Background/Purpose: The coronavirus disease 2019 (COVID-19) pandemic is of particular concern for people with autoimmune rheumatic diseases and for those who are immunosuppressed given the risk for complications during and after the acute infection. Some studies on SLE have been reported, but most have evaluated the clinical manifestations, complications, and outcomes of COVID-19 rather than the impact on lupus. As seen for other viral infections, COVID-19 could induce an exacerbation of lupus. Therefore, we studied the short- and mid-term clinical outcomes after COVID-19 in a cohort of lupus patients.

Methods: A cohort of adult Puerto Ricans with SLE (per 1997 American College of Rheumatology classification criteria) was studied from March 2020 to May 2021. Demographic parameters, COVID-19 manifestations, SLE manifestations, disease activity (per Systemic Lupus Erythematosus Disease Activity Index ([SLEDAI]), disease damage (per Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), pharmacologic treatment, SLE exacerbations, emergency room (ER) visits, and hospitalizations were ascertained. SARS CoV-2 infection was confirmed by polymerase chain reaction test. The proportion of COVID-19 cases was compared to the entire population of Puerto Rico per data provided by the Department of Health.

Results: Of the entire SLE cohort (n=337), 18 patients (5.3%) had COVID-19. During the same study period, 3.7% of the adult population of Puerto Rico had COVID-19, but this was not statistically different from that observed for SLE patients (p=0.11). The mean (standard deviation [SD]) age of SLE patients that had COVID-19 was 43.7 (8.9) years; 94.4% were female. Except for one patient who had COVID-19 pneumonia requiring hospitalization and oxygen therapy, the rest had mild symptoms (77.8%) or were asymptomatic (22.2%). The main COVID-19 manifestations were anosmia (50.0%), myalgias (50.0%), polyarthralgia (35.7%), headaches (35.7%), fever (22.6%), and fatigue (22.6%). At the time of COVID-19, patients had mean (SD) SLEDAI and SDI scores of 0.7 (0.3) and 1.0 (1.1), respectively, and were receiving therapy with hydroxychloroquine (72.2%), corticosteroids (66.7%), mycophenolate mofetil (50.0%), tacrolimus (11.1%), and azathioprine (11.1%). Patients were followed for a mean (SD) period of 6.8 (2.8) months. During the follow-up, none had disease exacerbations, ER visits, hospitalizations, or worsening of disease activity or damage accrual.

Conclusion: In this group of Puerto Ricans with SLE, 5.3% had COVID-19. All patients had low disease activity or were in clinical remission at the time of infection. After a mean follow-up of nearly 7 months after infection, none had disease exacerbations or damage accrual. This study suggests that COVID-19 does not have a negative impact in the short and mid-term clinical outcomes of these patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-outcomes-in-a-cohort-of-puerto-ricans-with-systemic-lupus-erythematosus-after-sars-cov-2-infection/