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Zachary S Wallace - One of the best experts on this subject based on the ideXlab platform.
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response to correspondence on sars cov 2 antibody response after covid 19 in patients with Rheumatic Disease by shanoj et al
Annals of the Rheumatic Diseases, 2021Co-Authors: Kristin M Dsilva, Naomi Serlingboyd, Tiffany Y T Hsu, Jeffrey A Sparks, Zachary S WallaceAbstract:We appreciate the comments by Shanoj et al 1 in response to our letter regarding the SARS-CoV-2 antibody response after COVID-19 in patients with Rheumatic Disease.2 Examining whether patients treated with CD20 inhibitors have antibody responses to SARS-CoV-2 is a question of great clinical importance in the management and vaccination of patients taking these medications during the COVID-19 pandemic. Shanoj et al describe anti-spike and anti-nucleocapsid antibody test results among five patients with PCR-confirmed COVID-19 and prior exposure to rituximab.1 Among these patients, one patient developed neither anti-spike nor anti-nucleocapsid antibodies.1 This patient had been treated with rituximab for several years and had no detectable CD19+ B cells shortly before the onset of COVID-19.1 One patient developed anti-spike but not anti-nucleocapsid antibodies; although the duration of rituximab treatment is not provided, this …
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sars cov 2 antibody response after covid 19 in patients with Rheumatic Disease
Annals of the Rheumatic Diseases, 2021Co-Authors: Kristin M Dsilva, Naomi Serlingboyd, Tiffany Y T Hsu, Jeffrey A Sparks, Zachary S WallaceAbstract:The impacts of Rheumatic Disease and immunosuppression on the development of antibodies to SARS-CoV-2 are unknown. A study of healthcare workers showed that detectable SARS-CoV-2 antibodies were associated with reduced risk of SARS-CoV-2 reinfection, and the robustness of this neutralising antibody response has implications for seroprevalence studies and vaccine efficacy.1 While Disease-modifying antiRheumatic drugs (DMARDs) generally blunt the immune response to pathogens, immunosuppressive medications such as dexamethasone and baricitinib have efficacy in reducing the severity of COVID-19.2 3 Additionally, tumour necrosis factor inhibition has been proposed as a potential mechanism for enhancing germinal centre formation and antibody production in severe COVID-19.4 Understanding the SARS-CoV-2 antibody response after COVID-19 among Rheumatic Disease patients is therefore of particular interest.5 We examined the SARS-CoV-2 antibody response among patients with Rheumatic Diseases and past COVID-19 at the Mass General Brigham (MGB) health system in Boston, Massachusetts, USA. Patients with COVID-19 confirmed by positive PCR testing and Rheumatic Disease confirmed by electronic health record (EHR) review were identified as previously described.6 We …
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clinical characteristics and outcomes of patients with coronavirus Disease 2019 covid 19 and Rheumatic Disease a comparative cohort study from a us hot spot
Annals of the Rheumatic Diseases, 2020Co-Authors: Kristin M Dsilva, Hyon K Choi, Naomi Serlingboyd, Rachel Wallwork, Tiffany Y T Hsu, Ellen M Gravallese, Jeffrey A Sparks, Zachary S WallaceAbstract:Objective To investigate differences in manifestations and outcomes of coronavirus Disease 2019 (COVID-19) infection between those with and without Rheumatic Disease. Methods We conducted a comparative cohort study of patients with Rheumatic Disease and COVID-19 (confirmed by severe acute respiratory syndrome coronavirus 2 PCR), compared in a 1:2 ratio with matched comparators on age, sex and date of COVID-19 diagnosis, between 1 March and 8 April 2020, at Partners HealthCare System in the greater Boston, Massachusetts area. We examined differences in demographics, clinical features and outcomes of COVID-19 infection. The main outcomes were hospitalisation, intensive care admission, mechanical ventilation and mortality. Results We identified 52 Rheumatic Disease patients with COVID-19 (mean age, 63 years; 69% female) and matched these to 104 non-Rheumatic Disease comparators. The majority (39, 75%) of patients with Rheumatic Disease were on immunosuppressive medications. Patients with and without Rheumatic Disease had similar symptoms and laboratory findings. A similar proportion of patients with and without Rheumatic Disease were hospitalised (23 (44%) vs 42 (40%)), p=0.50) but those with Rheumatic Disease required intensive care admission and mechanical ventilation more often (11 (48%) vs 7 (18%), multivariable OR 3.11 (95% CI 1.07 to 9.05)). Mortality was similar between the two groups (3 (6%) vs 4 (4%), p=0.69). Conclusions Patients with Rheumatic Disease and COVID-19 infection were more likely to require mechanical ventilation but had similar clinical features and hospitalisation rates as those without Rheumatic Disease. These findings have important implications for patients with Rheumatic Disease but require further validation.
Jeffrey A Sparks - One of the best experts on this subject based on the ideXlab platform.
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response to correspondence on sars cov 2 antibody response after covid 19 in patients with Rheumatic Disease by shanoj et al
Annals of the Rheumatic Diseases, 2021Co-Authors: Kristin M Dsilva, Naomi Serlingboyd, Tiffany Y T Hsu, Jeffrey A Sparks, Zachary S WallaceAbstract:We appreciate the comments by Shanoj et al 1 in response to our letter regarding the SARS-CoV-2 antibody response after COVID-19 in patients with Rheumatic Disease.2 Examining whether patients treated with CD20 inhibitors have antibody responses to SARS-CoV-2 is a question of great clinical importance in the management and vaccination of patients taking these medications during the COVID-19 pandemic. Shanoj et al describe anti-spike and anti-nucleocapsid antibody test results among five patients with PCR-confirmed COVID-19 and prior exposure to rituximab.1 Among these patients, one patient developed neither anti-spike nor anti-nucleocapsid antibodies.1 This patient had been treated with rituximab for several years and had no detectable CD19+ B cells shortly before the onset of COVID-19.1 One patient developed anti-spike but not anti-nucleocapsid antibodies; although the duration of rituximab treatment is not provided, this …
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association of race and ethnicity with covid 19 outcomes in Rheumatic Disease data from the covid 19 global rheumatology alliance physician registry
Arthritis & Rheumatism, 2021Co-Authors: Milena Gianfrancesco, Zara Izadi, Jeffrey A Sparks, Liza A Leykina, Tiffany Taylor, Carly Harrison, Laura Trupin, Stephanie Rush, Gabriela Schmajuk, Patricia P KatzAbstract:Objective Racial/ethnic minorities experience more severe outcomes of coronavirus Disease 2019 (COVID-19) in the general US population. This study was undertaken to examine the association between race/ethnicity and COVID-19 hospitalization, ventilation status, and mortality in people with Rheumatic Disease. Methods US patients with Rheumatic Disease and COVID-19 were entered into the COVID-19 Global Rheumatology Alliance physician registry between March 24, 2020 and August 26, 2020 were included. Race/ethnicity was defined as White, African American, Latinx, Asian, or other/mixed race. Outcome measures included hospitalization, requirement for ventilatory support, and death. Multivariable regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) adjusted for age, sex, smoking status, Rheumatic Disease diagnosis, comorbidities, medication use prior to infection, and Rheumatic Disease activity. Results A total of 1,324 patients were included, of whom 36% were hospitalized and 6% died; 26% of hospitalized patients required mechanical ventilation. In multivariable models, African American patients (OR 2.74 [95% CI 1.90-3.95]), Latinx patients (OR 1.71 [95% CI 1.18-2.49]), and Asian patients (OR 2.69 [95% CI 1.16-6.24]) had higher odds of hospitalization compared to White patients. Latinx patients also had 3-fold increased odds of requiring ventilatory support (OR 3.25 [95% CI 1.75-6.05]). No differences in mortality based on race/ethnicity were found, though power to detect associations may have been limited. Conclusion Similar to findings in the general US population, racial/ethnic minorities with Rheumatic Disease and COVID-19 had increased odds of hospitalization and ventilatory support. These results illustrate significant health disparities related to COVID-19 in people with Rheumatic Diseases. The rheumatology community should proactively address the needs of patients currently experiencing inequitable health outcomes during the pandemic.
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association of race and ethnicity with covid 19 outcomes in Rheumatic Disease data from the covid 19 global rheumatology alliance physician registry
Arthritis & Rheumatism, 2021Co-Authors: Milena Gianfrancesco, Zara Izadi, Jeffrey A Sparks, Liza A Leykina, Tiffany Taylor, Carly Harrison, Laura Trupin, Stephanie Rush, Gabriela Schmajuk, Patricia P KatzAbstract:Racial/ethnic minorities experience more severe outcomes of coronavirus Disease 2019 (COVID-19) in the general US population. This study was undertaken to examine the association between race/ethnicity and COVID-19 hospitalization, ventilation status, and mortality in people with Rheumatic Disease. US patients with Rheumatic Disease and COVID-19 were entered into the COVID-19 Global Rheumatology Alliance physician registry between March 24, 2020 and August 26, 2020 were included. Race/ethnicity was defined as White, African American, Latinx, Asian, or other/mixed race. Outcome measures included hospitalization, requirement for ventilatory support, and death. Multivariable regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) adjusted for age, sex, smoking status, Rheumatic Disease diagnosis, comorbidities, medication use prior to infection, and Rheumatic Disease activity. A total of 1,324 patients were included, of whom 36% were hospitalized and 6% died; 26% of hospitalized patients required mechanical ventilation. In multivariable models, African American patients (OR 2.74 [95% CI 1.90-3.95]), Latinx patients (OR 1.71 [95% CI 1.18-2.49]), and Asian patients (OR 2.69 [95% CI 1.16-6.24]) had higher odds of hospitalization compared to White patients. Latinx patients also had 3-fold increased odds of requiring ventilatory support (OR 3.25 [95% CI 1.75-6.05]). No differences in mortality based on race/ethnicity were found, though power to detect associations may have been limited. Similar to findings in the general US population, racial/ethnic minorities with Rheumatic Disease and COVID-19 had increased odds of hospitalization and ventilatory support. These results illustrate significant health disparities related to COVID-19 in people with Rheumatic Diseases. The rheumatology community should proactively address the needs of patients currently experiencing inequitable health outcomes during the pandemic.
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sars cov 2 antibody response after covid 19 in patients with Rheumatic Disease
Annals of the Rheumatic Diseases, 2021Co-Authors: Kristin M Dsilva, Naomi Serlingboyd, Tiffany Y T Hsu, Jeffrey A Sparks, Zachary S WallaceAbstract:The impacts of Rheumatic Disease and immunosuppression on the development of antibodies to SARS-CoV-2 are unknown. A study of healthcare workers showed that detectable SARS-CoV-2 antibodies were associated with reduced risk of SARS-CoV-2 reinfection, and the robustness of this neutralising antibody response has implications for seroprevalence studies and vaccine efficacy.1 While Disease-modifying antiRheumatic drugs (DMARDs) generally blunt the immune response to pathogens, immunosuppressive medications such as dexamethasone and baricitinib have efficacy in reducing the severity of COVID-19.2 3 Additionally, tumour necrosis factor inhibition has been proposed as a potential mechanism for enhancing germinal centre formation and antibody production in severe COVID-19.4 Understanding the SARS-CoV-2 antibody response after COVID-19 among Rheumatic Disease patients is therefore of particular interest.5 We examined the SARS-CoV-2 antibody response among patients with Rheumatic Diseases and past COVID-19 at the Mass General Brigham (MGB) health system in Boston, Massachusetts, USA. Patients with COVID-19 confirmed by positive PCR testing and Rheumatic Disease confirmed by electronic health record (EHR) review were identified as previously described.6 We …
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clinical characteristics and outcomes of patients with coronavirus Disease 2019 covid 19 and Rheumatic Disease a comparative cohort study from a us hot spot
Annals of the Rheumatic Diseases, 2020Co-Authors: Kristin M Dsilva, Hyon K Choi, Naomi Serlingboyd, Rachel Wallwork, Tiffany Y T Hsu, Ellen M Gravallese, Jeffrey A Sparks, Zachary S WallaceAbstract:Objective To investigate differences in manifestations and outcomes of coronavirus Disease 2019 (COVID-19) infection between those with and without Rheumatic Disease. Methods We conducted a comparative cohort study of patients with Rheumatic Disease and COVID-19 (confirmed by severe acute respiratory syndrome coronavirus 2 PCR), compared in a 1:2 ratio with matched comparators on age, sex and date of COVID-19 diagnosis, between 1 March and 8 April 2020, at Partners HealthCare System in the greater Boston, Massachusetts area. We examined differences in demographics, clinical features and outcomes of COVID-19 infection. The main outcomes were hospitalisation, intensive care admission, mechanical ventilation and mortality. Results We identified 52 Rheumatic Disease patients with COVID-19 (mean age, 63 years; 69% female) and matched these to 104 non-Rheumatic Disease comparators. The majority (39, 75%) of patients with Rheumatic Disease were on immunosuppressive medications. Patients with and without Rheumatic Disease had similar symptoms and laboratory findings. A similar proportion of patients with and without Rheumatic Disease were hospitalised (23 (44%) vs 42 (40%)), p=0.50) but those with Rheumatic Disease required intensive care admission and mechanical ventilation more often (11 (48%) vs 7 (18%), multivariable OR 3.11 (95% CI 1.07 to 9.05)). Mortality was similar between the two groups (3 (6%) vs 4 (4%), p=0.69). Conclusions Patients with Rheumatic Disease and COVID-19 infection were more likely to require mechanical ventilation but had similar clinical features and hospitalisation rates as those without Rheumatic Disease. These findings have important implications for patients with Rheumatic Disease but require further validation.
Kristin M Dsilva - One of the best experts on this subject based on the ideXlab platform.
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laboratory trends hyperinflammation and clinical outcomes for patients with a systemic Rheumatic Disease admitted to hospital for covid 19 a retrospective comparative cohort study
The Lancet. Rheumatology, 2021Co-Authors: Kristin M Dsilva, Tiffany Y T Hsu, Naomi J Patel, Jiaqi Wang, Alisa A Mueller, Lauren C Prisco, Lily W Martin, Kathleen VanniAbstract:Summary Background COVID-19 can induce a hyperinflammatory state, which might lead to poor clinical outcomes. We aimed to assess whether patients with a systemic Rheumatic Disease might be at increased risk for hyperinflammation and respiratory failure from COVID-19. Methods We did a retrospective, comparative cohort study of patients aged 18 years or older admitted to hospital with PCR-confirmed COVID-19 at Mass General Brigham (Boston, USA). We identified patients by a search of electronic health records and matched patients with a systemic Rheumatic Disease 1:5 to comparators. We compared individual laboratory results by case status and extracted laboratory results and COVID-19 outcomes for each participant. We calculated the COVID-19-associated hyperinflammation score (cHIS), a composite of six domains (a score of ≥2 indicating hyperinflammation) and used logistic regression to estimate odds ratios (ORs) for COVID-19 outcomes by hyperinflammation and case status. Findings We identified 57 patients with a systemic Rheumatic Disease and 232 matched comparators who were admitted to hospital with COVID-19 between Jan 30 and July 7, 2020; 38 (67%) patients with a Rheumatic Disease were female compared with 158 (68%) matched comparators. Patients with a systemic Rheumatic Disease had higher peak median neutrophil-to-lymphocyte ratio (9·6 [IQR 6·4–22·2] vs 7·8 [4·5–16·5]; p=0·021), lactate dehydrogenase concentration (421 U/L [297–528] vs 345 U/L [254–479]; p=0·044), creatinine concentration (1·2 mg/dL [0·9–2·0] vs 1·0 mg/dL [0·8–1·4], p=0·014), and blood urea nitrogen concentration (31 mg/dL [15–61] vs 23 mg/dL [13–37]; p=0·033) than comparators, but median C-reactive protein concentration (149·4 mg/L [76·4–275·3] vs 116·3 mg/L [58·8–225·9]; p=0·11) was not significantly different. Patients with a systemic Rheumatic Disease had higher peak median cHIS than comparators (3 [1–5] vs 2 [1–4]; p=0·013). All patients with a peak cHIS of 2 or more had higher odds of admission to intensive care (OR 3·45 [95% CI 1·98–5·99]), mechanical ventilation (66·20 [8·98–487·80]), and in-hospital mortality (16·37 [4·75–56·38]) than patients with a peak cHIS of less than 2. In adjusted analyses, patients with a Rheumatic Disease had higher odds of admission to intensive care (2·08 [1·09–3·96]) and mechanical ventilation (2·60 [1·32–5·12]) than comparators, but not in-hospital mortality (1.78 [0·79–4·02]). Among patients who were discharged from hospital, risk of rehospitalisation (1·08 [0·37–3·16]) and mortality within 60 days (1·20 [0·58–2·47]) was similar in patients and comparators. Interpretation Patients with a systemic Rheumatic Disease who were admitted to hospital for COVID-19 had increased risk for hyperinflammation, kidney injury, admission to intensive care, and mechanical ventilation compared with matched comparators. However, among patients who survived, post-discharge outcomes were not significantly different. The cHIS identified patients with hyperinflammation, which was strongly associated with poor COVID-19 outcomes in both patients with a Rheumatic Disease and comparators. Clinicians should be aware that patients with systemic Rheumatic Diseases and COVID-19 could be susceptible to hyperinflammation and poor hospital outcomes. Funding None.
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response to correspondence on sars cov 2 antibody response after covid 19 in patients with Rheumatic Disease by shanoj et al
Annals of the Rheumatic Diseases, 2021Co-Authors: Kristin M Dsilva, Naomi Serlingboyd, Tiffany Y T Hsu, Jeffrey A Sparks, Zachary S WallaceAbstract:We appreciate the comments by Shanoj et al 1 in response to our letter regarding the SARS-CoV-2 antibody response after COVID-19 in patients with Rheumatic Disease.2 Examining whether patients treated with CD20 inhibitors have antibody responses to SARS-CoV-2 is a question of great clinical importance in the management and vaccination of patients taking these medications during the COVID-19 pandemic. Shanoj et al describe anti-spike and anti-nucleocapsid antibody test results among five patients with PCR-confirmed COVID-19 and prior exposure to rituximab.1 Among these patients, one patient developed neither anti-spike nor anti-nucleocapsid antibodies.1 This patient had been treated with rituximab for several years and had no detectable CD19+ B cells shortly before the onset of COVID-19.1 One patient developed anti-spike but not anti-nucleocapsid antibodies; although the duration of rituximab treatment is not provided, this …
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sars cov 2 antibody response after covid 19 in patients with Rheumatic Disease
Annals of the Rheumatic Diseases, 2021Co-Authors: Kristin M Dsilva, Naomi Serlingboyd, Tiffany Y T Hsu, Jeffrey A Sparks, Zachary S WallaceAbstract:The impacts of Rheumatic Disease and immunosuppression on the development of antibodies to SARS-CoV-2 are unknown. A study of healthcare workers showed that detectable SARS-CoV-2 antibodies were associated with reduced risk of SARS-CoV-2 reinfection, and the robustness of this neutralising antibody response has implications for seroprevalence studies and vaccine efficacy.1 While Disease-modifying antiRheumatic drugs (DMARDs) generally blunt the immune response to pathogens, immunosuppressive medications such as dexamethasone and baricitinib have efficacy in reducing the severity of COVID-19.2 3 Additionally, tumour necrosis factor inhibition has been proposed as a potential mechanism for enhancing germinal centre formation and antibody production in severe COVID-19.4 Understanding the SARS-CoV-2 antibody response after COVID-19 among Rheumatic Disease patients is therefore of particular interest.5 We examined the SARS-CoV-2 antibody response among patients with Rheumatic Diseases and past COVID-19 at the Mass General Brigham (MGB) health system in Boston, Massachusetts, USA. Patients with COVID-19 confirmed by positive PCR testing and Rheumatic Disease confirmed by electronic health record (EHR) review were identified as previously described.6 We …
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clinical characteristics and outcomes of patients with coronavirus Disease 2019 covid 19 and Rheumatic Disease a comparative cohort study from a us hot spot
Annals of the Rheumatic Diseases, 2020Co-Authors: Kristin M Dsilva, Hyon K Choi, Naomi Serlingboyd, Rachel Wallwork, Tiffany Y T Hsu, Ellen M Gravallese, Jeffrey A Sparks, Zachary S WallaceAbstract:Objective To investigate differences in manifestations and outcomes of coronavirus Disease 2019 (COVID-19) infection between those with and without Rheumatic Disease. Methods We conducted a comparative cohort study of patients with Rheumatic Disease and COVID-19 (confirmed by severe acute respiratory syndrome coronavirus 2 PCR), compared in a 1:2 ratio with matched comparators on age, sex and date of COVID-19 diagnosis, between 1 March and 8 April 2020, at Partners HealthCare System in the greater Boston, Massachusetts area. We examined differences in demographics, clinical features and outcomes of COVID-19 infection. The main outcomes were hospitalisation, intensive care admission, mechanical ventilation and mortality. Results We identified 52 Rheumatic Disease patients with COVID-19 (mean age, 63 years; 69% female) and matched these to 104 non-Rheumatic Disease comparators. The majority (39, 75%) of patients with Rheumatic Disease were on immunosuppressive medications. Patients with and without Rheumatic Disease had similar symptoms and laboratory findings. A similar proportion of patients with and without Rheumatic Disease were hospitalised (23 (44%) vs 42 (40%)), p=0.50) but those with Rheumatic Disease required intensive care admission and mechanical ventilation more often (11 (48%) vs 7 (18%), multivariable OR 3.11 (95% CI 1.07 to 9.05)). Mortality was similar between the two groups (3 (6%) vs 4 (4%), p=0.69). Conclusions Patients with Rheumatic Disease and COVID-19 infection were more likely to require mechanical ventilation but had similar clinical features and hospitalisation rates as those without Rheumatic Disease. These findings have important implications for patients with Rheumatic Disease but require further validation.
Ellen M Gravallese - One of the best experts on this subject based on the ideXlab platform.
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american college of rheumatology guidance for the management of Rheumatic Disease in adult patients during the covid 19 pandemic version 3
Arthritis & Rheumatism, 2021Co-Authors: Ted R Mikuls, Bonnie L Bermas, Sindhu R Johnson, Liana Fraenkel, Reuben J Arasaratnam, Lindsey R Baden, Winn W Chatham, Stanley N Cohen, Karen H Costenbader, Ellen M GravalleseAbstract:Objective To provide guidance to rheumatology providers on the management of adult Rheumatic Disease in the context of the coronavirus Disease 2019 (COVID-19) pandemic. Methods A task force, including 10 rheumatologists and 4 infectious Disease specialists from North America, was convened. Clinical questions were collated, and an evidence report was rapidly generated and disseminated. Questions and drafted statements were reviewed and assessed using a modified Delphi process. This included asynchronous anonymous voting by email and webinars with the entire panel. Task force members voted on agreement with draft statements using a 1-9-point numerical scoring system, and consensus was determined to be low, moderate, or high based on the dispersion of votes. For approval, median votes were required to meet predefined levels of agreement (median values of 7-9, 4-6, and 1-3 defined as agreement, uncertainty, or disagreement, respectively) with either moderate or high levels of consensus. Results Draft guidance statements approved by the task force have been combined to form final guidance. Conclusion These guidance statements are provided to promote optimal care during the current pandemic. However, given the low level of available evidence and the rapidly evolving literature, this guidance is presented as a "living document," and future updates are anticipated.
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american college of rheumatology guidance for the management of Rheumatic Disease in adult patients during the covid 19 pandemic version 2
Arthritis & Rheumatism, 2020Co-Authors: Ted R Mikuls, Bonnie L Bermas, Sindhu R Johnson, Liana Fraenkel, Reuben J Arasaratnam, Lindsey R Baden, Winn W Chatham, Stanley N Cohen, Karen H Costenbader, Ellen M GravalleseAbstract:Objective To provide guidance to rheumatology providers on the management of adult Rheumatic Disease in the context of the coronavirus Disease 2019 (COVID-19) pandemic. Methods A task force, including 10 rheumatologists and 4 infectious Disease specialists from North America, was convened. Clinical questions were collated, and an evidence report was rapidly generated and disseminated. Questions and drafted statements were reviewed and assessed using a modified Delphi process. This included asynchronous anonymous voting by e-mail and webinars with the entire panel. Task force members voted on agreement with draft statements using a 1-9-point numerical scoring system, and consensus was determined to be low, moderate, or high based on the dispersion of votes. For approval, median votes were required to meet predefined levels of agreement (median values of 7-9, 4-6, and 1-3 defined as agreement, uncertainty, or disagreement, respectively) with either moderate or high levels of consensus. Results To date, the task force has approved 80 guidance statements: 36 with moderate and 44 with high consensus. These were combined, resulting in 27 final guidance statements. Conclusion These guidance statements are provided to promote optimal care during the current pandemic. However, given the low level of available evidence and the rapidly evolving literature, this guidance is presented as a "living document," and future updates are anticipated.
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clinical characteristics and outcomes of patients with coronavirus Disease 2019 covid 19 and Rheumatic Disease a comparative cohort study from a us hot spot
Annals of the Rheumatic Diseases, 2020Co-Authors: Kristin M Dsilva, Hyon K Choi, Naomi Serlingboyd, Rachel Wallwork, Tiffany Y T Hsu, Ellen M Gravallese, Jeffrey A Sparks, Zachary S WallaceAbstract:Objective To investigate differences in manifestations and outcomes of coronavirus Disease 2019 (COVID-19) infection between those with and without Rheumatic Disease. Methods We conducted a comparative cohort study of patients with Rheumatic Disease and COVID-19 (confirmed by severe acute respiratory syndrome coronavirus 2 PCR), compared in a 1:2 ratio with matched comparators on age, sex and date of COVID-19 diagnosis, between 1 March and 8 April 2020, at Partners HealthCare System in the greater Boston, Massachusetts area. We examined differences in demographics, clinical features and outcomes of COVID-19 infection. The main outcomes were hospitalisation, intensive care admission, mechanical ventilation and mortality. Results We identified 52 Rheumatic Disease patients with COVID-19 (mean age, 63 years; 69% female) and matched these to 104 non-Rheumatic Disease comparators. The majority (39, 75%) of patients with Rheumatic Disease were on immunosuppressive medications. Patients with and without Rheumatic Disease had similar symptoms and laboratory findings. A similar proportion of patients with and without Rheumatic Disease were hospitalised (23 (44%) vs 42 (40%)), p=0.50) but those with Rheumatic Disease required intensive care admission and mechanical ventilation more often (11 (48%) vs 7 (18%), multivariable OR 3.11 (95% CI 1.07 to 9.05)). Mortality was similar between the two groups (3 (6%) vs 4 (4%), p=0.69). Conclusions Patients with Rheumatic Disease and COVID-19 infection were more likely to require mechanical ventilation but had similar clinical features and hospitalisation rates as those without Rheumatic Disease. These findings have important implications for patients with Rheumatic Disease but require further validation.
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american college of rheumatology guidance for the management of Rheumatic Disease in adult patients during the covid 19 pandemic version 1
Arthritis & Rheumatism, 2020Co-Authors: Ted R Mikuls, Bonnie L Bermas, Sindhu R Johnson, Liana Fraenkel, Reuben J Arasaratnam, Lindsey R Baden, Winn W Chatham, Stanley N Cohen, Karen H Costenbader, Ellen M GravalleseAbstract:OBJECTIVE: To provide guidance to rheumatology providers on the management of adult Rheumatic Disease in the context of the coronavirus Disease 2019 (COVID-19) pandemic. METHODS: A task force, including 10 rheumatologists and 4 infectious Disease specialists from North America, was convened. Clinical questions were collated, and an evidence report was rapidly generated and disseminated. Questions and drafted statements were reviewed and assessed using a modified Delphi process. This included 2 rounds of asynchronous anonymous voting by e-mail and 3 webinars with the entire panel. Task force members voted on agreement with draft statements using a 1-9-point numerical scoring system, and consensus was determined to be low, moderate, or high based on the dispersion of votes. For approval, median votes were required to meet predefined levels of agreement (median values of 7-9, 4-6, and 1-3 defined as agreement, uncertainty, or disagreement, respectively) with either moderate or high levels of consensus. RESULTS: The task force approved 77 initial guidance statements: 36 with moderate and 41 with high consensus. These were combined, resulting in 25 final guidance statements. CONCLUSION: These guidance statements are provided to promote optimal care during the current pandemic. However, given the low level of available evidence and the rapidly evolving literature, this guidance is presented as a "living document," and future updates are anticipated.
Naomi Serlingboyd - One of the best experts on this subject based on the ideXlab platform.
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response to correspondence on sars cov 2 antibody response after covid 19 in patients with Rheumatic Disease by shanoj et al
Annals of the Rheumatic Diseases, 2021Co-Authors: Kristin M Dsilva, Naomi Serlingboyd, Tiffany Y T Hsu, Jeffrey A Sparks, Zachary S WallaceAbstract:We appreciate the comments by Shanoj et al 1 in response to our letter regarding the SARS-CoV-2 antibody response after COVID-19 in patients with Rheumatic Disease.2 Examining whether patients treated with CD20 inhibitors have antibody responses to SARS-CoV-2 is a question of great clinical importance in the management and vaccination of patients taking these medications during the COVID-19 pandemic. Shanoj et al describe anti-spike and anti-nucleocapsid antibody test results among five patients with PCR-confirmed COVID-19 and prior exposure to rituximab.1 Among these patients, one patient developed neither anti-spike nor anti-nucleocapsid antibodies.1 This patient had been treated with rituximab for several years and had no detectable CD19+ B cells shortly before the onset of COVID-19.1 One patient developed anti-spike but not anti-nucleocapsid antibodies; although the duration of rituximab treatment is not provided, this …
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sars cov 2 antibody response after covid 19 in patients with Rheumatic Disease
Annals of the Rheumatic Diseases, 2021Co-Authors: Kristin M Dsilva, Naomi Serlingboyd, Tiffany Y T Hsu, Jeffrey A Sparks, Zachary S WallaceAbstract:The impacts of Rheumatic Disease and immunosuppression on the development of antibodies to SARS-CoV-2 are unknown. A study of healthcare workers showed that detectable SARS-CoV-2 antibodies were associated with reduced risk of SARS-CoV-2 reinfection, and the robustness of this neutralising antibody response has implications for seroprevalence studies and vaccine efficacy.1 While Disease-modifying antiRheumatic drugs (DMARDs) generally blunt the immune response to pathogens, immunosuppressive medications such as dexamethasone and baricitinib have efficacy in reducing the severity of COVID-19.2 3 Additionally, tumour necrosis factor inhibition has been proposed as a potential mechanism for enhancing germinal centre formation and antibody production in severe COVID-19.4 Understanding the SARS-CoV-2 antibody response after COVID-19 among Rheumatic Disease patients is therefore of particular interest.5 We examined the SARS-CoV-2 antibody response among patients with Rheumatic Diseases and past COVID-19 at the Mass General Brigham (MGB) health system in Boston, Massachusetts, USA. Patients with COVID-19 confirmed by positive PCR testing and Rheumatic Disease confirmed by electronic health record (EHR) review were identified as previously described.6 We …
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clinical characteristics and outcomes of patients with coronavirus Disease 2019 covid 19 and Rheumatic Disease a comparative cohort study from a us hot spot
Annals of the Rheumatic Diseases, 2020Co-Authors: Kristin M Dsilva, Hyon K Choi, Naomi Serlingboyd, Rachel Wallwork, Tiffany Y T Hsu, Ellen M Gravallese, Jeffrey A Sparks, Zachary S WallaceAbstract:Objective To investigate differences in manifestations and outcomes of coronavirus Disease 2019 (COVID-19) infection between those with and without Rheumatic Disease. Methods We conducted a comparative cohort study of patients with Rheumatic Disease and COVID-19 (confirmed by severe acute respiratory syndrome coronavirus 2 PCR), compared in a 1:2 ratio with matched comparators on age, sex and date of COVID-19 diagnosis, between 1 March and 8 April 2020, at Partners HealthCare System in the greater Boston, Massachusetts area. We examined differences in demographics, clinical features and outcomes of COVID-19 infection. The main outcomes were hospitalisation, intensive care admission, mechanical ventilation and mortality. Results We identified 52 Rheumatic Disease patients with COVID-19 (mean age, 63 years; 69% female) and matched these to 104 non-Rheumatic Disease comparators. The majority (39, 75%) of patients with Rheumatic Disease were on immunosuppressive medications. Patients with and without Rheumatic Disease had similar symptoms and laboratory findings. A similar proportion of patients with and without Rheumatic Disease were hospitalised (23 (44%) vs 42 (40%)), p=0.50) but those with Rheumatic Disease required intensive care admission and mechanical ventilation more often (11 (48%) vs 7 (18%), multivariable OR 3.11 (95% CI 1.07 to 9.05)). Mortality was similar between the two groups (3 (6%) vs 4 (4%), p=0.69). Conclusions Patients with Rheumatic Disease and COVID-19 infection were more likely to require mechanical ventilation but had similar clinical features and hospitalisation rates as those without Rheumatic Disease. These findings have important implications for patients with Rheumatic Disease but require further validation.
