COVID-19 and Rheumatology

COVID-19 and Rheumatology

Disclosures: D’Silva reports funding from the NIH. Please see the study for all other authors’ relevant financial disclosures.
December 29, 2020
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Patients with systemic autoimmune rheumatic diseases, COVID-19 at greater risk for VTE

Disclosures: D’Silva reports funding from the NIH. Please see the study for all other authors’ relevant financial disclosures.
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Patients with systemic autoimmune rheumatic diseases and COVID-19 may be at greater risk for hospitalization, ICU admission, acute renal failure and venous thromboembolism, according to data published in Arthritis & Rheumatology.

“Patients living with systemic autoimmune rheumatic diseases (SARDs) continue to be concerned about the risk of severe COVID-19 outcomes, given the chronic inflammatory state, use of immunosuppressive medications and comorbidities,” Kristin M. D’Silva, MD, of Massachusetts General Hospital and Harvard Medical School, told Healio Rheumatology.

“Systemic autoimmune rheumatic disease patients with significant cardiac and pulmonary comorbidities should be advised of the potentially higher risks of severe COVID-19 and encouraged to follow public health guidelines regarding social distancing to avoid infection,” Kristin M. D’Silva, MD, told Healio Rheumatology.

To examine COVID-19 outcomes among patients with systemic autoimmune rheumatic diseases, compared with control individuals, D’Silva and colleagues conducted a comparative cohort study using the TriNetX Dataworks network. According to the researchers, this large, multicenter network contains electronic health record data from 41 health care organizations from across the United States.

Systemic autoimmune rheumatic disease was defined as rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s syndrome, systemic sclerosis, dermatomyositis, polymyositis, other connective tissue diseases — including mixed or undifferentiated connective tissue diseases — systemic vasculitis — including granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis, polyarteritis nodosa, giant cell arteritis and Behçet’s disease — psoriatic arthritis and ankylosing spondylitis.

Kristin M. D’Silva

In all, the researchers identified 2,379 patients with systemic autoimmune rheumatic disease and COVID-19, as well as 142,750 comparators with COVID-19 but without systemic autoimmune rheumatic disease.

A total of 2,379 comparators were used in the primary matched model, with matching performed based on age, sex, race/ethnicity, BMI, comorbidities and health care use. The researchers assessed 30-day outcomes, including hospitalization, ICU admission, mechanical ventilation, acute renal failure requiring replacement therapy, ischemic stroke, venous thromboembolism and death.

According to the researchers, in the primary matched model, patients with systemic autoimmune rheumatic disease demonstrated significantly higher risks for hospitalization (RR = 1.14; 95% CI, 1.03-1.26), ICU admission (RR = 1.32; 95% CI, 1.03-1.68), acute renal failure (RR = 1.81; 95% CI, 1.07-3.07) and venous thromboembolism (RR = 1.74; 95% CI, 1.23-2.45), compared with control individuals. However, in the extended model, all risks were largely attenuated save for the risk for venous thromboembolism (RR = 1.6; 95% CI, 1.14-2.25).

“Clinically, SARDs patients with significant cardiac and pulmonary comorbidities should be advised of the potentially higher risks of severe COVID-19 and encouraged to follow public health guidelines regarding social distancing to avoid infection,” D’Silva said. “SARDs patients without comorbidities do not appear to be at higher risk of many severe outcomes, which is reassuring. However, SARDs patients do seem to have higher risk of venous thromboembolism in the setting of COVID-19 and should be closely monitored for deep venous thrombosis and pulmonary embolism if infected with SARS-CoV-2.”