Clinical characteristics of COVID-19 patients with underlying rheumatic diseases in Japan: data from a multicenter observational study using the COVID-19 Global Rheumatology Alliance physician-reported registry

Abstract

Introduction To describe clinical characteristics of patients in Japan with coronavirus disease 19 (COVID-19) and pre-existing rheumatic disease and examine the possible risk factors associated with severe COVID-19. Methods Adults with rheumatic disease and a COVID-19 diagnosis who were registered in the COVID-19 Global Rheumatology Alliance (C19-GRA) physician-reported registry from Japan between 15 May 2020 and 12 May 2021 were included. Multivariable logistic regression models were used to assess factors associated with severe COVID-19 progression, defined as death or requiring oxygen inhalation. Results In total, 222 patients were included in the study. Rheumatoid arthritis (48.2%), gout (14.4%), and systemic lupus erythematosus (8.1%) were the most common types of rheumatic disease, 55.1% of patients were in remission and 66.2% had comorbid disease. Most patients were hospitalised (86.9%) for COVID-19, 43.3% received oxygen, and 9.0% died. Older age (≥ 65 years), corticosteroid use, comorbid diabetes, and lung diseases are associated with higher risk for severe COVID-19 progression (odds ratio (OR) 3.52 [95% confidence interval (CI) 1.69–7.33], OR 2.68 [95% CI 1.23–5.83], OR 3.56 [95% CI 1.42–8.88], and OR 2.59 [95% CI 1.10–6.09], respectively). Conclusions This study described clinical characteristics of COVID-19 patients with rheumatic diseases in Japan. Several possible risk factors for severe COVID-19 progression were suggested. Key points • Clinical characteristics of 222 adult patients in Japan with coronavirus disease 19 (COVID-19) and pre-existing rheumatic diseases were described. • Most patients were hospitalised (86.9%) for COVID-19 in Japan, 43.3% received oxygen, and 9.0% died. • The COVID-19 characteristics of patients with rheumatic diseases did not show any obvious different pattern from those of the general population in Japan. • In this study, older age ( ≥ 65 years), corticosteroid use, comorbid diabetes, and lung diseases are associated with higher risk for severe COVID-19 progression. Supplementary information The online version contains supplementary material available at 10.1007/s10067-022-06305-w.

Managing Patients with Immune-Mediated Inflammatory Diseases on Disease-Modifying Antirheumatic Drug Therapy in a COVID-19 Endemic World: A Narrative Review and Expert Insights

“…Comorbidities and clinical risk factors linked to COVID-19 outcomes in IMIDs: Certain clinical characteristics, such as age and sex, and comorbid conditions are predictors of poor outcomes in patients with IMIDs (Figure 1), highlighting the varying levels of risk and their correlation with adverse COVID-19 outcomes [9,16,17]. In the UK, 90% of COVID-19-related deaths occurred in people over 60, and 60% in men [16].…”

“…In the COVID-19 Global Rheumatology Alliance (C19-GRA) physician-reported registry of adults with rheumatic diseases and COVID-19 in Japan, older age (≥65 years) was associated with a higher risk of severe COVID-19 progression (defined as death or requiring oxygen inhalation) (odds ratio [OR] 3.52; 95% CI, 1.69-7.33) [17]. The likelihood of progression to severe disease, along with rates of mortality and critical disease, increased across age groups [17].…”

“…Additionally, comorbidities strongly correlate with adverse COVID-19 outcomes in patients with rheumatic diseases [9,16,17]. In the C19-GRA registry studies, pre-existing conditions like diabetes, lung disease (including chronic obstructive pulmonary disease, asthma and ILD), hypertension, cardiovascular disease, and chronic renal insufficiency were identified as potential risk factors for severe COVID-19 outcomes [17]. These findings align with an analysis of RA patients in a US COVID-19 health record database (Optum ® ) [18].…”

“…However, COVID-19 risks remained elevated for patients with IMIDs compared to the general population due to reduced immune responses to the SARS-CoV-2 vaccine. Their risks of poor COVID-19 outcomes are further influenced by comorbidities and background therapies [3,10,17].…”