Factors associated with COVID-19 and its outcome in patients with rheumatoid arthritis

Abstract

Objective We assessed the factors associated with COVID-19, clinical manifestations, and a 30-day-prognosis of COVID-19 in a cohort of rheumatoid arthritis (RA) patients compared with the index population. Methods In a cross-sectional study, RA patients were followed in rheumatology clinics of Tabriz University of Medical Sciences, and a group of patients diagnosed with COVID-19 from index population were recruited. Outcomes of COVID-19 were assessed by the hospitalization rate and need to intensive care unit (ICU) and mortality. During a period of 12 weeks, 128 RA patients diagnosed with COVID-19, 760 RA control group, and 92 COVID-19 patients from index population were enrolled. Results Being female, obese, and diabetic, having pulmonary disease and chronic kidney disease (CKD), and treatment with prednisolone > 5 mg/d and TNFα inhibitors (TNFis) were independent predictors of COVID-19 in RA patients. Dyspnea, anosmia, and taste loss were more common in RA patients compared with the index population. Admission in hospital, need to ICU care, and mortality occurred in 38, 11.9, and 8.6 percent of RA patients, respectively. Although hospitalization rate in RA patients was more than the index population, there were no significant differences in need to ICU care and mortality between the two groups. Conclusions Treatment with prednisolone and TNFis and having comorbidities including obesity, diabetes, pulmonary disease, and CKD increase the risk of COVID-19 in RA patients. Although some differences exist in the clinical manifestations of COVID-19 in RA patients and index population, prognosis of COVID-19 in RA patients is not any worse. Key Points • Being female, obese and diabetic, having pulmonary disease, chronic kidney disease (CKD), treatment with prednisolone > 5 mg/d and TNFα inhibitors (TNFis) were independent predictors of COVID-19 in RA patients. • Dyspnea, anosmia and taste loss were more common in RA patients compared with the index population. • Although COVID-19 related hospitalization was higher in RA patients than in the index population, there was no significant differences in the need to ICU care and mortality between the two groups.

Interplay of diabetes mellitus and rheumatic diseases amidst the COVID-19 pandemic: influence on the risk of infection, outcomes, and immune responses

“…However, GC use was significantly associated with both of these poor outcomes. Additionally, on primary analysis, the risks for all complications and adverse outcomes were significantly higher in patients with RA [45]. But after propensity matching for age and comorbidities, the risks for adverse outcomes with RA did not differ as compared to non-RA patients except for sepsis and venous thromboembolism [46].…”

“…Similarly, a cross-sectional study in Iran analyzed 128 patients with RA and COVID-19 and found an increased risk of infection and hospitalization with DM on univariate and multivariate analysis [42]. Another comparative study from the TriNetX in the USA did not find an association between DM and hospitalization or death [45]. However, GC use was significantly associated with both of these poor outcomes.…”

“…All three studies have analyzed patients before the availability of COVID-19 vaccines and need to be interpreted accordingly as discussed below [44][45][46].…”

“…Studies in Europe and the USA have revealed an increased association of DM with the severity of disease as well as worse outcomes like ICU admission and mortality [44,45]. A study from the GRA with 1606 patients with SLE reported an increased association of poor outcomes with older age, male sex, GC dose, active disease, and the number of comorbidities [49].…”

Connections between Orthopedic Conditions and Oxidative Stress: Current Perspective and the Possible Relevance of Other Factors, Such as Metabolic Implications, Antibiotic Resistance, and COVID-19

“…One study has identified a higher risk of venous thromboembolism in RA patients that have contracted the infection, with glucocorticoids only increasing the risk of adverse effects [ 58 ], whereas systemic therapies did not influence it [ 34 ], nor did other classes of disease-modifying antirheumatic drugs [ 64 ]. On the other hand, one study has suggested that respiratory viral infections might be in fact a risk factor for the development of RA [ 65 ], but treatments with prednisolone and TNFα inhibitors (TNFis) increase the risk of COVID-19 [ 36 ], and the risk of hospital admissions [ 29 ] in RA patients with comorbidities such as diabetes. Two studies have found contradicting results; one found no association between RA and COVID-19 in a cohort study in South Korea [ 31 ], whereas the other stated that RA patients are more prone to the infection due to the iatrogenic effects of the RA medications [ 30 ].…”