Susceptibility factors for COVID-19 identified in patients with rheumatic diseases
medwireNews: Observational study findings from Spain show that some but not all rheumatic diseases are associated with an increased risk for hospital-diagnosed COVID-19 and the risk is influenced by age and previous therapies.
The results indicate that patients with rheumatic diseases had a significant 1.32-fold higher prevalence of hospital polymerase chain reaction (PCR)-positive COVID-19 than people without these diseases.
But when the patients were assessed according to type of rheumatic disease, Jose Pablos (Instituto de Investigación Hospital 12 de Octubre, Madrid) and team found that the risk was significantly increased for those with systemic autoimmune or immune-mediated disease, but not those with inflammatory arthritis or systemic lupus erythematosus (SLE).
The rates of hospital-confirmed COVID-19 were 0.76% among 26,131 rheumatic disease patients under follow-up in seven rheumatology hospitals in Spain, compared with 0.58% among a reference population comprising 2.9 million people.
In all, 19,975 of those with rheumatic diseases had inflammatory arthritis – rheumatoid arthritis, psoriatic arthritis, or spondyloarthritis – and their prevalence of hospitalized COVID-19 was comparable to that of the reference population, at 0.63%. This was in spite of patients with rheumatoid arthritis being older than patients with other rheumatic diseases, the researchers note.
A similar prevalence was seen for each condition separately, with the exception of spondyloarthritis. The hospitalized COVID-19 prevalence in this group reached 0.89%, corresponding to a 54% risk increase compared with the reference population.
Pablos and colleagues also note that among the patients with inflammatory arthritis, the 7558 patients taking conventional synthetic (cs)DMARDs were not at increased risk for hospitalized COVID-19, whereas the 5802 receiving biologic or targeted synthetic DMARDs were. This latter group had a significant 60% increased risk, with a prevalence of 0.94%.
“This suggests that these specific immunomodulators may increase the risk for hospitalized COVID-19, similarly as for other viral infections,” say the researchers.
In the 4781 patients with autoimmune or immune-related conditions, the prevalence of hospitalized COVID-19 was significantly higher than that of the reference population, at 1.11%, reflecting a significant 92% increase in risk. This increased risk was true for all diagnostic groups except SLE, reports the team, “where it was remarkably lower,” they note, at 0.62%.
This was an unanticipated finding, given an “expected greater use of corticosteroids and immunosupressants,” say Pablos and colleagues, who suggest that the frequent use of antimalarials “may have played a protective role.”
Most patients with rheumatic disease hospitalized with COVID-19 tended to be older than the reference population across the various diagnostic groups but not all.
A partial sample from two centers showed that patients with rheumatic diseases who were hospitalized for COVID-19 were twice as likely as the reference population to be older than 65 years (40 vs 20%), but the relative prevalence of older to younger patients was similar to that for the reference population.
“Therefore, although older age is a clear risk factor, disease or therapy-related factors also seem to modify the risk for hospital COVID-19 cases in the different rheumatic patients’ groups.”
The researchers conclude: “Our data on specific groups should be translated to current recommendations regarding alert on infection risk and prevention measures in rheumatic patients.”
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
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