Background To study the effect of COVID-19 infection on disease flares and herpes zoster (HZ) reactivation in patients with SLE
Methods We identified patients who fulfilled the SLICC criteria for SLE and had documented COVID-19 infection (Omicron and its variants) between Feb-Nov 2022 and SLE controls who did not have COVID-19 randomly matched for age, sex and the period of COVID infection in a 1:2 ratio. The primary outcomes of interest were SLE flares and HZ infection within 90 days of COVID-19 infection. SLE flares were assessed by the SELENA flare instruments, with modifications. The rates of SLE flares and HZ reactivation were compared between the two groups
Results 91 SLE patients with COVID-19 infection (age 48.6±14.0 years; 95.6% women; SLE duration 14.2±8.3 years; 53% history of lupus nephritis) and 182 matched SLE controls not infected by COVID-19 were studied. 11/90 (12.2%) COVID-infected patients had serious manifestations (oxygen requirement, use of mechanical ventilator, lung infiltrates on imaging studies or admission to the ICU). One (1.1%) patient died and 7(7.7%) patients developed severe complications. Within 90 days of COVID-19 infection, 14 (15.4%) patients developed mild/moderate SLE flares and 2 (2.2%) patients had severe SLE flares, and the rate of any flares was significantly higher than those not infected with COVID (17.6% vs 5.5%; p=0.001). Among COVID-19 infected patients, those with SLE flares had significantly lower C3 values (p=0.004). HZ reactivation occurred in 2 patients (2.2%) with COVID-19 infection, which was numerically higher than those not infected with COVID (2 patients, 1.1%; p=0.48)
Conclusions Clinical flares within 90 days were significantly more frequent in SLE patients infected with COVID-19 than age/gender matched non-infected SLE controls. HZ reactivation occurred at a numerically higher rate after COVID-19 infection in SLE patients than controls.
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