Risk for COVID-19 varies by rheumatic disease, age, prior therapy use
The risk for hospital-diagnosed COVID-19 among patients with autoimmune or immune-mediated disease may depend on age, specific disease and prior therapy, according to data published in the Annals of the Rheumatic Diseases.
“We previously knew that aged patients and patients with some common diseases had an increased risk for more severe disease — i.e., getting hospitalized or death — but we did not know about patients with rheumatic and musculoskeletal diseases,” José L. Pablos, MD, PhD, of the Instituto de Investigación Hospital 12 de Octubre, in Madrid, Spain, told Healio Rheumatology. “We examined whether patients with inflammatory or autoimmune rheumatic conditions, often on immunosuppressive therapies, are protected or, contrarily, at higher risk of COVID-19.”
To accomplish this task, Pablos and colleagues conducted a retrospective study with patients under follow-up in rheumatology departments from seven hospitals across Spain. The researchers matched updated databases of patients with rheumatic diseases with positive COVID-19 PCR tests performed in the hospital to reference populations between April 7 and 17, following the peak of coronavirus infection in Spain. Rates of PCR-positive, severe COVID-19 were compared among the groups.
The total reference population among the participating hospitals was 2.9million people. The screened COVID-19 population included 26,131 patients under follow-up in rheumatology departments in their reference hospitals.
According to the researchers, patients with chronic inflammatory diseases demonstrated a 1.32-fold higher overall prevalence of hospital-diagnosed COVID-19, compared with the reference population. However, not all diseases and therapies conferred the same risk. Patients with systemic autoimmune or immune-mediated disease — such as Sjogren’s syndrome, scleroderma or vasculitis — showed a 2- to 3-fold higher risk for COVID-19. Meanwhile, patients with inflammatory arthritis or systemic lupus erythematosus demonstrated no increased risk.
“Not all diseases and therapies conferred the same risk,” Pablos said. “For example, the risk was very high for patients with autoimmune conditions with the remarkable exception of lupus patients who did not show an increased risk. Conversely, patients with chronic arthritis were not at higher risk unless were taking biologic therapies.”
Notably, the researchers found that COVID-19 cases in some but not all diagnostic groups had older ages than those in the reference population. In addition, patients with inflammatory arthritis who were treated with targeted-synthetic or biological DMARDs, but not those on conventional-synthetic DMARDs, had a greater prevalence of COVID-19 despite a similar age distribution.
“This data are of help to tailor specific recommendations on COVID-19 to rheumatic patients,” Pablos said. “The mentioned groups — autoimmune, biologic therapy — are at higher risk to get more severe COVID-19 than the general population and should practice extreme general prevention measures, such as confinement, mask, hygiene and vaccination when available, or seek early medical care if they have symptoms.”
“Other groups of patients, such as those with lupus or arthritis on conventional therapy, should also know that they are not at increased risk,” he added. “We also always recommend maintaining previous therapies to avoid worsening of the rheumatic disease that may also increase the risk for infections and many other complications.”