[Caution with the use of dexamethasone in patients with COVID-19 in its initial phases]

INTRODUCTION

The effect of dexamethasone in the initial phase of infection by SARS-CoV-2 and its influence on COVID-19 is not well defined. We describe clinical-radiological characteristics, the cytokine storm parameters, and the clinical evolution of a series of patients treated with dexamethasone in the disease's initial phase.

METHOD

A study of 8 patients who received dexamethasone before the development of COVID-19. We evaluate clinical variables, imaging tests, cytokine release parameters, treatment used and patient evolution.

RESULTS

All patients received a 6 mg/day dose with a mean duration of 4.5 days before admission. High resolution computed tomography (HRCT) revealed that most of them presented a severe extension; most patients had a slightly elevated level of cytokine release parameters. Three patients required high-flow oxygen therapy due to respiratory failure; none required orotracheal intubation or died.

CONCLUSION

Dexamethasone in the early stages of SARS-CoV-2 infection appears to be associated with severe COVID-19.

Caution with the use of dexamethasone in patients with COVID-19 in its initial phases

Introduction

The effect of dexamethasone in the initial phase of infection by SARS-CoV-2 and its influence on COVID-19 is not well defined. We describe clinical-radiological characteristics, the cytokine storm parameters, and the clinical evolution of a series of patients treated with dexamethasone in the disease's initial phase.

Method

A study of 8 patients who received dexamethasone before the development of COVID-19. We evaluate clinical variables, imaging tests, cytokine release parameters, treatment used and patient evolution.

Results

All patients received a 6 mg/day dose with a mean duration of 4.5 days before admission. High resolution computed tomography (HRCT) revealed that most of them presented a severe extension; most patients had a slightly elevated level of cytokine release parameters. Three patients required high-flow oxygen therapy due to respiratory failure; none required orotracheal intubation or died.

Conclusion

Dexamethasone in the early stages of SARS-CoV-2 infection appears to be associated with severe COVID-19.

AB0316 ADHERENCE TO THE MEDITERRANEAN DIET AND ITS ASSOCIATION WITH DISEASE ACTIVITY AND DAMAGE ACCRUAL IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

There is limited evidence regarding the impact of the Mediterranean Diet (Med Diet) on autoimmune diseases although it has been proposed that adherence to the Med Diet may decrease the risk of certain autoimmune diseases. However, the potential usefulness of the Med Diet as a high-quality dietary pattern for other autoimmune diseases such as SLE has not yet been investigated.

Objectives:

The aim of this study was to evaluate the potential association between the adherence to the Med Diet and disease activity, damage accrual and SLE-related clinical markers in a large cohort of women with SLE.

Methods:

In this cross-sectional study, we assessed Med Diet adherence through a 14-item questionnaire in 253 women with SLE (mean age 46.74 ± 12.70 years). The SLE Disease Activity Index (SLEDAI-2K) and the SDI Damage Index were used to asses disease activity and disease-related damage, respectively. Levels of C-reactive protein (CRP; mg/dL), homocysteine (Hcy; mol/L), anti-double stranded DNA antibodies (anti-dsDNA) (IU/mL), complement C3 (mg/dL), and complement C4 (mg/dL) were determined.

Results:

The Med Diet adherence score was classified as follows: low adherence (≤ 5 points); medium adherence (6–9 points) and good adherence (≥ 10 points). Only 50.2% of the SLE women had good adherence to the Med Diet. The ANCOVA models showed significant differences between patients with good adherence to the Med Diet and those with medium and low adherence in SLEDAI (p ≤ 0.001) and SDI (p ≤ 0.001). Age, medical treatment (immunosuppressors, corticoids, or antimalarials), smoking status, and body mass index (BMI) were included as confounding factors. The odds ratio (OR) for having active SLE (SLEDAI ≥ 5) or the presence of damage (SDI ≥ 1) was lower among patients whose Med Diet score was higher (p ≤ 0.001).

Conclusion:

Adherence to the Med Diet influences disease activity and damage accrual in SLE women. Thus, these patients would benefit from nutritional counselling and education on modification, to help adapt their lifestyles towards the Med Diet pattern. This would help slow the progression of SLE and the damage it causes.

References:

[1]Sedaghat F, Jessri M, Behrooz M, Mirghotbi M, Rashidkhani B. Mediterranean diet adherence and risk of multiple sclerosis: a case-control study. Asia Pac J Clin Nutr. 2016;25(2):377–84.

[2]orsyth C, Kouvari M, D’Cunha NM, Georgousopoulou EN, Panagiotakos DB, Mellor DD, et al. The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies. Rheumatol Int. 2018 May 18;38(5):737–47.

[3]Minihane AM, Vinoy S, Russell WR, Baka A, Roche HM, Tuohy KM, et al. Low-grade inflammation, diet composition and health: current research evidence and its translation. Br J Nutr. 2015 Oct 14;114(7):999–1012.

Acknowledgements:

This research was supported by the grant PI0523-2016 from “Consejería de igualdad, salud y políticas sociales” (Junta de Andalucía) and is part of the research group LyDIMED “Lupus y Dieta Mediterránea”.

Disclosure of Interests:

None declared

Interstitial lung disease in systemic sclerosis: data from the spanish scleroderma study group

OBJECTIVES

To evaluate the clinical characteristics of patients with interstitial lung disease (ILD) in the setting of a large cohort of systemic sclerosis (SSc) patients, and to analyse the differences according to the SSc subtype (following the modification of classification criteria of the American College of Rheumatology for SSc proposed by LeRoy and Medsger), factors are associated with moderate-to-severe impairment of lung function, as well as mortality and causes of death.

METHODS

A descriptive study was performed, using the available data from the Spanish Scleroderma Study Group.

RESULTS

Twenty-one referral centers participated in the registry. By April 2014, 1374 patients with SSc had been enrolled, and 595 of whom (43%) had ILD: 316 (53%) with limited cutaneous SSc (lcSSc), 240 (40%) with diffuse cutaneous SSc (dcSSc), and 39 (7%) with SSc sine scleroderma (ssSSc). ILD in the lcSSc and the ssSSc subsets tended to develop later, and showed a less impaired forced vital capacity (FVC) and a ground glass pattern on high-resolution computed tomography (HRCT) less frequently, compared with the dcSSc subset. Factors related to an FVC < 70% of predicted in the multivariate analysis were: dcSSc, positivity to anti-topoisomerase I antibodies, a ground glass pattern on HCRT, an active nailfold capillaroscopy pattern, lower DLco, older age at symptoms onset, and longer time between symptoms onset and ILD diagnosis. Finally, SSc-associated mortality and ILD-related mortality were highest in dcSSc patients, whereas that related to pulmonary arterial hypertension was highest in those with lcSSc-associated ILD.

CONCLUSIONS

Our study indicates that ILD constitutes a remarkable complication of SSc with significant morbidity and mortality, which should be borne in mind in all three subgroups (lcSSc, dcSSc, and ssSSc).

Antiphospholipid syndrome, antiphospholipid antibodies and solid organ transplantation

Antiphospholipid syndrome is considered a high risk factor for any kind of surgery. Considering that all solid organ transplants are critically dependent on the patency of vascular anastomosis, there is much concern about the consequences this pro-thrombotic condition may have on transplantation. Relatively little information is available in the literature assessing the real risk that antiphospholipid syndrome or the presence of antiphospholipid antibodies represent in solid organ transplantation. The aim of this article is to review the literature related to transplantation of solid organs in patients diagnosed with antiphospholipid syndrome or patients with positive antiphospholipid antibodies.