Coronavirus disease 2019 (COVID-19) in autoimmune and inflammatory conditions: clinical characteristics of poor outcomes

Abstract

Objective To describe clinical characteristics of patients with rheumatic and musculoskeletal diseases (RMDs) and immunosuppressive therapies with Coronavirus disease 2019 (COVID-19) at an academic rheumatology center in Madrid and to identify baseline variables associated with a severe infection requiring hospitalization. Methods We identified SARS-CoV-2 positive cases by polymerase chain reaction performed at our center within an updated RMDs database in our clinic. Additional RMDs patients were identified when they contacted the clinic because of a positive infection. Data extraction included diagnosis, demographics, immunosuppressive treatment, comorbidities, and laboratory tests. Comparisons between patients with or without hospitalization were performed. Multivariate logistic regression was used to analyze associations between baseline variables and need for hospitalization. Results A total of 62 patients with COVID-19 and underlying RMDs were identified by April 24, 2020. Median age was 60.9 years, and 42% men. Forty-two patients required hospitalization; these were more frequently men, older and with comorbidities. There were no statistically significant between-group differences for rheumatologic diagnosis and for baseline use of immunosuppressive therapy except for glucocorticoids that were more frequent in hospitalized patients. Total deaths were 10 (16%) patients. In multivariate analysis, male sex (odds ratio [OR], 8.63; p = 0.018), previous lung disease (OR, 27.47; p = 0.042), and glucocorticoids use (> 5 mg/day) (OR, 9.95; p = 0.019) were significantly associated to hospitalization. Conclusion Neither specific RMD diagnoses or exposures to DMARDs were associated with increased odds of hospitalization. Being male, previous lung disease and exposure to glucocorticoids were associated with higher odds of hospitalization in RMDs patients.

Public interest in rheumatic diseases and rheumatologist in the United States during the COVID-19 pandemic: evidence from Google Trends

“…This finding that indicates the increased need for rheumatologists during the COVID-19 pandemic may be attributable to two factors: (a) patients with a rheumatic disease and/or receiving immunosuppressive treatments wanted to consult rheumatologists on their disease/treatments [30]; (b) patients consult rheumatologists on properties of several anti-inflammatory and immunomodulatory drugs that are being used in the treatment of COVID-19 because rheumatologists are experts in the use of these drugs [1,7]. Rheumatic patients may be at a higher risk of receiving COVID infection with worse outcomes, as many of them tend to be susceptible from their underlying rheumatic disease or immunocompromised due to their treatment [9][10][11][12][13][14][15][16]. Thus, this pandemic has put great responsibility on the shoulders of the rheumatologists for caring for this vulnerable patient group.…”

“…Since rheumatologists have substantial knowledge in the benefits and adverse effects of these drugs as well, rheumatologists are playing a significant role in this pandemic. Besides fighting COVID-19, the rheumatologists also have an essential role in caring for their rheumatic patients who may express concerns about their potential increased risk of acquiring COVID-19 infection due to their underlying disease itself and any immunosuppressive treatments they may be on [9][10][11][12][13][14][15][16].…”

COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease

“…SLE was not a risk factor for severe COVID-19 requiring hospitalization, but male sex, previous lung disease, and sGC use (> 5 mg/day of prednisone) were significantly associated with hospital admission. 195 Similarly, a study from Belgium which included 18 patients with confirmed or suspected COVID-19 did not find differences in the proportion of patients who developed COVID-19 between patients on immunosuppressants and those not on these medications. However, sGC dose was found to be positively associated with a positive reverse transcription polymerase chain reaction (RT-PCR) test for COVID-19, hospitalization, and various COVID-19 symptoms.…”

COVID-19 Among Patients With Inflammatory Rheumatic Diseases

“…Since excessive in ammatory response is known to be associated with severe COVID-19, it is of particular interest to nd out whether a speci c IRD diagnosis in uences COVID-19 outcome. Two studies with a relatively small number of patients found no association between IRD diagnoses and a worse outcome [11,12] and two other studies showed a higher risk for severe COVID-19 among patients with diagnoses other than in ammatory arthritis such as connective tissue diseases, vasculitis and sarcoidosis [13,14].…”

“…In Turkey the TMoH advocates hospitalization of all patients with comorbidities, which may have resulted in hospitalization of less severe patients compared with other countries. Moreover, our patients were younger than most of the other cohorts including IRD patients [7,11,12]. Our other limitation was that we did not have a non-IRD comparator group in this registry.…”