Autoimmune inflammatory rheumatic diseases and COVID-19 outcomes in South Korea: a nationwide cohort study

Abstract

Background Real-world evidence on the association between autoimmune inflammatory rheumatic diseases, therapies related to these diseases, and COVID-19 outcomes are inconsistent. We aimed to investigate the potential association between autoimmune inflammatory rheumatic diseases and COVID-19 early in the COVID-19 pandemic. Methods We did an exposure-driven, propensity score-matched study using a South Korean nationwide cohort linked to general health examination records. We analysed all South Korean patients aged older than 20 years who underwent SARS-CoV-2 RT-PCR testing between Jan 1 and May 30, 2020, and received general health examination results from the Korean National Health Insurance Service. We defined autoimmune inflammatory rheumatic diseases (inflammatory arthritis and connective tissue diseases) based on the relevant ICD-10 codes, with at least two claims (outpatient or inpatient) within 1 year. The outcomes were positive SARS-CoV-2 RT-PCR test, severe COVID-19 (requirement of oxygen therapy, intensive care unit admission, application of invasive ventilation, or death), and COVID-19-related death. Adjusted odds ratios (ORs) with 95% CIs were estimated after adjusting for the potential confounders. Findings Between Jan 1 and May 30, 2020, 133 609 patients (70 050 [52·4%] female and 63 559 [47·6%] male) completed the general health examination and were tested for SARS-CoV-2; 4365 (3·3%) were positive for SARS-CoV-2, and 8297 (6·2%) were diagnosed with autoimmune inflammatory rheumatic diseases. After matching, patients with an autoimmune inflammatory rheumatic disease showed an increased likelihood of testing positive for SARS-CoV-2 (adjusted OR 1·19, 95% CI 1·03–1·40; p=0·026), severe COVID-19 outcomes (1·26, 1·02–1·59; p=0·041), and COVID-19-related death (1·69, 1·01–2·84; p=0·046). Similar results were observed in patients with connective tissue disease and inflammatory arthritis. Treatment with any dose of systemic corticosteroids or disease-modifying antirheumatic drugs (DMARDs) were not associated with COVID-19-related outcomes, but those receiving high dose (≥10 mg per day) of systemic corticosteroids had an increased likelihood of a positive SARS-CoV-2 test (adjusted OR 1·47, 95% CI 1·05–2·03; p=0·022), severe COVID-19 outcomes (1·76, 1·06–2·96; p=0·031), and COVID-19-related death (3·34, 1·23–8·90; p=0·017). Interpretation Early in the COVID-19 pandemic, autoimmune inflammatory rheumatic diseases were associated with an increased likelihood of a positive SARS-CoV-2 PCR test, worse clinical outcomes of COVID-19, and COVID-19-related deaths in South Korea. A high dose of systemic corticosteroid, but not DMARDs, showed an adverse effect on SARS-CoV-2 infection and COVID-19-related clinical outcomes. Funding National Research Foundation of Korea.

The incidence, clinical characteristics, and outcome of COVID-19 in a prospectively followed cohort of patients with Behçet’s syndrome

“…Despite our first report [14] with relatively small sample size (n = 10), we found a favorable outcome in this large prospective cohort of BS patients. Our current observations are also in contrast with a number of studies who reported increased risk for severe COVID-19 infection and COVID-19 related death among patients with RD [4,26,27]. In our study, while 18.7% had lung involvement, none of the patients died or had a thrombotic event.…”

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Association between previous rheumatoid arthritis and COVID-19 and its severity: a nationwide cohort study in South Korea

“…Recently, patients with inflammatory arthritis showed an increased likelihood of testing positive for COVID-19 and severe COVID-19 outcomes inconsistent with our study. 32 However, that study involved some differences in the inclusion criteria and the definition of severe COVID-19. The researchers included RA as an inflammatory arthritis with other types of arthritis such as psoriatic arthritis and compared patients with and without inflammatory arthritis; in contrast, we only included patients with RA.…”

Association between chronic hepatitis B infection and COVID-19 outcomes: A Korean nationwide cohort study

“…This COVID-19 cohort study is a retrospective, nationwide case-control study using Korean National Health Insurance Service COVID database (NHIS-COVID DB) that includes all Koreans who were tested for SARS-CoV-2 through services facilitated by Korean National Health Insurance Service (NHIS), Korea Centers for Disease Control and Prevention, and the Health Insurance, Review & Assessment Service of Korea between January 1, 2020 and June 4, 2020 as a result of medical or Korea Centers for Disease Control referral. From this data, we obtained the demographic information, previous health screening results, three years of complete healthcare records, test results for SARS-CoV-2, and clinical outcomes of COVID-19 from January 1, 2015 to August 18, 2020 [ 8 ]. The detailed study protocol used was previously described [ 9 , 10 ].…”