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Background:Phase III clinical trials have shown that COVID-19 vaccines are safe and effective in healthy children. There are few studies in children with juvenile autoimmune disease (AID).Objectives:The study aims to evaluate the immunogenicity and safety of the vaccine against COVID-19 in Juvenile JAID in the real life.Methods:These data are from “Safety and efficacy on COVID-19 Vaccine in Rheumatic Disease” - SAFER study, a Brazilian multicentric prospective phase IV study to evaluate COVID-19 vaccine AID. Immunogenicity and adverse events (AE) were assessed, after 3 doses, in children compared to adults with AID. Inclusion criteria were fulfilling criteria according to international classification for AID. Exclusion criteria: pregnancy, previous severe AE to any vaccine and other immunosuppression causes. Stratification of post-vaccination AE was performed using a diary, filled out daily and returned at the end of 28 days of each dose. The IgG antibodies to SARS-CoV-2 spike receptor-binding domain by chemiluminescence were measured at baseline and after first and 2nd dose. The seropositivity was defined for titers ≥ 7 BAU/mL. The Kruskal-Wallis, post-hoc Dwass-Steel-Critchlow-Fligner pairwise comparisons tests, and multiple linear regression analysis were used. The p-value ≤0.05 was considered significant.Results:A total of 123 volunteers with AID, 37 adults and 86 juvenile AID patients were included in the study.The juvenile group was aged < 18 years (adult 32.5 ±6 vs children group 14.5 ±1.7, p<0.01) and had fewer comorbidities (19 vs. 60%, p<0.01). The groups were homogeneous for sex (female 86% vs. 75%, p=0.23), ethnicity (Caucasians 47 vs. 43%, p=0.7) and degree of immunosuppression (high grade 62 vs. 60%, p=0.25). The frequency of diseases in adults was SLE= 56%, SpA= 5.41%, RA= 5.1%, others= 33.2%; and in children it was SLE= 38.4%, JIA= 41.8, others= 19.7%. The frequency of previous natural exposure to COVID-19 was higher in adults (30.6 vs. 8.1%, p<0.001). Both groups received BNT162b2 vaccine in the 1st. and 2nd. doses and in more than 90% in the 3rd. dose. The frequency of joint paint in post-1st dose (41 vs. 15%, p= 0.003) and in 2nd. dose (24 vs. 0%, p=0.003) was higher in adults. There was no difference in adverse events between the groups after the third dose. The groups were homogeneous for IgG-S titers at baseline. Patients with positive or negative IgG-S at baseline were analyzed separately. There was a significant increase (p<0.001) in IgG-S levels after the 1st, 2nd and 3th doses in the juvenile AID (0.71(0.28-35.07) vs. 443.04 (36.92-2155.77) vs. 2232.38 (1207.43-3688.45) vs. 1920.72 (1383.45-5680.00)), and in the adult group ((1.14(0.14-46.86) vs. 280.17 (49.70-4991.06) vs. 3787.14 (964.28-5680) vs. 2445.24 (868.12-4.418.19)). There was no difference between groups in the 4 times of comparison (p<0.05), regardless of the antibody level at baseline and the degree of immunosuppression. The seroconversion rate was 95% and 100% in both groups, after the 2nd and 3th dose.Conclusion:BNT162b2 vaccine is effective, safe and induced high titles and seroconversion rate in juvenile AID, similar to adults, independent of immunosuppression, comorbidities or previous natural infection. Children showed more joint pain as AE than adults.REFERENCES:NIL.Table 1.IgG-S measurement after vaccination against COVID-19 in baseline, 28 days after 1st dose, 2nd and 3th doseTotalAdultsJuvenilePN=123N=37N=86IgG at inclusion, Median (IQR)0.85 (0.14-46.15)0.71 (0.28-35.07)1.14 (0.14-46.86)0.98IgG 28 days after 1st dose Median (IQR)326.96 (45.16-3887.32)443.04 (36.92-2155.77)280.17 (49.70-4991.06)0.33IgG 28 days after 2nd dose, Median (IQR)3189.32 (965.15-5245.62)2232.38 (1207.43-3688.45)3787.14 (964.28-5680.00)0.14IgG after 3th dose, Median (IQR)2287.78 (888.89-5680.00)1920.72 (1383.45-5680.00)2445.24 (868.12-4418.19)0.67Figure 1.IgG-S measurement after vaccination against COVID-19 in T1(baseline, at inclusion), T2 (28 days after 1st dose), T3 (28 days after 2nd dose) and T3 (28 days after 3th dose).Acknowledgements:We thank Safer Study Group, and the Brazilian Society of Rheumatology for supporting this study. This study was funded by Department of Science and Technology of Federal Government of Brazil.Disclosure of Interests:None declared.

Background:Patients with immune-mediated rheumatic diseases (IMRD) undergoing immunosuppressive treatment are at greater risk of infection. Infectious are one of the main causes of death in this group of patients. Although vaccination impacts in reducing the incidence of infections, the vaccine coverage of the general population in Brazil has been falling over the years.Objectives:To present the preliminary results on influenza and pneumococcal (PCV10/13 and PPV23) vaccination coverage in patients with juvenile IMRD in Brazil.Methods:This is a cross-sectional multicenter study designed to evaluate the vaccination coverage of patients under 18 years, from 2019 to 2022. Investigators from Pediatric Rheumatology outpatient clinics representing the five regions of Brazil were invited to participate. The clinical data were collected in medical records and in vaccination cards using a standardized protocol. Vaccination was evaluated considering the immunization schedule for the current year of inclusion based on the National Immunization Program and Reference Centers for special groups. Clinical and demographic data were sex, age, education level, diagnosis, time since diagnosis, current and previous treatments, disease activity and analysis of the vaccination card. Results were expressed using frequencies and percentages for qualitative variables, and measures of central tendency (mean or median) and measures of dispersion (standard deviation - SD) for quantitative ones. Comparisons of variables were performed using Student’s t-test or Mann-Whitney test. A significance level of 5% was considered.Results:Two-hundred twenty-nine patients were included, 48% were diagnosed with juvenile idiopathic arthritis and 23% with systemic lupus erythematosus; 70.8% were female with mean age of 12 years (SD 4.17) and average time of diagnosis of 3.77 years (SD 3.17). Regarding treatment, 22.68% were using biological agents, 8.24% were in corticosteroids (>20mg/day or >2mg/kg/day or pulse therapy with methylprednisolone), and 2.4% in cyclophosphamide. According to specific disease activity criteria, 51.89% of patients were in remission. Of total, 178 (61.16%) patients were not vaccinated against influenza in last campaign; 130 of 188 (69.14%) patients had complete schedule for PCV10/13 but only 12.4% (31/250) received PPV23.Conclusion:These results show the low vaccination coverage against influenza and pneumococcal vaccines among patients with juvenile IMRD. Additional studies are necessary to identify the reasons to the decline the vaccination among immunosuppressed children.REFERENCES:[1] MAKAROVA E et al. Vaccination coverage in children with juvenile idiopathic arthritis, inflammatory bowel diseases, and healthy peers: Cross-sectional electronic survey data. World J Clin Pediatr 2023 March 9; 12(2): 45-56.[2] Chevallard M et. al. Active vaccination campaign to increase seasonal influenza vaccination coverage: a monocenter experience in a cohort of Italian patients with systemic autoimmune diseases. Clinical Rheumatology 2023 42:923–928. https://doi.org/10.1007/s10067-022-06380-z.[3] Balažiová B, Kuková Z, Mišíková D, Novosedlíková K, Dallos T. Real-life vaccination coverage in Slovak children with rheumatic diseases. Front. Pediatr. 10:956136. doi: 10.3389/fped.2022.956136.[4] Furer V, Rondaan C, Heijstek MW, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseasesAnn Rheum Dis 2020;79:39–52Acknowledgements:NIL.Disclosure of Interests:None declared.

BackgroundSome individuals may have persistent symptoms after COVID-19, a new condition known as long COVID-19. However, these complaints can be misunderstood with disease activity in patients with immune-mediated rheumatic diseases (IMRD), especially fatigue and mental distress.ObjectivesTo evaluate fatigue, depression, anxiety, and stress in IMRD patients after 6 months of COVID-19, compared with IMRD patients without COVID-19.MethodsThe ReumaCoV Brasil is a longitudinal study designed to follow-up IMRD patients for 6 months after COVID-19 diagnosis (cases) compared with IMRD patients no COVID-19 (controls). Clinical data, such as age, sex, comorbidities, as well as disease activity measurements and current treatment regarding IMRD, and COVID-19 outcomes were evaluated in all patients. The FACIT questionnaire (Functional Assessment of Chronic Illness Therapy) and the DASS 21 (Depression, Anxiety and Stress Scale - 21 Items) were applied at 6 months after COVID in both groups.ResultsA total of 606 IMRD patients were included, of whom 322 (53.1%) cases and 284 (46.9%) controls. Most patients were female (85.3%) with mean age 46.1 (13.0) years old. Specific disease activity were similar between cases and controls. There was a significant difference between FACIT scores and 3 domains of DASS-21 comparing cases and controls (Figure 1). The factors associated with FACIT were female gender, diabetes, obesity, no comorbidities, COVID manifestations (skin, joint pain, asthenia, diarrhea, and dyspnea), and chronic oral corticosteroid use. DASS-21 Depression was associated with these same factors. Female gender, COVID manifestations as skin, joint pain, asthenia, cough, dyspnea, and chronic oral corticosteroid use were associated with DASS-21-Anxiety. DASS-21 Stress was associated with female gender, asthenia, diarrhea, dyspnea, cough, chronic oral corticosteroid use, and hospitalization. Table 1 shows the variables that remained in the models after the univariate logistic analysis. A weak correlation between disease activity and FACIT was observed in rheumatoid arthritis (p=0.010; r2 = 0.035) and ankylosing spondylitis patients (p=0.010; r2 = 0.129). No other correlations were observed between the scores results and disease activity (patient’s global assessment - PGA), medications or specific IMRD.ConclusionFatigue and mental changes such as depression, anxiety, and stress, occurred more frequently in IMRD patients who had COVID-19 than in those who did not have COVID-19, especially in women, regardless of disease activity score. Fatigue was more related to female gender, diabetes, obesity, and current joint pain. Mental impairment was more associated with severity of COVID-19, including respiratory and non-respiratory symptoms.Figure 1.Comparison between cases and controls of FACIT and DASS-21 depression, anxiety, and stress scoresFACIT (Functional Assessment of Chronic Illness Therapy); DASS-21 (Depression, Anxiety and Stress Scale - 21 Items):Table 1.Final model using binary Logistic Regression analysis to evaluate the preditive factors associated with FACIT and DASS-21 scoresFACIT Score ≤ 37 x score > 37§DASS-21-DEPRESSION Score ≤ 6 (normal/mild) x score > 6 (moderate/severeDASS-21-ANXIETY Score ≤ 5 (normal/mild) x score > 5 (moderate/severe)DASS-21-STRESS Score ≤ 9 (normal/mild) x score > 9 (moderate/severeVariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)Female0.151.83(1.12-2.98)Nocomorbidities0.0290.66(0.46-0.95)Joint pain0.0022.44(1.39-4.26)Female0.0122.31(1.20-4.46)Diabetes0.0062.35(1.28-4.32)Joint pain**0.0012.58(1.57-4.22)Dyspnea0.0013.61(2.11-6.19)Dyspnea0.0013.69(2.09-6.51)Dyspneia0.0012.00(1.23-3.26)Dyspnea0.0012.82(1.79-4.44)Oral CE0.0141.55(1.09-2.21)Joint pain0.0052.20(1.41-3.43)Oral CE0.0481.41(1.00-1.99)§Lower scores mean worse fatigue; CE: corticosteroid; OR: odds ratio; CI: confiance intervalAcknowledgementsReumaCoV Brasil researchers, Brazilian Rheumatology Society and National Council for Scientific and Technological Development.Disclosure of InterestsNone Declared.

BackgroundThe COVID-19 pandemic has brought uncertainties to rheumatology practice, mainly related to the possibility of triggering disease activity after infection in immune mediated rheumatic diseases (IMRD). To date, there are few data in the literature specifically evaluating this issue.ObjectivesEvaluate the disease activity in IMRD patients after 6 months of the infection, compared to pre infection status.MethodsReumaCoV Brasil is a longitudinal study performed at 35 study centers designed to follow-up IMRD patients for 6 months after clinical or laboratorial COVID-19 diagnosis (cases), comparing with patients with IMRD who had not had the infection at the time of inclusion (controls). Demographic data such as age, sex, comorbidities, clinical characteristics, treatment, evolution of COVID-19 and disease activity status were collected using a Research Eletronic Data Capture (REDCap) database on three consecutive visits (inclusion and 6 months). The analysis was carried out on the four diseases with the highest inclusion number in the study: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). In addition to specific disease activity assessment metrics, we used patient’s global assessment of disease activity (PGA), ranging from 0 to 10, at all visits, with 0 being no activity and 10 being intense activity. All conclusions were drawn considering the significance level of 5%. This study was registered at the Brazilian Registry of Clinical Trials—REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.ResultsBetween May 2020 and January 2021, 2032 patients were included in the registry, and of these, 1322 patients (721 cases and 601 controls), completed 6 months of follow-up, being 550 SLE (42.0%), 497 RA (37.6%) and 176 SpA (13.3%) and 99 (7.4%) PsA. Most patients were female (82.0%); the median age was 46.7 (13.8). Disease activity at the time of enrollment, according to the PGA, was similar between cases and controls, except for patients with RA and AS, where it was higher in controls. After the follow up time, no worsening of activity was observed in any of the diseases evaluated in the case group (Table 1). Despite this, worsening of disease symptoms after COVID-19 was reported by 23.3%, 24.6%, 25.0% and 25.8% of patients with SLE, RA, AS and PsA respectively, not related with disease activity.ConclusionIn patients with IMRD, no worsening of disease activity was observed after COVID-19 in this cohort of Brazilian patients. Despite this, many patients noticed worsening of symptoms, possibly associated not with the triggering of the activity, but with the so-called long COVID syndrome.Table 1.Comparison of disease activity, according to PGA, comparing disease activity status at inclusion and after 6 months of follow up, in cases and controlsINCLUSIONAFTER 6 MONTHSCasesControlsp-valueCasesControlsp-valueSLE2 (0-4,5)2 (0-4)0,8102 (0-5)2 (0-4)0,172RA3 (1-5)4 (2-6)0.0013 (1-5)3 (1-5,5)0,731AS2 (0-5)4 (1-6)0,0022 (0-5)3,5 (1-6)0,044PsA2 (0-4)2 (0-5)0,8162 (0-5)2 (0-5)0,939*Median and interquatile range; Student t test; CI 95%AcknowledgementsReumaCoV Brasil researchers, Brazilian Society of Rheumatology and National Council for Ccientific and Technological Development.Disclosure of InterestsNone Declared.

Background:The role of chronic use of hydroxychloroquine (HCQ) in rheumatic disease (RD) patients during the SARS-CoV-2 pandemic is still subject of discussion.Objectives:To compare the occurrence of COVID-19 and its outcomes between RD patients on HCQ use with individuals from the same household not taking the drug during community viral transmission in an observational prospective multicenter study in Brazil.Methods:Participants were enrolled and monitored through 24-week (From March 29th to Sep 30th, 2020) regularly scheduled phone calls performed by trained medical professionals. Epidemiological and demographic data, as well as RD disease activity status and current treatment data, specific information about COVID-19, hospitalization, need for intensive care, and death was recorded in both groups and stored in the Research Electronic Data Capture (REDCap) database. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. The statistical analysis was performed using IBM-SPSS v.20.0 software. Group comparisons were made using the Man-Whitney, Chi-Square and Fisher Exact Test, as well as multivariate regression models adjusted to confounders. Survival curves were performed using Kaplan-Meier analysis.Results:A total of 10,427 participants mean age (SD) of 44.04 (14.98) years were enrolled, including 6004 (57.6%) rheumatic disease patients, of whom 70.8% had systemic lupus erythematosus (SLE), 6.7% rheumatoid arthritis (RA), 4% primary Sjögren’s syndrome (pSS), 1.8% mixed connective tissue disease (DMTC), 1% systemic sclerosis (SSc) and others (15.9), including overlap syndromes. In total, 1,132 (10.8%) participants fulfilled criteria for COVID-19, being 6.7% RD patients and 4.1% controls (p=0.002). A recent influenza vaccination had a protective role (p<0.001). Moderate and severe COVID-19 included the need for hospitalization, intensive care, mechanical ventilation or death. Infection severity was not different between groups (p=0.391) (Table 1). After adjustments for multiple confounders, the main risk factors significantly associated with COVID-19 were higher education level (OR=1.29 95%CI 1.05-1.59), being healthcare professionals (OR=1.91; 95%CI 1.45-2.53), presence of two comorbidities (OR=1.31; 95%CI 1.01-1.66) and three or more comorbidities associated (OR=1.69; 95%CI 1.23-2.32). Interestingly, age >=65 years (OR=0.20; 95%CI 0.11-0.34) was negatively associated. Regarding RD, the risk factors associated with COVID-19 diagnosys were SLE (OR= 2.37; 95%CI 1.92-293), SSc (OR=2.25; 95%CI 1.05-4.83) and rituximab use (OR=1.92; 95%CI 1.13-3.26). In addition, age >=65 years (OR=5.47; 95%CI 1.7-19.4) and heart disease (OR=2.60; 95%CI 1.06-6.38) were associated with hospitalization. Seven female RD patients died, six with SLE and one with pSS, and the presence of two or more comorbidities were associated with higher mortality rate.Conclusion:Chronic HCQ use did not prevent COVID-19 in RD compared to their household cohabitants. Health care profession, presence of comorbidities LES, SSc and rituximab were identified as main risk factors for COVID-19 and aging and heart disease as higher risk for hospitalization. Our data suggest these outcomes could be considered to manage them in clinical practice.Table 1.Frequency and severity of COVID-19 in patients with rheumatic diseases on chronic use of hydroxychloroquine compared to their household controlsCOVID-19 outcomesTotal (%)GroupsPPatients (%)Controls (%)DiagnosisNo9256 (89.1)5300 (88.3)3956 (90.2)0.002Yes1132 (10.9)704 (11.7)428 (9.8)SeverityMild1059 (93.6)662 (94.0)397 (92.8)0.391Moderate52 (4.6)32 (4.5)20 (4.7)Severe21 (1.9)10 (1.4)11 (2.6)HCQ: hydroxychloroquine.Moderate and severe COVID-19 included the need for any of the following: hospitalization, intensive care, mechanical ventilation or death.Acknowledgements:To the Brazilian Society of Rheumatology for technical support and rapid nationwide mobilization.To all the 395 interviewers (medical students and physicians) who collaborated in the study and the participantsTo CNPq (Number 403442/2020-6)Disclosure of Interests:None declared

Background:Mental health was widely affected during the new coronavirus pandemic. In addition, some measures adopted by most countries in order to contain the virus spread, such as isolation and social distancing, leading to the interruption of routine activities, including partial or complete interruption of face-to-face classes may be associated with increased stress, depression and anxiety among undergraduate medical students (1). From March to September, 2020, the Brazilian Society of Rheumatology carried out the Mario Pinotti II Project (MPII), a prospective, multicenter, observational cohort study designed to monitor the COVID-19 in patients with rheumatic disease on hydroxychloroquine, using periodic telephone calls performed by undergraduate medical students (2).Objectives:To compare the mental health status of medical students who were participating from the MPII with theirs colleagues not involved in this project.Methods:A web-based survey via google forms platform was developed by a panel composed of undergraduate medical students, rheumatologists, medical school professors, and a psychology professor. It included details on demographic and life habits data and domains regarding depression, anxiety and stress, using the DASS-21 (Depression, Anxiety & Stress Scale), Brazilian version. Data collection occurred from July 20th to August 31st, 2020. Statistical analysis was performed using the SPSS version 20.0. Univariate and multivariate linear regression analysis were performed to verify associations with the DASS-21, defined as dependent variable. A p-value < 0.05 was deemed as significant. This study was approved by the Institutional Research Ethics Committee.Results:A total of 684 undergraduate medical students were included in this study, of whom 228 as MPII volunteers (VG) and 456 as control group (CG). Median age was 23 years (IQ 21-24) and the CG was older than the VG (p<0.03). Most of them were white (68.8%) and women (63%). There were no significant differences regarding comorbidities, ethnicity, smoking status, alcohol intake and physical activity. Older age, male gender, participation of MPII study, absence of a worsening in sleep pattern during the pandemic and a lower number of prior comorbidities were associated with lower DASS21 scores, suggesting a better mental health (Table 1).Conclusion:Several aspects may be involved with mental health, including increased emotional maturity, gender and sleep pattern. Although with marginal independent association, medical students with participation in the MPII study had better mental health than their student colleagues not engaged with this research. Our data pointed out that voluntary participation in a research project which foresees interaction by telephone contact with rheumatic patients, professors, rheumatologists, and colleagues is associated with better mental health.References:[1]Meo SA, Abukhalaf AA, Alomar AA, Sattar K, Klonoff DC. Covid-19 pandemic: Impact of quarantine on medical students’ mental wellbeing and learning behaviors. Pakistan J Med Sci 2020;36(COVID19-S4):S43–8.[2]Gomides A, Ferreira G, Kakehas A, Lacerda M, Marques C, Paiva E et al. Impact of chronic use of antimalarials on SARS-COV-2 infection in patients with immune-mediated rheumatic diseases: protocol design for a multicentric observational cohort in Brazil. JMIR Research Protocols, 2020.PreprintTable 1.Univariate and multivariate analysis of predictors associated to the DASS-21 in undergraduate medical students during the COVID-19 pandemicUnivariate analysisMultivariate analysisVariableB95%CIp-ValueB95%CIp-ValueAge-0.32-0.61 to -0.030.03-0.47-0.81 to -0.130.008Female gender4.883.021 to 6.76<0.001---Stable love relationship-2.49-4.35 to -0.640.008-2.5-4.4 to -0.590.01Number of previous comorbidities reported4.693.71 to 5.68<0.0014.823.73 to 5.92<0.001MP-II volunteering-2.81-4.74 to -0.860.005---Worsening in sleep pattern6.414.62 to 8.20<0.0015.013.07 to 6.96<0.001Disclosure of Interests:None declared

Background:Host, viral and environmental factors have been associated with severe clinical outcome of COVID-19. A large body of accumulating evidence supports the idea that age, ethnicity, sex, comorbidities, immunological history, viral factors and low socioeconomic status (SES) are risk factors for severe COVID-19 outcomes. Studies addressing the impact of these factors in Latin American patients with rheumatic immune-mediated inflammatory diseases (IMIDs) are scarce.Objectives:To assess the effect of socioeconomic characteristics on mortality due SARS-CoV-2 infection in patients with IMIDs from Argentina, Brazil and Mexico.Methods:Data from three national registries, SAR-COVID (Argentina), CMR-COVID (Mexico) and ReumaCoV-Brasil (Brazil), were combined. Adult IMIDs patients with SARS-CoV-2 infection were recruited between 08.2020 and 09.2022 in SAR-COVID, between 04.2020 and 06.2022 in CMR-COVID and between 05.2020 and 11.2020 in ReumaCoV-Brasil. National data for each province/state including population density, number of physicians per inhabitant, income, unemployment, GINI index, Human Development Index (HDI), vaccination rate and most frequent viral strains per time period were assessed as risk factors for mortality due to COVID-19.Results:A total of 4744 patients were included, 2534 (53.4%) from SAR-COVID, 1166 (24.6%) from CMR-COVID and 1044 (22.0%) from ReumaCoV-Brasil. Hospitalization was reported in 22.7% of the patients and 5.3% died due to COVID-19. Bivariable analysis showed higher mortality in Mexican, older, male, users of glucocorticoids, users of CD20 inhibitors and diabetic patients; having chronic kidney disease, and higher disease activity also showed a higher mortality. Worse socioeconomic status, doctors per 1000 inhabitants, delta variant and non-vaccination were factors associated with mortality in the bivariate analysis (Table 1).In the multivariable analysis, living in Mexico, higher GINI index (increased inequity), lower monthly income, higher population density, lower HDI, and higher unemployment rate, were independently associated with increased mortality, while belonging to a fully vaccinated population, or developing COVID-19 during Omicron virus variant spread period were associated with decreased mortality (Table 1, Figure 1).Conclusion:These findings corroborate the association of some host, viral,environmental and socioeconomic factors with death due to COVID-19 in Argentina, Brazil and Mexico. The increased mortality in patients living in Mexico may be attributable to factors not evaluated in this study, such as ethnicity or not prioritizing vaccination for IMIDs patients.REFERENCES:NIL.Figure 1.Factors associated with mortality. Multivariable analysisAbbreviations: RD: rheumatic diseases, IRD: inflammatory rheumatic diseases, IJD: inflammatory joint diseases, CTDVasculitis: connective tissue diseases and vasculitis, Physicians_1000h: number of physicians/1000 inhabitants, Q: quartile.Acknowledgements:NIL.Disclosure of Interests:None declared.

ObjectivesTo evaluate risk factors associated with unfavourable outcomes: emergency care, hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death in patients with immune-mediated rheumatic disease (IMRD) and COVID-19.MethodsAnalysis of the first 8 weeks of observational multicentre prospective cohort study (ReumaCoV Brasil register). Patients with IMRD and COVID-19 according to the Ministry of Health criteria were classified as eligible for the study.Results334 participants were enrolled, a majority of them women, with a median age of 45 years; systemic lupus erythematosus (32.9%) was the most frequent IMRD. Emergency care was required in 160 patients, 33.0% were hospitalised, 15.0% were admitted to the ICU and 10.5% underwent mechanical ventilation; 28 patients (8.4%) died. In the multivariate adjustment model for emergency care, diabetes (prevalence ratio, PR 1.38; 95% CI 1.11 to 1.73; p=0.004), kidney disease (PR 1.36; 95% CI 1.05 to 1.77; p=0.020), oral glucocorticoids (GC) (PR 1.49; 95% CI 1.21 to 1.85; p<0.001) and pulse therapy with methylprednisolone (PR 1.38; 95% CI 1.14 to 1.67; p=0.001) remained significant; for hospitalisation, age >50 years (PR 1.89; 95% CI 1.26 to 2.85; p=0.002), no use of tumour necrosis factor inhibitor (TNFi) (PR 2.51;95% CI 1.16 to 5.45; p=0.004) and methylprednisolone pulse therapy (PR 2.50; 95% CI 1.59 to 3.92; p<0.001); for ICU admission, oral GC (PR 2.24; 95% CI 1.36 to 3.71; p<0.001) and pulse therapy with methylprednisolone (PR 1.65; 95% CI 1.00 to 2.68; p<0.043); the two variables associated with death were pulse therapy with methylprednisolone or cyclophosphamide (PR 2.86; 95% CI 1.59 to 5.14; p<0.018).ConclusionsAge >50 years and immunosuppression with GC and cyclophosphamide were associated with unfavourable outcomes of COVID-19. Treatment with TNFi may have been protective, perhaps leading to the COVID-19 inflammatory process.