to study post-COVID (i.e., short-term) and long-COVID (i.e., long-term) effects, specifically as local and systemic pathophysiological outcomes of other coronavirus-related diseases (such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS)) were well-cataloged. We conducted a comprehensive review of adverse post-COVID health outcomes and potential long-COVID effects. We observed that such adverse outcomes were not localized. Rather, they affected different human systems, including: (i) immune system (e.g., Guillain-Barre syndrome, rheumatoid arthritis, pediatric inflammatory multisystem syndromes such as Kawasaki disease), (ii) hematological system (vascular hemostasis, blood coagulation), (iii) pulmonary system (respiratory failure, pulmonary thromboembolism, pulmonary embolism, pneumonia, pulmonary vascular damage, pulmonary fibrosis), (iv) cardiovascular system (myocardial hypertrophy, coronary artery atherosclerosis, focal myocardial fibrosis, acute myocardial infarction, cardiac hypertrophy), (v) gastrointestinal, hepatic, and renal systems (diarrhea, nausea/vomiting, abdominal pain, anorexia, acid reflux, gastrointestinal hemorrhage, lack of appetite/constipation), (vi) skeletomuscular system (immune-mediated skin diseases, psoriasis, lupus), (vii) nervous system (loss of taste/smell/hearing, headaches, spasms, convulsions, confusion, visual impairment, nerve pain, dizziness, impaired consciousness, nausea/vomiting, hemiplegia, ataxia, stroke, cerebral hemorrhage), (viii) mental health (stress, depression and anxiety). We additionally hypothesized mechanisms of action by investigating possible molecular mechanisms associated with these disease outcomes/symptoms. Overall, the COVID-19 pathology is still characterized by cytokine storm that results to endothelial inflammation, microvascular thrombosis, and multiple organ failures.

https://www.mdpi.com/1999-4915/13/4/700/pdf

Long-COVID and Post-COVID Health Complications: An Up-to-Date Review on Clinical Conditions and Their Possible Molecular Mechanisms.

http://www.thelancet.com/article/S2665991321003258/pdf

Long-term use of immunosuppressive medicines and in-hospital COVID-19 outcomes: a retrospective cohort study using data from the National COVID Cohort Collaborative

At the beginning of the COVID-19 pandemic, patients with immune-mediated inflammatory diseases were considered to be at high risk for SARS-CoV-2 infection and the development of severe COVID-19. Data collected over the past year, however, suggest that a diagnosis of inflammatory arthritis, psoriasis, or inflammatory bowel diseases does not increase risk for SARS-CoV-2 infection or severe COVID-19 compared with people without these diseases. Furthermore, substantial data suggest that certain medications frequently used in patients with immune-mediated inflammatory diseases, in particular cytokine inhibitors, might even lower the risk for severe COVID-19. Conversely, glucocorticoids and potentially B-cell-depleting treatments seem to worsen COVID-19 outcomes. Additionally, the first data on SARS-CoV-2 vaccination in patients with these diseases suggest that tolerability of vaccination in patients with immune-mediated inflammatory diseases is good, although the immune response to vaccination can be somewhat reduced in this patient group, particularly those taking methotrexate or CD20-targeted treatment.

COVID-19 and immune-mediated inflammatory diseases: effect of disease and treatment on COVID-19 outcomes and vaccine responses.

Less than a year since the start of the COVID-19 pandemic, ten vaccines against SARS-CoV-2 have been approved for at least limited use, with over sixty others in clinical trials. This swift achievement has generated excitement and arrives at a time of great need, as the number of COVID-19 cases worldwide continues to rapidly increase. Two vaccines are currently approved for full use, both built on mRNA and lipid nanotechnology platforms, a success story of mRNA technology 20 years in the making. For patients with cancer, questions arise around the safety and efficacy of these vaccines in the setting of immune alterations engendered by their malignancy and/or therapies. We summarize the current data on leading COVID-19 vaccine candidates and vaccination of patients undergoing immunomodulatory cancer treatments. Most current cancer therapeutics should not prevent the generation of protective immunity. We call for more research in this area and recommend that the majority of patients with cancer receive COVID vaccinations when possible.

/pdf/covid-19-vaccines-for-patients-with-cancer-benefits-likely-15dedylxq9.pdf

COVID-19 vaccines for patients with cancer: benefits likely outweigh risks.

The objective of this study is to describe the characteristics and outcomes of rheumatic and musculoskeletal disease (RMD) patients who were treated with rituximab and had suspected or confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this descriptive study, RMD patients who were treated with rituximab in the last 12 months at the Rheumatology Department of our hospital were screened for SARS-CoV-2 infection via telephone interview and a comprehensive review of clinical health records (01/02/2020-26/05/2020). Those with probable or confirmed SARS-CoV-2 infection were included. In total, 76 patients were screened. Of these, 13 (17.1%) had suspected or confirmed SARS-CoV-2 infection. With regard to these 13 patients, the median age at coronavirus disease (COVID-19) diagnosis was 68 years (range 28-76 years) and 8 (61.5%) were female. Five patients had rheumatoid arthritis, three had systemic vasculitis, two had Sjogren syndrome, and two had systemic lupus erythematosus. Additionally, seven patients (53.8%) had pulmonary involvement secondary to RMD. Eight patients (61.5%) developed severe disease leading to hospitalization, and seven developed bilateral pneumonia and respiratory insufficiency. Of the eight hospitalized patients, five (62.5%) fulfilled the acute respiratory distress syndrome criteria and three developed a critical disease and died. Our cohort had a high rate of severe disease requiring hospitalization (61.5%), with bilateral pneumonia and hyperinflammation leading to a high mortality rate (23.1%). Treatment with rituximab should be considered a possible risk factor for unfavorable outcomes in COVID-19 patients with RMD. However, further study is required to confirm this association.

/pdf/high-rates-of-severe-disease-and-death-due-to-sars-cov-2-2jismfakbb.pdf

High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study.

I nfectious arthritis and monoarticular gout flares have important clinical similarities. However, the management of these 2 conditions is substantially different. In the first case, hospital admission and often surgical clearance are required, and in the second case, management may be ambulatory even after an intra-articular steroid injection. In fact, their discrimination is a challenge even for veteran clinicians. Clinical features of these 2 conditions are overlapping and in both the development of symptoms may follow an acute or hyperacute pattern. In circumstances of usual clinical practice, the development of arthritis in a patient with a previous diagnosis of gout will intensely seduce the clinician to diagnose a new gout outbreak. This becomes even more feasible in emergency medicine or primary care settings, especially when the affected joint is not as accessible by puncture as a knee or elbow. The consequences of delaying the diagnosis of infectious arthritis are well known: deterioration of articular cartilage, loss of joint function, sepsis, and even mortality. The immediately available conventional evidence is not sufficient to assist the clinician to rule out septic arthritis in a patient with suspected monoarticular gout outbreak. Both the erythrocyte sedimentation rate and C-reactive protein will be elevated in both conditions. The results of the microbiological study by Gram staining do not have sufficient specificity to use them in decision making, and the time needed to have the result of a synovial fluid culture makes this test unhelpful. Recently, it has been postulated that the serological determination of procalcitonin is useful in the diagnosis of osteomyelitis and septic arthritis using a cutoff point of 0.4 ng/μL. However, the included population presented infectious arthritis or another form of arthritis, without specifying its etiology; therefore, only some of the “control” patients could have had a previous diagnosis of gout. The aim of our study was to determine the accuracy of the serum determination of procalcitonin in the diagnosis of septic arthritis in patients with a known history of gout. Our hypothesis is that in order to distinguish 2 pathologies with a large systemic inflammatory component a higher level of serum procalcitonin would be useful to differentiate septic arthritis from gouty arthritis.

Procalcitonin Serum Level Is a Specific Marker to Distinguish Septic Arthritis of the Knee in Patients With a Previous Diagnosis of Gout.

Introduction: Dactylitis is a manifestation of gout that can occur on debut or throughout the course of the disease, although it is usually considered a sign of chronicity or a hallmark of long-term disease. The etiological prevalence based on imaging studies is unknown. The aim of present study is to determine the prevalence of different ultrasonographic features of dactylitis of the hands in patients with gout. Methods: A cross-sectional study was conducted based on a registry of ultrasound images of patients with gout and clinical dactylitis either in debut or throughout evolution. Results: We included images of 66 patients diagnosed with gout and with dactylitis of at least one finger at the time of the ultrasound evaluation. The mean age of the patients was 59.2 standard deviation 4.3 years. 62 patients were male. Of the total number of patients, 60 had tenosynovitis of the flexor tendinous apparatus (90.9%). Four of these patients also presented tenosynovitis of the tendinous extensor apparatus. No patient presented only extensor tenosynovitis. Enthesopathy was identified in 6 patients (9.1%), in no case did enthesopathy occur with power Doppler (PD) signal. Synovitis was identified in 43 patients (65.1%). Of these, in 13 patients a Grade I was registered and in 26 a PD signal was demonstrated. Tophi were identified in 16 patients (24.2%). Conclusions: This is, as far as we know, the first iconographic prevalence study of gouty dactylitis based on ultrasound. According to our results, tenosynovitis of the flexors is the most frequent finding in gouty dactylitis while enthesopathy is rather rare. Our results demonstrate a main etiological difference of the gouty dactylitis and those seen in spondyloarthritis.

/pdf/ultrasound-characterization-of-gouty-dactylitis-5g14tlclku.pdf

Verónica García-García

Papers

High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study.

Procalcitonin Serum Level Is a Specific Marker to Distinguish Septic Arthritis of the Knee in Patients With a Previous Diagnosis of Gout.

Ultrasound Characterization of Gouty Dactylitis