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29-05-2020 | Rheumatology | News | Article

Elevated rates of COVID-19 respiratory complications in people with rheumatic diseases

Claire Barnard

medwireNews: People with rheumatic diseases have a significantly higher risk for developing severe COVID-19 respiratory complications than those without, suggest findings from a US cohort study.

“Our findings are important benchmarks in the care of patients with rheumatic disease as the COVID-19 pandemic continues to unfold and highlight the need for close monitoring when patients with rheumatic disease are diagnosed with COVID-19,” say Zachary Wallace (Massachusetts General Hospital, Boston, USA) and colleagues.

The study included 52 patients with rheumatic diseases and confirmed SARS-CoV-2 infection from the Partners HealthCare System in Boston who were matched to 104 patients without rheumatic diseases based on age, sex, and SARS-CoV-2 test date. The most common rheumatic disease diagnosis was rheumatoid arthritis (37%), followed by systemic lupus erythematosus (19%), polymyalgia rheumatica (13%), and seronegative spondyloarthritis (13%).

In all, 37% of rheumatic disease patients were in remission at the time of COVID-19 diagnosis, whereas 63% had active rheumatic disease. Three-quarters of patients were taking an immunosuppressive medication – including 31% on conventional DMARDs, 31% on biologic DMARDs, and 6% on a Janus kinase inhibitor – while 17% were taking hydroxychloroquine.

As reported in the Annals of the Rheumatic Diseases, a comparable proportion of patients with and without rheumatic diseases were admitted to hospital (44 vs 40%), but among hospitalized patients those with rheumatic disease had a significant 3.1-fold higher risk for requiring mechanical ventilation than those without after adjustment for age, BMI, smoking, and comorbidities.

Specifically, 48% of the 23 hospitalized patients with rheumatic disease required intensive care unit admission and mechanical ventilation, compared with just 17% of the 42 without.

Wallace and team say that the higher risk for severe COVID-19 respiratory complications among individuals with rheumatic diseases “is concerning,” and note that “the factors underlying this association are unclear.” They suggest that unmeasured confounding due to “differences in severity of comorbidities or conditions not measured” may have played a role, as well as “[d]ifferences in exposures to immunosuppressive medications.”

Despite these differences in rates of mechanical ventilation, the researchers found no significant difference in the proportion of patients requiring supplemental oxygen (74 vs 67%) among people with versus without rheumatic diseases, and the symptoms of COVID-19 were also similar in the two groups, with cough, fever, shortness of breath, and myalgia being the most common.

There was also no significant difference in mortality risk between the two groups, although the researchers point out that rates were numerically higher among people with versus without rheumatic diseases (6 vs 4%).

“This difference may have large public health significance if confirmed in larger sample sizes,” they say.

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group

29 May 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Ann Rheum Dis 2020; doi:10.1136/annrheumdis-2020-217888

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