Patients with rheumatic diseases may not have elevated COVID-19 mortality risk
medwireNews: Findings from two studies published in the Annals of the Rheumatic Diseases suggest that people with rheumatic diseases may not have a higher risk for COVID-19 mortality and other adverse outcomes than those without.
The first study involved 143 patients with rheumatic diseases and COVID-19 from a US multicenter healthcare system who were matched by age, sex, and COVID-19 diagnosis date to 688 patients without rheumatic diseases. Patients were aged an average of approximately 60 years and 76% were women; the most common rheumatic disease was rheumatoid arthritis (RA; 31%), followed by systemic lupus erythematosus (19%).
Zachary Wallace (Massachusetts General Hospital, Boston, USA) and colleagues found that the risk for hospitalization, admission to an intensive care unit (ICU), or death was comparable among people with and without rheumatic diseases after adjustment for factors including race, smoking, and comorbidities, at rates of 41% versus 43%, 20% versus 14%, and 8% versus 7%, respectively.
There was a trend toward a higher risk for mechanical ventilation among rheumatic disease patients versus controls (15 vs 9%), but the between-group difference was not statistically significant after adjustment for comorbidities.
The researchers note that “[e]arlier studies observed a higher risk of mechanical ventilation in patients with rheumatic disease versus comparators early in the pandemic,” but suggest that “[o]utcomes of COVID-19 infection in patients with rheumatic disease may have improved over time due to improved COVID-19 management, less stress on the healthcare system due to capacity issues during the early surge or increased testing capacity allowing detection of milder cases.”
They conclude: “These results may provide reassurance to patients with rheumatic disease and their providers during the ongoing COVID-19 pandemic.”
In the second study, the investigators found that among hospitalized patients with COVID-19 in France, mortality rates were not significantly different among 175 patients with rheumatic diseases compared with 175 matched individuals without rheumatic diseases, at rates of 25.1% and 18.9%, respectively.
Eric Hachulla (CHU Lille, France) and colleagues also evaluated risk factors for severe COVID-19 in the total cohort of 694 patients with rheumatic diseases – most commonly RA (31%) and spondyloarthritis (24%) – and COVID-19. In all, 13% developed severe disease, defined as death or ICU admission, while 24% had moderate COVID-19 (hospitalized but not in the ICU), and the remaining 63% were not hospitalized and were categorized as having mild disease.
In a multivariable analysis, older age, male sex, higher BMI, and hypertension were all associated with a significantly increased risk for severe COVID-19, as were some rheumatic disease treatments, namely corticosteroids, mycophenolate mofetil/mycophenolic acid, and rituximab.
“In addition to common risk factors for severe SARS-CoV-2 infection, patients with [inflammatory rheumatic and musculoskeletal diseases] on any dose of corticosteroid should be considered as particularly fragile and at high risk for developing severe disease,” conclude Hachulla and team.
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