Different COVID-19 outcomes among systemic rheumatic diseases: a nation-wide cohort study

Abstract

Objectives To investigate Covid-19-associated risk of hospitalization and death in rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) in comparison with the general population during pandemic’s first year and compare their overall mortality with 2019. Methods Interlinking nation-wide electronic registries, we recorded confirmed Covid-19-associated infections, hospitalizations and deaths, and all-cause deaths between 1-March-2020 and 28-February-2021 in all adults with RA, AS, PsA, SLE, and SSc under treatment (n = 74 970, median age 67.5, 51.2, 58.1, 56.2, 62.2 years, respectively) and in matched (1:5) on age, sex, and region of domicile random comparators from the general population. Deaths from all causes during 2019 were also recorded. Results Compared with the general population incidence rates (IR) for Covid-19-associated hospitalization were higher in RA [IR ratio (IRR):1.71(1.50–1.95)], SLE [2.0(1.4–2.7)] and SSc [2.28(1.29–3.90)], while Covid-19-associated death rates were higher in RA [1.91(1.46–2.49)]. When focusing only on SARS-CoV-2 infected subjects, after adjusting for age and gender, the odds ratio for Covid-19 associated death was higher in RA [1.47(1.11– 1.94)] and SSc [2.92(1.07–7.99)] compared with the general population. All-cause mortality rate compared with the general population increased in RA during the first pandemic year (IRR : 0.71) with reference to 2019 (0.59) and decreased in SSc (IRR : 1.94 vs 4.36). Conclusion Covid-19 may have more severe impact in patients with systemic rheumatic disease than the general population. Covid-19-related mortality is increased in subgroups of patients with specific rheumatic diseases, underscoring the need for priority vaccination and access to targeted treatments.

COVID-19 and protection of vaccination in patients with systemic sclerosis–associated interstitial lung disease

“…27,28 Interestingly, all-cause mortality in SSc patients during the first pandemic year decreased by more than half comparing to previous years 29 in our country, reflecting the extent and efficacy of self-protective measures taken by these patients. 28 It should be noted that a similar reduction in all-cause mortality was also reported during the early phase of the pandemic in Greece for patients with idiopathic ILD, again possibly due to the implementation of austere public health measures against COVID-19, including lock-down. 30…”

“…26 However, COVID-19 hospitalization and death rates are significantly increased in unvaccinated patients with SSc compared to the general population, as confirmed in our 12-month study, analyzing data derived from merging large nationwide databases covering the entire Greek population. 27,28 Interestingly, all-cause mortality in SSc patients during the first pandemic year decreased by more than half comparing to previous years 29 in our country, reflecting the extent and efficacy of self-protective measures taken by these patients. 28 It should be noted that a similar reduction in allcause mortality was also reported during the early phase of the pandemic in Greece for patients with idiopathic ILD, again possibly due to the implementation of austere public health measures against COVID-19, including lock-down.…”

“…27,28 Interestingly, all-cause mortality in SSc patients during the first pandemic year decreased by more than half comparing to previous years 29 in our country, reflecting the extent and efficacy of self-protective measures taken by these patients. 28 It should be noted that a similar reduction in allcause mortality was also reported during the early phase of the pandemic in Greece for patients with idiopathic ILD, again possibly due to the implementation of austere public health measures against COVID-19, including lock-down. 30 Our findings indicate a protective effect of COVID-19 vaccination against hospitalization and possibly also against death in SARS-CoV-2 infected patients with underlying SSc-associated ILD, corroborating the results of a previous study from our group, which shows that vaccinated patients with SRD and breakthrough COVID-19 have by far better outcomes compared with their unvaccinated counterparts.…”

The outcome of COVID‐19 in patients with autoimmune rheumatic diseases: Comparable to the general population or worse?

“…There are several studies analyzing the differences in severe COVID‐19 risk for different types of AIRDs. Bournia et al 21 have recently investigated COVID‐19 outcomes in patients with RA, ankylosing spondylitis (AS), psoriatic arthritis (PsA), SLE, and systemic sclerosis (SSc), compared to the general population. COVID‐19 associated hospitalization rate was higher among RA, SLE, and SSc, while COVID‐19 associated mortality was higher in RA patients than the general population.…”

Does the Impact of COVID‐19 on Patients With Systemic Sclerosis Change Over Time?

“…Many patients receive immunosuppressive treatment, which has been shown to impact the outcome of COVID‐19 infection 13,14 . As demonstrated recently, patients with SSc are at risk for a more severe COVID‐19 disease course 13,15 . Multiple common risk factors are known to have a relevant impact on the outcome of COVID‐19 in the general population, such as older age, male sex, and comorbidities like cardiovascular disease 16,17 .…”