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Article Type

Original Study

Abstract

Objective The patients who have rheumatic diseases and have coronavirus disease 2019 (COVID-19) infection, their clinical features have not been reported. This study aims to identify the characteristic clinical features of COVID-19 in patients with rheumatic diseases admitted either inside or outside the ICU and present data to handle these conditions in clinical practice. Patients and methods We conducted a retrospective study, including data about the sex, age, laboratory and radiographic findings, clinical symptoms and signs, ICU admission, and drug history, from 180 patients having COVID-19 infection, and includes 61 patients having in combination of rheumatic diseases, in the period between April and June 2020 in Mataria Teaching Hospital. Results The risk of admission in the ICU in the rheumatic group 20 (32.8%) did not exceed those expected in the nonrheumatic group 59 (49.6%). Nevertheless, the mortality of these patients was lower three (15%) than nonrheumatic group who were admitted in the ICU 33 (55.9%). Patients with rheumatic diseases presented with less symptoms and signs of respiratory failure, in comparison with those not having rheumatic diseases (rheumatic group vs. nonrheumatic group: 34.4 vs. 49.6%, P < 0.005). Comorbidities were similar in those with rheumatic diseases and comparators [25 (41.0%) vs. 48 (40.3%), respectively]. Symptoms of fever, fatigue, and diarrhea were seen in 55.7, 78.7, and 41% of patients, respectively. Nine patients with rheumatic diseases developed rheumatic disease flare during their hospital stay, represented in muscle aches, rash, and pain in the back and joints. Lymphocytopenia was seen in 16.7% of patients with rheumatic diseases, but 14.8% of patients presented with leukopenia. Patients with rheumatic diseases experienced same radiographic findings of ground-glass opacity and consolidation. Patients who have preexisting interstitial lung disease presented at an early stage with massive fibrous stripes and crazy-paving signs. Conclusions Symptoms of respiratory failure were less common in patients with rheumatic diseases infected with COVID-19. The ICU admission in the rheumatic group did not exceed those expected in the nonrheumatic group. Differential diagnosis should be considered between COVID-19 infection and rheumatic disease flare.

Keywords

Rheumatic patients, Covid – 19, Intensive care unit, Respiratory failure

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