Incidence and severeness of COVID-19 hospitalization in patients with inflammatory rheumatic disease: a nationwide cohort study from Denmark

Cordtz, René; Lindhardsen, Jesper; Soussi, Bolette Gylden; Vela, Jonathan; Uhrenholt, Line; Westermann, Rasmus; Kristensen, Salome; Nielsen, Henrik; Torp‐Pedersen, Christian; Dreyer, Lene

doi:10.1093/rheumatology/keaa897

Cited by 114 publications

(116 citation statements)

References 25 publications

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“…Other studies and case reports of patients with immune-mediated inflammatory diseases are in line with these results and point to similar observations (Table 1): the use of GCs is higher among hospitalized patients, and chronic oral GC use is associated with a higher risk of hospitalization due to COVID-19 in this population [32][33][34][35]. In contrast, other studies and case reports of patients with rheumatic diseases showed no direct and significant relation between GC use and the risk of a severe course of disease [36][37][38]. In general, the outcome for patients with rheumatic diseases does not seem to differ from that of the general population when demographic factors and comorbidities are taken into account [39].…”

Section: Risk In Exogenous Glucocorticoid Excesssupporting

confidence: 83%

Endocrine risk factors for COVID-19: Endogenous and exogenous glucocorticoid excess

Vogel

Reincke

2021

Rev Endocr Metab Disord

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Patients with endogenous or exogenous glucocorticoid (GC) excess exhibit a range of side effects, including an increased risk of infections. Via both mechanism, immune impairments and cardiometabolic concomitant diseases, patients with GC excess could be at increased risk for COVID-19. The impact on incidence and outcome of a SARS-CoV-2 infection in this population are not yet completely clear. This review aims to compile the data available to date and to discuss the existing literature on this topic. Further we highlight potential effects of SARS-CoV-2 on the hypothalamic-pituitary-adrenal axis as well as the influence of endogenous or exogenous GC excess on SARS-CoV-2 mRNA vaccination. There is growing evidence suggesting an increased risk of infection and severe outcome in patients with high-dose GC therapy after contracting SARS-CoV-2. The few data and case reports on patients with endogenous GC excess and SARS-CoV-2 infection point in a similar direction: chronic GC excess seems to be associated with an unfavorable course of COVID-19. Whether this is mainly a primary immune-mediated effect, or also triggered by the many GC-associated comorbidities in this population, is not yet fully understood. Patients with endogenous or exogenous GC excess should be considered as a vulnerable group during the SARS-CoV-2 pandemic. Regardless of the cause, vaccination and consistent surveillance and control of associated comorbidities are recommended.

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Section: Risk In Exogenous Glucocorticoid Excesssupporting

confidence: 83%

Endocrine risk factors for COVID-19: Endogenous and exogenous glucocorticoid excess

Vogel

Reincke

2021

Rev Endocr Metab Disord

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“…The use of prednisone at a dosage ≥10 mg/ day was an additional risk factor for hospitalisation and worse outcomes. 11 13 This study indicated a possible protective effect of the use of ts/bDMARDs, 11 further supported by other series from USA, 18 21 Spain 22 and Denmark, 17 which did not find a correlation between the use of ts/bDMARDs and the severity of COVID-19.…”

Section: Is Covid-19 Disease More Severe In Patients With Aiird?mentioning

confidence: 62%

“…16 A nationwide cohort study from Denmark reported a moderately increased incidence of hospitalisation with COVID-19 infection for patients with RA compared with the general population. 17 A large cohort study conducted in the USA reported a higher rate of venous thromboembolism in patients with AIIRD within 30 days follow-up of COVID-19 infection compared with the matched population without AIIRD. 18 A large US electronic health records based study investigated temporal trends in COVID-19 outcomes in patients with rheumatic diseases over the course of the pandemic.…”

Section: Is Covid-19 Disease More Severe In Patients With Aiird?mentioning

confidence: 99%

Point of view on the vaccination against COVID-19 in patients with autoimmune inflammatory rheumatic diseases

Furer

Rondaan²,

Agmon‐Levin

et al. 2021

RMD Open

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In view of the COVID-19 pandemic, there is an unmet clinical need for the guidelines on vaccination of patients with autoimmune inflammatory rheumatic diseases (AIIRD). This position paper summarises the current data on COVID-19 infection in patients with AIIRD and development of vaccines against COVID-19, discusses the aspects of efficacy and safety of vaccination, and proposes preliminary considerations on vaccination against COVID-19 in patients with AIIRD, mainly based on the expert opinion and knowledge on the use of other vaccines in this population of patients.

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“…The literature on adult patients indicates that some patients with rheumatic diseases and comorbidities (e.g., lung disease), receiving moderate-to-highdose steroids, may be at higher risk (25). Patients with certain diseases such as SLE that especially alter immune responses may be at higher risk for worse outcomes; however, these findings were not consistent across studies (26). The Childhood Arthritis and Rheumatology Research Alliance (CARRA) patient registry is currently collecting data on the prevalence of COVID-19 among children with PRD, with results yet to be reported.…”

Section: General Guidance Regarding Patients With Prdmentioning

confidence: 99%

American College of Rheumatology Guidance for the Management of Pediatric Rheumatic Disease During the COVID‐19 Pandemic: Version 2

Wahezi

Rubinstein

et al. 2021

Arthritis & Rheumatology

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Objective. To provide clinical guidance to rheumatology providers who treat children with pediatric rheumatic disease (PRD) in the context of the coronavirus disease 2019 (COVID-19) pandemic.Methods. The task force, consisting of 7 pediatric rheumatologists, 2 pediatric infectious disease physicians, 1 adult rheumatologist, and 1 pediatric nurse practitioner, was convened on May 21, 2020. Clinical questions and subsequent guidance statements were drafted based on a review of the queries posed by the patients as well as the families and healthcare providers of children with PRD. An evidence report was generated and disseminated to task force members to assist with 3 rounds of asynchronous, anonymous voting by email using a modified Delphi approach. Voting was completed using a 9-point numeric scoring system with predefined levels of agreement (categorized as disagreement, uncertainty, or agreement, with median scores of 1-3, 4-6, and 7-9, respectively) and consensus (categorized as low, moderate, or high). To be approved as a guidance statement, median vote ratings were required to fall into the highest tertile for agreement, with either moderate or high levels of consensus.Results. To date, 39 guidance statements have been approved by the task force. Those with similar recommendations were combined to form a total of 33 final guidance statements, all of which received median vote ratings within the highest tertile of agreement and were associated with either moderate consensus (n = 5) or high consensus (n = 28).Conclusion. These guidance statements have been generated based on review of the available literature, indicating that children with PRD do not appear to be at increased risk for susceptibility to SARS-CoV-2 infection. This guidance is presented as a "living document," recognizing that the literature on COVID-19 is rapidly evolving, with future updates anticipated.Due to the rapidly expanding information and evolving evidence related to COVID-19, which may lead to modification of some guidance statements over time, it is anticipated that updated versions of this article will be published, with the version number included in the title. Readers should ensure that they are consulting the most current version.Guidance developed and/or endorsed by the American College of Rheumatology (ACR) is intended to inform particular patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to this guidance to be voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient's individual circumstances. Guidance statements are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome. Guidance developed or endorsed by the ACR is subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice.

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Incidence and severeness of COVID-19 hospitalization in patients with inflammatory rheumatic disease: a nationwide cohort study from Denmark

Cited by 114 publications

References 25 publications

Endocrine risk factors for COVID-19: Endogenous and exogenous glucocorticoid excess

Endocrine risk factors for COVID-19: Endogenous and exogenous glucocorticoid excess

Point of view on the vaccination against COVID-19 in patients with autoimmune inflammatory rheumatic diseases

American College of Rheumatology Guidance for the Management of Pediatric Rheumatic Disease During the COVID‐19 Pandemic: Version 2

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