Abstract：
This study aims to explore disease patterns of coronavirus disease (COVID-19) in patients with rheumatic musculoskeletal disorders (RMD) treated with immunosuppressive drugs in comparison with the general population. The observational study considered a cohort of RMD patients treated with biologic drugs or small molecules from September 2019 to November 2020 in the province of Udine, Italy. Data include the assessment of both pandemic waves until the start of the vaccination, between February 2020 and April 2020 (first), and between September 2020 and November 2020 (second). COVID-19 prevalence in 1051 patients was 3.5% without significant differences compared to the general population, and the course of infection was generally benign with 2.6% mortality. A small percentage of COVID-19 positive subjects were treated with low doses of steroids (8%). The most used treatments were represented by anti-TNF agents (65%) and anti-IL17/23 agents (16%). More than two-thirds of patients reported fever, while gastro-intestinal symptoms were recorded in 27% of patients and this clinical involvement was associated with longer swab positivity. The prevalence of COVID-19 in RMD patients has been confirmed as low in both waves. The benign course of COVID-19 in our patients may be linked to the very low number of chronic corticosteroids used and the possible protective effect of anti-TNF agents, which were the main class of biologics herein employed. Gastro-intestinal symptoms might be a predictor of viral persistence in immunosuppressed patients. This finding could be useful to identify earlier COVID-19 carriers with uncommon symptoms, eventually eligible for antiviral drugs.
摘要：
这项研究旨在探索与普通人群相比，接受免疫抑制药物治疗的风湿性肌肉骨骼疾病（RMD）患者中冠状病毒病（COVID-19）的疾病模式。该观察性研究考虑了2019年9月至2020年11月在乌迪内省接受生物药物或小分子治疗的RMD患者队列，意大利。数据包括对两次大流行浪潮的评估，直到疫苗接种开始，2020年2月至2020年4月（第一次），2020年9月至2020年11月（第二次）。1051例患者的COVID-19患病率为3.5%，与普通人群相比无显著差异，感染过程通常是良性的，死亡率为2.6％。一小部分COVID-19阳性受试者接受了低剂量类固醇治疗(8%)。最常用的治疗以抗TNF剂(65%)和抗IL17/23剂(16%)为代表。超过三分之二的患者报告发烧，而27％的患者记录到胃肠道症状，这种临床参与与更长的拭子阳性相关。已证实COVID-19在RMD患者中的患病率在两个波中都很低。COVID-19在我们患者中的良性病程可能与使用的慢性皮质类固醇的数量很少以及抗TNF药物的可能的保护作用有关，这是这里使用的主要生物制剂。胃肠道症状可能是免疫抑制患者中病毒持续存在的预测因子。这一发现可能有助于识别早期症状不常见的COVID-19携带者，最终有资格获得抗病毒药物。
