COVID-19 IS ASSOCIATED WITH LUPUS FLARE AND PERSISTENT DISEASE ACTIVITY: LONGITUDINAL DATA FROM THE REUMACOV-BRAZIL REGISTER

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PV149 / #422 Poster Topic: AS17 - Miscellaneous Background/Purpose The study aimed to evaluate flares in systemic lupus erythematosus (SLE) patients over a period of 6 months after COVID-19. Methods A multicenter, observational, and prospective cohort study. SLE adult patients with COVID-19 (case group) were compared to SLE patients without COVID-19 (control group). Assessments were performed at baseline (V0), immediately after COVID-19 (V1), and 3 and 6 months after infection (V2 and V3). Disease activity was evaluated by patient global assessment (PGA) and the modified SLE Disease Activity Index 2000 (SLEDAI-2K). A flare was defined as an increase in SLEDAI-2K score greater than 3 and persistent disease activity was measured by SLEDAI-2K greater than 3 over 2 consecutive visits. Results 715 patients were included, 363 in the case group and 352 in the control group. The case group had a higher mean age (SD) compared with the control group [41 years (12.38) vs 38.8 years (12.07), p=0.017]. There were no differences between groups at baseline regarding sex, comorbidities, treatment, or disease activity scores. The control group showed a significant reduction in PGA [0.24 (95% CI: -0.39 to -0.09), p=0.001] and SLEDAI-2K [0.85 (95% CI: 0.76 to 0.96) p=0.010] throughout the visits while in the case group the scores remained stable. The frequency of new SLE manifestations was higher in the case group compared with patients in the control group at V2 [20 (9.4%) vs 5 (3.0%), p=0.012] and V3 [22 (9.6%) vs 4 (2.8%), p=0.012]. In the case group, 11 severe disease manifestations (nephritis, neurological, vasculitis, pneumonitis, and myositis) were described at V2 and eight at V3, while in the case group there was only severe disease manifestation (nephritis). Patients with COVID-19 were 3.7 (95% CI: 1.2 to 10.9) times more likely to have new SLE disease manifestations compared to patients without COVID-19. Case group presented more frequent flares or persistent disease activity [74 (18.5%) vs 33 (10.5%), p=0.001]. COVID-19 at any time in the study was linked to a higher chance of a flare and persistent disease activity [OR=1.70 (95% CI: 1.06 to 2.74), p=0.029]. Conclusions COVID-19 was associated with new SLE disease manifestations and worse outcomes (flares and persistent disease activity) in SLE patients. Acknowledgments: We thank the researchers involved in the centers participating in ReumaCoV-Brasil, the Brazilian Society of Rheumatology and the Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq.

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