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16-07-2020 | Rheumatology | News | Article

Further evidence for increased COVID-19 susceptibility in patients with rheumatic diseases

Hannah Kitt

medwireNews: Retrospectively collected data suggest that patients with autoimmune rheumatic diseases from the Hubei province in China had a greater susceptibility to COVID-19 infection than their family members living in the same household during the outbreak.

The results indicate a 2.68-fold elevated risk for COVID-19 among individuals with an autoimmune rheumatic disease compared with those without and the researchers therefore recommend that such patients “take all necessary precautions to protect themselves from COVID-19 and reduce the risk of SARS-CoV-2 infection.”

Lingli Dong (Huazhong University of Science and Technology, Wuhan, Hubei) and colleagues note that the “findings can be valuable for strategic planning and management of patients with rheumatic disease during the ongoing COVID-19 pandemic.”

Telephone surveys conducted in March 2020 with 6228 patients with autoimmune rheumatic diseases, including rheumatoid arthritis, systemic lupus erythematous, Sjögren’s syndrome, IgG4-related disease, and undifferentiated connective tissue disease, identified 42 families who reported having at least one household member diagnosed with COVID-19 between 20 December 2019 and 20 March 2020.

Among these families, 27 of 43 patients with autoimmune rheumatic diseases exposed to the infection were diagnosed with COVID-19, compared with 28 of 83 of their family members without a rheumatic disease, at respective rates of 63% versus 34%.

Participants were diagnosed based on a SARS-CoV-2 RNA test or a clinical assessment that identified COVID-19 symptoms plus typical high-resolution computerized tomography imaging features of COVID-19. The researchers note that a higher rate of COVID-19 was still observed among the rheumatic disease patients compared with their exposed family members when the analysis was restricted to RNA-confirmed cases.

In all, 27 rheumatic disease patients had COVID-19 out of the 6228 patients contacted, giving an incidence rate of 0.43%, which the researchers note was higher than the overall infection rate of 0.12% reported for Hubei province as of 20 March 2020.

They emphasize that “the overall infection rate calculated in this study might be an underestimate considering the number of unidentifiable asymptomatic cases.”

Dong and colleagues add that patients taking hydroxychloroquine were 91% less likely to have COVID-19 than patients on other DMARDs. But they warn that “the number of patients with exposure to hydroxychloroquine was small and the lower COVID-19 incidence observed in comparison with patients taking other immunosuppressive medications should be interpreted with caution.”

They stress that “the overall effects of hydroxychloroquine in the general population require further investigation.”

On the other hand, the risk for COVID-19 increased significantly with age, by 0.4% with every additional year, after adjusting for sex and rheumatic disease.

Dong et al say their findings are consistent with previous studies suggesting that “patients with rheumatic disease might be more vulnerable to COVID-19 than the general population.”

But they add that “[f]uture investigations in larger studies are needed to gather more evidence.”

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

16 July 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.

Lancet Rheumatol 2020; doi:10.1016/S2665-9913(20)30227-7

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