Background/Purpose: In mid-March 2020, state of alarm was declared in Spain due to the novel coronavirus disease 2019 (COVID-19) pandemic. Patients with rheumatic diseases (RD) under immunosuppressive drugs are considered at high risk of severe outcome. Some commonly used treatments in RD such as corticosteroids, hydroxycloroquine or anti-IL6 drugs are also hypothesized to help treat COVID-19. We set out to determine the prevalence of SARS-CoV-2 infection among patients who reported respiratory symptoms during COVID-19 pandemic from March up to June 2020 in a group of patients treated with biological agents such as anti-TNF, anti-IL6, abatacept and JAK inhibitors like baricitinib or tofacitinib.

Methods: A registry of all patients under treatment with adalimumab, anti-IL6, abatacept, baricitinib and tofacitinib in our Rheumatology Service was obtained. All the patients were called and asked to participate in a telephone survey screening for infectious respiratory symptoms in the past 4 months (phone calls were made from mid-April to early-June). Other epidemiological data (previous contact with a suspected case, number of household members and confinement measures) were collected. Reported symptoms were evaluated by a clinician to assess whether or not these were suggestive of acute respiratory disease.  Those who presented new onset acute respiratory symptoms were tested for SARS-Cov-2 serology (IgM/IgG). 

Results: A total of 355 patients participated in the survey, 66.5% were females. Mean age (S.D.) was 54.7 years (16.5). Rheumatoid arthritis was the most common diagnosis (56%), followed by spondyloarthritis (16.3%), psoriasic arthritis (11.3%), idiopathic juvenile arthritis (6.8%) and others (9.6%). Adalimumab (46%) and tocilizumab (20.9%) were the most common treatment groups, followed by abatacept (12.4%), tofacitinib (12.1%), baricitinib (6.5%) and sarilumab (2.3%). Mean time under current treatment was 59.8 months.

Patients were asked for the presence of respiratory symptoms out of a list with 20 items. Follow-up questions were asked when necessary to determine the acute or chronic nature of the symptoms. The most common reported symptoms were cough (8.2%), odynophagia (6.8%), fatigue (5.4%), shortness of breath (4.8%), joint or muscular pain (3.7%) and diarrhea (3.4%). 87.24% complied with the confinement measures. 4.94% reported contact with people with symptoms suspicious of COVID-19. No patient required hospital care.

A total of 25 were selected for serological testing based on reported symptoms compatible with COVID-19 disease. The remaining 330 patients reported no symptoms or had symptoms not attributable to infection. Peak incidence of reported symptoms occurred in March (n = 10). All patients tested negative for IgM and only one patient was positive for IgG. 

Conclusion: Patients with RD showed a high level of compliance to confinement measures. COVID-19 was extremely low among patients with RD treated with biological agents or JAK inhibitors. Confinement measures are key to prevent SARS-Cov-2 transmission. 

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/serological-evidence-of-sars-cov-2-in-symptomatic-patients-under-biological-treatment-in-a-rheumatology-service/