COVID-19 in people with rheumatic diseases: risks, outcomes, treatment considerations

Grainger, Rebecca; Kim, Alfred H.J.; Conway, Richard; Yazdany, Jinoos; Robinson, Philip C

doi:10.1038/s41584-022-00755-x

Cited by 119 publications

(103 citation statements)

References 139 publications

(201 reference statements)

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“…To end the pandemic, vaccination has been considered an effective measure. For patients with rheumatic diseases (RD), the American College of Rheumatology (ACR) recommended a priority of receiving vaccination based on the possibility of increased infection risk and severe outcomes of COVID-19 ( 2 , 3 ). However, a recently published high-quality meta-analysis revealed that patients with RD do not face more risk of contracting SARS-CoV-2 or worse prognosis of COVID-19, which may partly combat the enthusiasm for vaccination in these patients ( 4 ).…”

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confidence: 99%

The Flare of Rheumatic Disease After SARS-CoV-2 Vaccination: A Review

Xie

Liu

2022

Front. Immunol.

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As the coronavirus disease 2019 (COVID-19) pandemic continues worldwide, vaccination has been considered an effective measure to protect people from the COVID-19 and end the pandemic. However, for patients with rheumatic diseases (RD), concern for the induction of RD flare may combat the enthusiasm for vaccination. In general, current evidence doesn’t support the increased risk of disease flare after COVID-19 vaccination. However, the disease flare of RDs may be triggered by COVID-19 vaccinations, especially for patients with high disease activity. Most of these flares after vaccination are mild and need no treatment escalation. Considering the benefits and risks, RD patients are recommended to receive the COVID-19 vaccination but should be vaccinated when the RDs are in stable states.

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confidence: 99%

The Flare of Rheumatic Disease After SARS-CoV-2 Vaccination: A Review

Xie

Liu

2022

Front. Immunol.

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“…However, the possibility that these patients were more susceptible to increased rates of testing cannot be excluded. Therefore, whether a tendency to contract the infection more easily, together with the increased comorbidity burden, can explain the higher Covid-19 associated death risk found collectively in systemic rheumatic disease patients compared to the general population needs further study [19].…”

Section: Discussionmentioning

confidence: 99%

“…19-associated hospitalization and death, during the study period. Following approval of our formal request, the Greek…”

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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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“…The ongoing pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has particularly concerned and affected patients with certain co-morbidities, not least those with various immunosuppressive disorders and therapies who have an increased risk of developing severe coronavirus disease 2019 (COVID-19) [ 1 , 2 , 3 , 4 , 5 ]. Several factors are likely to contribute to the increase in risk.…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 Specific Antibody Response and T Cell-Immunity in Immunocompromised Patients up to Six Months Post COVID: A Pilot Study

Sjöwall

Hjorth

Gustafsson

et al. 2022

JCM

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COVID-19 generates SARS-CoV-2-specific antibodies in immunocompetent individuals. However, in immunocompromised patients, the humoral immunity following infection may be impaired or absent. Recently, the assessment of cellular immunity to SARS-CoV-2, both following natural infection and vaccination, has contributed new knowledge regarding patients with low or no antibody responses. As part of a prospective cohort study which included hospitalized patients with COVID-19, we identified immunocompromised patients and compared them with age- and sex-matched immunocompetent patients regarding co-morbidities, biomarkers of COVID-19 and baseline viral load by real-time PCR in nasopharyngeal swabs. Spike and nucleocapsid antibody responses were analyzed at inclusion and after two weeks, six weeks and six months. Plasma immunoglobulin G (IgG) levels were quantified, lymphocyte phenotyping was performed, and SARS-CoV-2 specific CD4 and CD8 T cell responses after in vitro antigen stimulation were assessed at six months post infection. All patients showed IgG levels above or within reference limits. At six months, all patients had detectable SARS-CoV-2 anti-spike antibody levels. SARS-CoV-2 specific T cell responses were detected in 12 of 12 immunocompetent patients and in four of six immunocompromised patients. The magnitude of long-lived SARS-CoV-2 specific T cell responses were significantly correlated with the number of CD4 T cells and NK cells. Determining the durability of the humoral and cellular immune response against SARS-CoV-2 in immunocompromised individuals could be of importance by providing insights into the risk of re-infection and the need for vaccine boosters.

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COVID-19 in people with rheumatic diseases: risks, outcomes, treatment considerations

Cited by 119 publications

References 139 publications

The Flare of Rheumatic Disease After SARS-CoV-2 Vaccination: A Review

The Flare of Rheumatic Disease After SARS-CoV-2 Vaccination: A Review

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

SARS-CoV-2 Specific Antibody Response and T Cell-Immunity in Immunocompromised Patients up to Six Months Post COVID: A Pilot Study

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