All-cause mortality in systemic rheumatic diseases under treatment compared with the general population, 2015–2019

Bournia, Vasiliki-Kalliopi; Fragoulis, G.; Mitrou, Panagiota; Mathioudakis, K.; Tsolakidis, Anastasios; Konstantonis, George; Vourli, Georgia; Paraskevis, Dimitrios; Tektonidou, Maria G; Sfikakis, Petros P.

doi:10.1136/rmdopen-2021-001694

Cited by 37 publications

(29 citation statements)

References 31 publications

(42 reference statements)

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“…Therefore, it seems that certain conditions, such as RA, PM, PsA or other Spondylarthritis, which in fact represent the majority of the patients included in these registries, might not be equivalent to SLE, SjS, Sarcoidosis, SSc or SV, among others [ 4 , 20 , 22 , 23 , 24 , 25 , 28 , 29 , 31 , 32 ]. This is not surprising since the pathophysiology, systemic involvement, and impact on mortality among these diseases differ significantly [ 33 , 34 , 35 ]. Accordingly, we only analyzed in our national registry systemic rheumatic or autoimmune diseases, excluding chronic inflammatory arthritis, in order to understand their real significance in COVID-19 outcomes.…”

Section: Discussionmentioning

confidence: 99%

Systemic Autoimmune Diseases in Patients Hospitalized with COVID-19 in Spain: A Nation-Wide Registry Study

Moreno-Torres

Mendoza

Mellor‐Pita

et al. 2022

Viruses

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We aimed to evaluate the clinical outcome of Systemic Autoimmune Diseases (SADs) patients hospitalized with COVID-19 in Spain, before the introduction of SARS-CoV-2 vaccines. A nationwide, retrospective and observational analysis of the patients admitted during 2020, based on the ICD10 codes in the National Registry of Hospital Discharges, was performed. Among 117,694 patients, only 892 (0.8%) presented any type of SAD before COVID-19-related admission: Sjogren’s Syndrome constituted 25%, Systemic Vasculitides 21%, Systemic Lupus Erythematosus 19%, Sarcoidosis 17%, Systemic Sclerosis 11%, Mixed and Undifferentiated Connective Tissue Disease 4%, Behçet’s Disease 4% and Inflammatory Myopathies 2%. The in-hospital mortality rate was higher in SAD individuals (20% vs. 16%, p < 0.001). After adjustment by baseline conditions, SADs were not associated with a higher mortality risk (OR = 0.93, 95% CI 0.78–1.11). Mortality in the SADs patients was determined by age (OR = 1.05, 95% CI 1.04–1.07), heart failure (OR = 1.67, 95% CI 1.10–2.49), chronic kidney disease (OR = 1.29, 95% CI 1.05–1.59) and liver disease (OR = 1.97, 95% CI 1.13–3.44). In conclusion, the higher COVID-19 mortality rate seen in SADs patients hospitalized in Spain in 2020 was related to the higher burden of comorbidities, secondary to direct organ damage and sequelae of their condition. Whilst further studies should evaluate the impact of baseline immunosuppression on COVID-19 outcomes in this population, efforts should be focused on the optimal management of SAD to minimize the impact of the organ damage that has been shown to determine COVID-19 prognosis.

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Section: Discussionmentioning

confidence: 99%

Systemic Autoimmune Diseases in Patients Hospitalized with COVID-19 in Spain: A Nation-Wide Registry Study

Moreno-Torres

Mendoza

Mellor‐Pita

et al. 2022

Viruses

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“…It seems, thus, that typical chest pain in SLE patients is mainly linked to CMD and is associated with myocardial ischaemia, which has been already confirmed using radionuclide techniques 92–94 . It is impressive that survival rates over 5 years in inflammatory arthritis under treatment are currently comparable with those of the general population, but all‐cause mortality is almost 2‐fold and 4‐fold higher in SLE and SSc respectively 95 …”

Section: Cmd In Rheumatologymentioning

confidence: 80%

“…[92][93][94] It is impressive that survival rates over 5 years in inflammatory arthritis under treatment are currently comparable with those of the general population, but all-cause mortality is almost 2-fold and 4-fold higher in SLE and SSc respectively. 95…”

Section: Systemic Lupus Erythematosusmentioning

confidence: 99%

Coronary microvascular disease: The “Meeting Point” of Cardiology, Rheumatology and Endocrinology

Markousis‐Mavrogenis

Bacopoulou

Mavragani

et al. 2022

Eur J Clin Investigation

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Background Exertional chest pain/dyspnea or chest pain at rest are the main symptoms of coronary artery disease (CAD), which are traditionally attributed to insufficiency of the epicardial coronary arteries. However, 2/3 of women and 1/3 of men with angina and 10% of patients with acute myocardial infarction have no evidence of epicardial coronary artery stenosis in X‐ray coronary angiography. In these cases, coronary microvascular disease (CMD) is the main causative factor. Aims To present the pathophysiology of CMD in Cardiology, Rheumatology and Endocrinology. Materials‐Methods The pathophysiology of CMD in Cardiology, Rheumatology and Endocrinology was evaluated. It includes impaired microvascular vasodilatation, which leads to inability of the organism to deal with myocardial oxygen needs and, hence, development of ischemic pain. CMD, observed in inflammatory autoimmune rheumatic and endocrine/metabolic disorders, brings together Cardiology, Rheumatology and Endocrinology. Causative factors include persistent systemic inflammation and endocrine/metabolic abnormalities influencing directly the coronary microvasculature. In the past, the evaluation of microcirculation was feasible only with the use of invasive techniques, such as coronary flow reserve assessment. Currently, the application of advanced imaging modalities, such as cardiovascular magnetic resonance (CMR), can evaluate CMD non‐invasively and without ionizing radiation. Results CMD may present with a variety of symptoms with 1/3 to 2/3 of them expressed as typical chest pain in effort, more commonly found in women during menopause than in men. Atypical presentation includes chest pain at rest or exertional dyspnea,but post exercise symptoms are not uncommon. The treatment with nitrates is less effective in CMD, because their vasodilator action in coronary micro‐circulation is less pronounced than in the epicardial coronary arteries. Discussion Although both classic and new medications have been used in the treatment of CMD, there are still many questions regarding both the pathophysiology and the treatment of this disorder. The potential effects of anti‐rheumatic and endocrine medications on the evolution of CMD need further evaluation. Conclusion CMD is a multifactorial disease leading to myocardial ischemia/fibrosis alone or in combination with epicardial coronary artery disease. Endothelial dysfunction/vasospasm, systemic inflammation, and/or neuroendocrine activation may act as causative factors and bring Cardiology, Rheumatology and Endocrinology together. Currently, the application of advanced imaging modalities, and specifically CMR, allows reliable assessment of the extent and severity of CMD. These measurements should not be limited to “pure cardiac patients”, as it is known that CMD affects the majority of patients with autoimmune rheumatic and endocrine/metabolic disorders.

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“…In this nationwide, population-based cohort study we identified all adult patients with RA, AS, PsA, SLE, and SSc alive on 1-March-2020 and matched each patient to 5 random referents from the general population for gender, age and region of domicile. For this purpose, we used our published data[13] derived from the electronic prescription database for social security services (IDIKA) including all adult (aged ≥18years old) patients who had filled at least one prescription for corticosteroids, conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), immunosuppressants, biologic DMARDs, targeted synthetic DMARDs, advanced vasodilatory medications or antifibrotic agents between 1-January-2015 and 31-December-2019 with a diagnosis of either RA, AS, PsA, SLE or SSc, based on prespecified for each disease ICD-10 codes. To avoid selection bias, we limited our requirements for inclusion in the cohort to one filled prescription with any of the above-mentioned medications of interest between 2015-2019.…”

Section: Methodsmentioning

confidence: 99%

Different Covid-19 Outcomes Among Systemic Rheumatic Diseases: A Nation-wide Cohort Study

Bournia

Fragoulis

Mitrou

et al. 2022

Preprint

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Background: Nationwide data at a country level on Covid-19 in unvaccinated patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) are scarce. Methods: By interlinking data from national electronic registries, covering nearly 99% of the Greek population (approximately 11,000,000), between March 2020 and February 2021, when vaccination became available, we recorded confirmed infections and Covid-19-associated hospitalizations and deaths in essentially all adult patients with RA, AS, PsA, SLE, and SSc under treatment (n=74,970, median age of 67.5, 51.2, 58.1, 56.2, 62.2 years, respectively) and in individually matched (1:5) on age, sex, and region of domicile random comparators from the general population. Results: Binary logistic regression analysis after adjusting for age, sex and biologic agents, revealed that RA, PsA, SLE and SSc, but not AS patients, had significantly higher risk of infection (by 43%, 25%, 20% and 49%, respectively), and hospitalization for Covid-19 (by 81%, 56%, 94%, and 111%, respectively), possibly due, at least in part, to increased testing and lower threshold for admission. Patients with RA and SSc had indeed higher Covid-19 associated mortality rates [OR:1.86 (95% CI 1.37 to 2.52) and OR:2.90 (95% CI 0.97 to 8.67), respectively] compared to the general population. Each additional year of age increased the risk of hospitalization for Covid-19 by 3% (OR 1.030, 95% CI: 1.028 to 1.034) and the risk of Covid-19 related death by 8% (OR 1.08, 95% CI: 1.07 to 1.09), independently of gender, systemic rheumatic disease, and biologic agents. A further analysis using AS patients as the reference category, adjusting again for age, sex and use of biologic agents showed that patients with SSc had increased mortality (OR: 6.90, 95% CI: 1.41 to 33.72), followed by SLE (OR: 4.05 95% CI: 0.96 to 17.12) and RA patients (OR: 3.65, 95% CI: 1.06 to 12.54), whereas PsA patients had comparable mortality risk with AS patients. Conclusion: Comparing to the general population, Covid-19 may have a more severe impact in real-world patients with systemic rheumatic disease. Covid-19 related mortality is increased in subgroups of patients with specific rheumatic diseases, especially in older ones, underscoring the need for priority vaccination policies and access to targeted treatments.

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All-cause mortality in systemic rheumatic diseases under treatment compared with the general population, 2015–2019

Cited by 37 publications

References 31 publications

Systemic Autoimmune Diseases in Patients Hospitalized with COVID-19 in Spain: A Nation-Wide Registry Study

Systemic Autoimmune Diseases in Patients Hospitalized with COVID-19 in Spain: A Nation-Wide Registry Study

Coronary microvascular disease: The “Meeting Point” of Cardiology, Rheumatology and Endocrinology

Different Covid-19 Outcomes Among Systemic Rheumatic Diseases: A Nation-wide Cohort Study

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