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. 2024 Sep 21;12(9):2145.
doi: 10.3390/biomedicines12092145.

Unraveling the Impact of COVID-19 on Rheumatoid Arthritis: Insights from Two Romanian Hospitals-Preliminary Results

Andreea-Iulia Vlădulescu-Trandafir  1   2 , Gelu Onose  1   2 , Constantin Munteanu  2   3 , Ioana Iancu  4 , Andra-Rodica Bălănescu  1   5 , Daniela Opriș-Belinski  1   5 , Florian Berghea  1   5 , Cristiana Prefac  5 , Elena Grădinaru  5 , Sorina Aurelian  1   6 , Vlad Ciobanu  7 , Violeta-Claudia Bojincă  1   5
Affiliations

Unraveling the Impact of COVID-19 on Rheumatoid Arthritis: Insights from Two Romanian Hospitals-Preliminary Results

Andreea-Iulia Vlădulescu-Trandafir et al. Biomedicines. .

Abstract

Background: Rheumatoid arthritis (RA) patients are at heightened risk of Coronavirus Disease-19 (COVID-19) complications due to immune dysregulation, chronic inflammation, and treatment with immunosuppressive therapies. This study aims to characterize the clinical and laboratory parameters of RA patients diagnosed with COVID-19, identify predictive risk factors for severe forms of this infection for RA patients, and determine if any RA immunosuppressive therapy is associated with worse COVID-19 outcomes.

Methods: A retrospective observational case-control study included 86 cases (43 diagnosed with RA and 43 cases without any inflammatory or autoimmune disease) that suffered from SARS-CoV-2 in two Romanian hospitals between March 2020 and February 2024. Data on demographics, RA disease characteristics, COVID-19 severity, treatment regimens, and outcomes were analyzed.

Results: RA patients exhibited a distinct symptom profile compared to non-RA controls, with higher incidences of neurological, musculoskeletal, and gastrointestinal symptoms, while the control group showed more respiratory and systemic manifestations. Severe COVID-19 is correlated with age and laboratory markers like erythrocyte sedimentation rate (ESR), leucocytes, neutrophils, neutrophil-to-lymphocyte ratio (NLR), aspartate aminotransferase (AST), serum creatinine, and urea. Additionally, RA treatments, particularly rituximab (RTX), were associated with more severe COVID-19 outcomes (but with no statistical significance), potentially due to the advanced disease stage and comorbidities in these patients. Post-infection, a significant number of RA patients experienced disease flares, necessitating adjustments in their treatment regimens.

Conclusions: This study underscores the complex interplay between RA and COVID-19, highlighting significant clinical heterogeneity and the need for tailored management strategies. Limitations include sample size constraints, possible selection, and information bias, as well as the lack of adjustments for potential confounding variables that hinder the ability to formulate definitive conclusions. Future research plans to expand the research group size and further elucidate these relationships.

Keywords: COVID-19; clinical characteristics; rheumatoid arthritis; severity; treatment outcomes.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The age histogram (measured in years) for the patients in the RA sample.
Figure 2
Figure 2
Distribution of COVID-19 clinical manifestations in the study sample.
Figure 3
Figure 3
Types of COVID-19-specific treatment in the sample studied.
Figure 4
Figure 4
The distribution of the most common comorbidities in our groups. BPH: benign prostate hyperplasia; CHD: coronary heart disease; CHF: chronic heart failure; COPD: chronic obstructive pulmonary disease; CKD: chronic kidney disease; CVI: chronic venous insufficiency; DM: diabetes mellitus; ILD: interstitial lung disease; PAD: peripheral artery disease; OA: osteoarthritis.
Figure 5
Figure 5
Distribution of RA treatment in our study group.
See this image and copyright information in PMC

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