Persistent post-discharge symptoms after COVID-19 in rheumatic and musculoskeletal diseases

  1. Leticia Leon
  2. Ines Perez-Sancristobal
  3. Alfredo Madrid
  4. Leticia Lopez-Pedraza
  5. Jose Ignacio Colomer
  6. Sergio Lerma
  7. Pia Lois
  8. Arkaitz Mucientes
  9. Luis Rodriguez-Rodriguez
  10. Benjamin Fernandez-Gutierrez
  11. Lydia Abasolo

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Abstract

Objectives

We aimed to describe persistent symptoms and sequelae in patients with rheumatic and musculoskeletal diseases (RMD) after admission owing to coronavirus disease 2019 (COVID-19), assessing the role of autoimmune rheumatic diseases (ARDs) compared with non-autoimmune rheumatic and musculoskeletal diseases (NARDs) on persistent symptoms and sequelae.

Methods

We performed an observational study including RMD patients who attended a rheumatology clinic in Madrid and required admission owing to COVID-19 (between March and May 2020) and survived. The study began at discharge and ran until October 2020. Main outcomes were persistence of symptoms and sequelae related to COVID-19. The independent variable was the RMD group (ARD and NARD). Covariates included sociodemographics, clinical and treatment data. We ran a multivariate logistic regression model to assess the risk of the main outcomes by RMD group.

Results

We included 105 patients, of whom 51.5% had ARD and 68.57% reported at least one persistent symptom. The most frequent symptoms were dyspnoea, fatigue and chest pain. Sequelae were recorded in 31 patients. These included lung damage in 10.4% of patients, lymphopenia in 10%, a central retinal vein occlusion and an optic neuritis. Two patients died. Eleven patients required re-admission owing to COVID-19 problems (16.7% ARD vs 3.9% NARD; P = 0.053). No statistically significant differences were found between RMD groups in the final models.

Conclusion

Many RMD patients have persistent symptoms, as in other populations. Lung damage is the most frequent sequela. Compared with NARD, ARD does not seem to differ in terms of persistent symptoms or consequences, although ARD might have more re-admissions owing to COVID-19.

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  1. Version published to 10.1093/rap/rkac008
  2. ScreenIT

    SciScore for 10.1101/2021.03.08.21253120: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIACUC: The study was conducted in accordance with the Declaration of Helsinki and the principles of Good Clinical Practice and was approved by the HCSC Institutional Ethics Committee (approval number 20/268-E-BS).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. First, it is a retrospective observational study, and we cannot assure that everything has been found and described. It is cross-sectional, not being able to capture how the problems evolve over time. In this sense, longitudinal studies specifically designed to assess the post Covid-19 evolution over time would be necessary to better understand the progression of symptoms and consequences after Covid-19. Notwithstanding these limitations, we believe is necessary acquiring “real-life” data after the acute phase of Covid-19 in RMD. In this sense, our study give us a general picture of what is going on in RMD patients spanning a period of up to 7 months. Although they are preliminary findings, this study provides rheumatologists and ARD patients some reassurance since their evolution does not seem worse that other post-Covid-19 patient, with the exception of higher percentage of readmissions found in ARD. In this sense, closer monitoring would be advisable. This study also give as a clue of which factors could influence in the post-Covid-19 phase. To conclude, we provide a report of symptoms and consequences, after a hospitalized episode of Covid-19 in RMD patients. This study is a starting point to advance in knowledge. Longer follow-up studies in a larger RMD cohorts are necessary to understand the full spectrum of health consequences from Covid-19 and to design future care plans.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.03.08.21253120v1 on medRxiv