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COVID-19 outcomes in patients with psoriasis and psoriatic arthritis: A prospective cohort study

Yan, Di; Kolla, Avani M; Young, Trevor; Fried, Lauren; Shankar, Shruthi; Rangel, Lauren; Yin, Lu; Castillo, Rochelle; Steuer, Alexa; Svigos, Katerina; Izmirly, Peter; Sekar, Vaish; Lesser, Robert; Solomon, Gary; Blank, Rebecca B; Haberman, Rebecca H; Neimann, Andrea L; Scher, Jose U
PMID: 35373153
ISSN: 2666-3287
CID: 5219542

COVID-19 in Patients with Inflammatory Arthritis: A Prospective Study on the Effects of Comorbidities and DMARDs on Clinical Outcomes

Haberman, Rebecca H; Castillo, Rochelle; Chen, Alan; Yan, Di; Ramirez, Deborah; Sekar, Vaish; Lesser, Robert; Solomon, Gary; Niemann, Andrea L; Blank, Rebecca B; Izmirly, Peter; Webster, Dan E; Ogdie, Alexis; Troxel, Andrea B; Adhikari, Samrachana; Scher, Jose U
OBJECTIVE:To characterize the hospitalization and death rates among patients with inflammatory arthritis affected by COVID-19 and to analyze the associations between comorbidities and immunomodulatory medications and infection outcomes. METHODS:Clinical, demographic, maintenance treatment, and disease course data and outcomes of individuals with inflammatory arthritis (IA; rheumatoid arthritis and spondylarthritis) with symptomatic COVID-19 infection were prospectively assessed via web-based questionnaire followed by individual phone calls and electronic medical record review. Baseline characteristics and medication use were summarized for hospitalized and ambulatory patients, and outcomes were compared for each medication class using multivariable logistic regression. RESULTS:A total of 103 patients with IA were included in the study (n=80 confirmed and n=23 highly suspicious for COVID-19). Twenty-six percent of participants required hospitalization, and 4% died. Patients who warranted hospitalization were significantly more likely to be older (P<0.001) and have comorbid hypertension (P=0.001) and chronic obstructive pulmonary disease (P=0.022). IA patients taking oral glucocorticoids had a higher likelihood of being admitted for COVID-19 (P<0.001) while those on maintenance anti-cytokine biologic therapies did not. CONCLUSION/CONCLUSIONS:In patients with underlying IA, COVID-19 outcomes were worse in those receiving glucocorticoids but not in patients on maintenance anti-cytokine therapy. Further work is needed to understand whether immunomodulatory therapies affect COVID-19 incidence.
PMID: 32725762
ISSN: 2326-5205
CID: 4557002

Improvement of Neuropsychiatric Lupus with Addition of SSRI Antidepressant/Antipsychotic Therapy

Lesser, R S; Walters, J L; Khan, R; Pebenito, R; Klee, S
Neuropsychiatric lupus erythematosus (NPLE) is a major cause of morbidity and mortality. We report a case involving an adolescent female who developed acute NPLE, manifesting as acute delusional depression with suicidal ideation. Despite high-dose corticosteroid therapy, these symptoms persisted. Within 7 to 10 days of initiation of paroxetine, a selective serotonin reuptake inhibitor (SSRI) and fluphenazine, an antipsychotic agent, the patient's neurovegetative symptoms of depression improved and suicidality remitted. Psychosis resolved with longer treatment. Undoubtedly these drugs were treating a psychiatric complication of the underlying disease. Our case supports the notion that some severe neuropsychiatric symptoms can be reversed without reliance upon immunosuppressants. It is premature to advocate unconditional acceptance of this approach, vet the findings in our case suggest that early adjunctive treatment with paroxetine and fluphenazine for steroid-resistant NPLE might spare a subset of patients the toxic effects and complications of immunosuppressants. This is the first report to describe a novel adjunctive treatment with the SSRI antidepressant, paroxetine. Our findings merit further investigation with larger numbers of patients.
PMID: 19078206
ISSN: 1076-1608
CID: 1421562

Non-giant cell arteritis of the temporal artery presenting as the polymyalgia rheumatica-temporal arteritis syndrome [Case Report]

Lesser, R S; Aledort, D; Lie, J T
We describe a heterogeneous group of 4 elderly patients with atypical vasculitis of the temporal artery who presented clinically with the polymyalgia rheumatica-temporal arteritis syndrome. The first had apparently isolated eosinophilic necrotizing vasculitis without peripheral blood eosinophilia, history of asthma, or pulmonary vasculitis (so called limited form of Churg-Strauss syndrome). Temporal artery biopsy in the 2nd patient revealed small vessel necrotizing vasculitis in the fragment of skeletal muscle surrounding a normal temporal artery (i.e., negative for giant cell arteritis, GCA). This patient subsequently developed rheumatoid polysynovitis. The temporal artery biopsies in the remaining 2 patients showed vasa vasorum vasculitis, without GCA, associated with malignancy in Patient 3 and as an unexpected and apparently isolated finding in Patient 4. All 4 patients responded to the standard corticosteroid therapy for giant cell temporal arteritis. Unusual temporal artery biopsies such as these should be interpreted in relation to clinical findings.
PMID: 8596167
ISSN: 0315-162x
CID: 1421572

The nonutility of chest roentgenographic examination in asymptomatic patients with positive tuberculin test results

Gottridge, J A; Meyer, B R; Schwartz, N S; Lesser, R S
To determine the value of chest roentgenograms in the management of asymptomatic persons with positive tuberculin skin test results, we undertook a retrospective review of all tests administered by our Employee Health Service, North Shore University Hospital, Manhasset, NY, between July 1, 1983 and November 1, 1987. Of 5200 tests, 247 results were positive. Two hundred twenty-one of these charts were reviewed for roentgenographic results and the presence of symptoms. All persons were asymptomatic. Chest roentgenograms revealed the following: normal, 188; unrelated abnormalities, 24; apical pleural thickening, 5; granulomas, 2; calcified hilar node, 1; and calcified node plus granuloma, 1. We noted no active tuberculosis, nor did the chest roentgenographic results influence recommendations for isoniazid prophylaxis. We conclude that chest roentgenograms are of value in 0% to 1.3% of asymptomatic people with positive tuberculin test results. A larger study should be undertaken to further define the usefulness of chest roentgenograms in this population.
PMID: 2742441
ISSN: 0003-9926
CID: 1421582


ISSN: 0009-9279
CID: 1421602

Aggressive lesion in osseous sarcoidosis [Case Report]

Lesser, R S; Dadparvar, S; Weiss, A A; Silverstein, G S; DeHoratius, R J
We describe an unusual aggressive lytic bone lesion with "sunburst/hair-on-end" periosteal reaction in a patient with surgically proven osseous sarcoid and review the pertinent literature.
PMID: 3379627
ISSN: 0315-162x
CID: 1421592