COVID-19 in patients with rheumatic disease in Hubei province, China: a multicentre retrospective observational study

Abstract

BackgroundIn the ongoing COVID-19 pandemic, the susceptibility of patients with rheumatic diseases to COVID-19 remains unclear. We aimed to investigate susceptibility to COVID-19 in patients with autoimmune rheumatic diseases during the ongoing COVID-19 pandemic. MethodsWe did a multicentre retrospective study of patients with autoimmune rheumatic diseases in Hubei province, the epicentre of the COVID-19 outbreak in China. Patients with rheumatic diseases were contacted through an automated telephone-based survey to investigate their susceptibility to COVID-19. Data about COVID-19 exposure or diagnosis were collected. Families with a documented history of COVID-19 exposure, as defined by having at least one family member diagnosed with COVID-19, were followed up by medical professionals to obtain detailed information, including sex, age, smoking history, past medical history, use of medications, and information related to COVID-19. FindingsBetween March 20 and March 30, 2020, 6228 patients with autoimmune rheumatic diseases were included in the study. The overall rate of COVID-19 in patients with an autoimmune rheumatic disease in our study population was 0•43% (27 of 6228 patients). We identified 42 families in which COVID-19 was diagnosed between Dec 20, 2019, and March 20, 2020, in either patients with a rheumatic disease or in a family member residing at the same physical address during the outbreak. Within these 42 families, COVID-19 was diagnosed in 27 (63%) of 43 patients with a rheumatic disease and in 28 (34%) of 83 of their family members with no rheumatic disease (adjusted odds ratio [OR] 2•68 [95% CI 1•14-6•27]; p=0•023). Patients with rheumatic disease who were taking hydroxychloroquine had a lower risk of COVID-19 infection than patients taking other disease-modifying anti-rheumatic drugs (OR 0•09 [95% CI 0•01-0•94]; p=0•044). Additionally, the risk of COVID-19 was increased with age (adjusted OR 1•04 [95% CI 1•01-1•06]; p=0•0081).Interpretation Patients with autoimmune rheumatic disease might be more susceptible to COVID-19 infection than the general population.

COVID-19 in rheumatoid arthritis cases: an Iranian referral center experience

“…Almost all physical symptoms and paraclinical features were similar to previous reports in RA cases and also normal healthy individuals. It was approved that COVID-19 in immunesuppressed cases, such as diabetic, rheumatologic cases, and who are receiving immune suppressants such as corticosteroids is more severe [7,8].…”

<p>Flattening the Risk: Pre-Exposure Prophylaxis for COVID-19</p>

“…In a multicenter retrospective study of 6,228 rheumatic disease patients from China, patients who were taking HCQ had a lower risk of SARS-CoV-2 infection compared to patients taking other disease-modifying anti-rheumatic drugs (odds ratio 0.09, p=0.044). 43 Another population-based analysis of over 360,000 subjects from Portugal found that chronic HCQ treatment was associated with a significant decrease in SARS-CoV-2 infection (adjusted odds ratio 0.51, p=0.04). 44 An observational study of 1,274 early outpatient COVID-19 cases in New Jersey found that a prescription of hydroxychloroquine reduced the risk of hospitalization by 47% (odds ratio 0.53).…”

COVID-19 and Systemic Lupus Erythematosus: Focus on Immune Response and Therapeutics

“…As a result, patients with autoimmune rheumatic disease have been identified as a vulnerable population at risk for severe COVID-19 illness. Although a strong antiviral immune response is needed for viral clearance, hyperactive immunity has been linked to cytokine storm and tissue damage in COVID-19 patients (9). Both SLE and COVID-19 have been shown to manifest multi-organ complications of interstitial pneumonia, cytopenia, arthralgia, myocarditis, and hemophagocytic lymphohistiocytosis (10).…”

“…Paradoxically, immunosuppressants have been investigated as a means of dampening inflammation and reducing likelihood of acute respiratory distress syndrome (ARDS) in patients already infected with coronavirus (11). The anti-rheumatic drugs, hydroxychloroquine and baricitinib, have also been identified as possible targets for COVID-19 treatment due to their proposed antiviral effects (9). However, despite initial buzz about the use of hydroxychloroquine in COVID-19 treatment, current research suggests no benefit when compared to placebo or standard care (12,13).…”

“…Current research primarily focuses on hospitalized patients which introduces bias towards those with severe COVID-19 illness. Literature suggests little if no correlation between rheumatic disease and COVID-19 disease severity in hospitalized patients (9,16,17). One case-control study of patients analyzed differences in disease course between patients with musculoskeletal or rheumatic diseases (cases) and those without musculoskeletal or rheumatic disease (controls) (16).…”