Isolation, Behavioral Changes, and Low Seroprevalence of SARS–CoV‐2 Antibodies in Patients With Systemic Lupus Erythematosus or Rheumatoid Arthritis

Abstract

Objectives Patients with chronic rheumatic diseases (CRD), such as Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA), require special attention during the COVID‐19 pandemic, as they are considered at risk of severe infections. We assessed the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antibodies in patients with SLE and RA and patient behavior, disease‐related symptoms, and mental health. Methods More than 900 participants were included: 405 patients with RA or SLE (CRD‐patients) and 513 blood donors. All participants had blood SARS‐CoV‐2 total antibodies measured (sensitivity 96.7%, specificity 99.5%) and answered a questionnaire concerning behavior, anxiety, and symptoms of depression (PHQ‐9). The CRD patients were further asked about physical activity, adherence to medication, and disease‐related symptoms. Results CRD‐patients had a significant lower seroprevalence of SARS‐CoV‐2 antibodies (n=1/365, 0.3%) compared to blood donors (n=10/513, 1.9%) (p=0.03). Almost 60% of patients were unable to exercise as usual, increased pain was experienced by 34% of patients and increased disease activity by 24%. Almost 10% of patients reduced or discontinued their immunosuppressive treatments at their own initiative. Symptoms of moderate depression were present in 19% of patients compared to 6,8% blood donors (p<0.001). Conclusions Low seroprevalence in patients with CRDs indicates successful mitigation of exposure to SARS‐CoV‐2. However, this appears to occur at the expense of physical activity, experience of increased pain, disease activity, and symptoms of depression. There is a need for care providers to be aware of these negative side‐effects and for further studies to investigate the possible long‐term consequences.

Pet ownership and lifestyle behaviours of immunosuppressed individuals and their relatives in the context of COVID-19 pandemic

“…When comparing changes in lifestyle behaviours from before to during the COVID-19 pandemic, our results show, based on the effect sizes, a small but significant decrease in VPA and a large increase in SED. These results are consistent with other studies suggesting a decrease in MPA and VPA in the general population ( Lesser and Nienhuis, 2020 , Wunsch et al, 2022 ) and in immunosuppressed populations with lupus, rheumatoid arthritis, or cystic fibrosis ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ) during the COVID-19 pandemic. In two studies among immunosuppressed individuals, 45–46% of participants reported being less active since the start of the pandemic ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ).…”

“…These results are consistent with other studies suggesting a decrease in MPA and VPA in the general population ( Lesser and Nienhuis, 2020 , Wunsch et al, 2022 ) and in immunosuppressed populations with lupus, rheumatoid arthritis, or cystic fibrosis ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ) during the COVID-19 pandemic. In two studies among immunosuppressed individuals, 45–46% of participants reported being less active since the start of the pandemic ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ). In both healthy adult populations and populations with chronic disease, SED was reported to increase during the COVID-19 pandemic ( Stockwell et al, 2021 ) similarly to what is observed in the present study.…”

Pet ownership and lifestyle behaviours of immunosuppressed individuals and their relatives in the context of COVID-19 pandemic

“…When comparing changes in lifestyle behaviours from before to during the COVID-19 pandemic, our results show, based on the effect sizes, a small but significant decrease in VPA and a large increase in SED. These results are consistent with other studies suggesting a decrease in MPA and VPA in the general population ( Lesser and Nienhuis, 2020 , Wunsch et al, 2022 ) and in immunosuppressed populations with lupus, rheumatoid arthritis, or cystic fibrosis ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ) during the COVID-19 pandemic. In two studies among immunosuppressed individuals, 45–46% of participants reported being less active since the start of the pandemic ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ).…”

“…These results are consistent with other studies suggesting a decrease in MPA and VPA in the general population ( Lesser and Nienhuis, 2020 , Wunsch et al, 2022 ) and in immunosuppressed populations with lupus, rheumatoid arthritis, or cystic fibrosis ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ) during the COVID-19 pandemic. In two studies among immunosuppressed individuals, 45–46% of participants reported being less active since the start of the pandemic ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ). In both healthy adult populations and populations with chronic disease, SED was reported to increase during the COVID-19 pandemic ( Stockwell et al, 2021 ) similarly to what is observed in the present study.…”

SARS-CoV-2 seroprevalence, seroconversion and neutralizing antibodies in a systemic lupus erythematosus cohort and comparison to controls

“…This and the absence of SARS-CoV2 antibodies in pre-pandemic sera suggests that molecular mimicry is an unlikely explanation for SARS-CoV-2 seropositivity. 6 Like other reports, 3,7,8 our SLE cohort had a lower rate of seropositivity pre-pandemic and a slightly lower to similar rate of seropositivity intra-pandemic compared to contemporaneous controls. In contrast, over a similar observation period, others reported that 4% (4/100) SLE patients had PCR-confirmed infection, but 36% showed SARS-CoV-2 antibodies of at least one isotype, particularly IgA and IgM.…”

COVID-19 vaccination in patients with rheumatic diseases leads to a high seroconversion rate and reduced self-imposed isolation and shielding behaviour

“…We found no change in the number of patients with symptoms of depression (21.8–23.6%) and anxiety (7.7–6.1%) after vaccination despite reduced isolation, fear of COVID-19, pain, and increased physical ability. Previously published data from this cohort collected at the start of the pandemic in May 2020 reported similar values for depression (19.0%) and anxiety (5.2%), while blood donors scored significantly lower for depression (6.8%, P < .001) but not anxiety (4.9%, P = .83) [ 18 ]. It is well established that patients with RDs have an increased prevalence of depression (15–38%) and anxiety (14–62%) depending on the method of case definition [ 24–27 ].…”

Pet ownership and lifestyle behaviours of immunosuppressed individuals and their relatives in the context of COVID-19 pandemic

“…When comparing changes in lifestyle behaviours from before to during the COVID-19 pandemic, our results show, based on the effect sizes, a small but significant decrease in VPA and a large increase in SED. These results are consistent with other studies suggesting a decrease in MPA and VPA in the general population ( Lesser and Nienhuis, 2020 , Wunsch et al, 2022 ) and in immunosuppressed populations with lupus, rheumatoid arthritis, or cystic fibrosis ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ) during the COVID-19 pandemic. In two studies among immunosuppressed individuals, 45–46% of participants reported being less active since the start of the pandemic ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ).…”

“…These results are consistent with other studies suggesting a decrease in MPA and VPA in the general population ( Lesser and Nienhuis, 2020 , Wunsch et al, 2022 ) and in immunosuppressed populations with lupus, rheumatoid arthritis, or cystic fibrosis ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ) during the COVID-19 pandemic. In two studies among immunosuppressed individuals, 45–46% of participants reported being less active since the start of the pandemic ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ). In both healthy adult populations and populations with chronic disease, SED was reported to increase during the COVID-19 pandemic ( Stockwell et al, 2021 ) similarly to what is observed in the present study.…”

SARS-CoV-2 seroprevalence, seroconversion and neutralizing antibodies in a systemic lupus erythematosus cohort and comparison to controls

“…This and the absence of SARS-CoV2 antibodies in pre-pandemic sera suggests that molecular mimicry is an unlikely explanation for SARS-CoV-2 seropositivity. 6 Like other reports, 3,7,8 our SLE cohort had a lower rate of seropositivity pre-pandemic and a slightly lower to similar rate of seropositivity intra-pandemic compared to contemporaneous controls. In contrast, over a similar observation period, others reported that 4% (4/100) SLE patients had PCR-confirmed infection, but 36% showed SARS-CoV-2 antibodies of at least one isotype, particularly IgA and IgM.…”

COVID-19 vaccination in patients with rheumatic diseases leads to a high seroconversion rate and reduced self-imposed isolation and shielding behaviour

“…We found no change in the number of patients with symptoms of depression (21.8–23.6%) and anxiety (7.7–6.1%) after vaccination despite reduced isolation, fear of COVID-19, pain, and increased physical ability. Previously published data from this cohort collected at the start of the pandemic in May 2020 reported similar values for depression (19.0%) and anxiety (5.2%), while blood donors scored significantly lower for depression (6.8%, P < .001) but not anxiety (4.9%, P = .83) [ 18 ]. It is well established that patients with RDs have an increased prevalence of depression (15–38%) and anxiety (14–62%) depending on the method of case definition [ 24–27 ].…”

Pet ownership and lifestyle behaviours of immunosuppressed individuals and their relatives in the context of COVID-19 pandemic

“…When comparing changes in lifestyle behaviours from before to during the COVID-19 pandemic, our results show, based on the effect sizes, a small but significant decrease in VPA and a large increase in SED. These results are consistent with other studies suggesting a decrease in MPA and VPA in the general population ( Lesser and Nienhuis, 2020 , Wunsch et al, 2022 ) and in immunosuppressed populations with lupus, rheumatoid arthritis, or cystic fibrosis ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ) during the COVID-19 pandemic. In two studies among immunosuppressed individuals, 45–46% of participants reported being less active since the start of the pandemic ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ).…”

“…These results are consistent with other studies suggesting a decrease in MPA and VPA in the general population ( Lesser and Nienhuis, 2020 , Wunsch et al, 2022 ) and in immunosuppressed populations with lupus, rheumatoid arthritis, or cystic fibrosis ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ) during the COVID-19 pandemic. In two studies among immunosuppressed individuals, 45–46% of participants reported being less active since the start of the pandemic ( Ammitzbøll et al, 2021 , Radtke et al, 2021 ). In both healthy adult populations and populations with chronic disease, SED was reported to increase during the COVID-19 pandemic ( Stockwell et al, 2021 ) similarly to what is observed in the present study.…”

SARS-CoV-2 seroprevalence, seroconversion and neutralizing antibodies in a systemic lupus erythematosus cohort and comparison to controls

“…This and the absence of SARS-CoV2 antibodies in pre-pandemic sera suggests that molecular mimicry is an unlikely explanation for SARS-CoV-2 seropositivity. 6 Like other reports, 3,7,8 our SLE cohort had a lower rate of seropositivity pre-pandemic and a slightly lower to similar rate of seropositivity intra-pandemic compared to contemporaneous controls. In contrast, over a similar observation period, others reported that 4% (4/100) SLE patients had PCR-confirmed infection, but 36% showed SARS-CoV-2 antibodies of at least one isotype, particularly IgA and IgM.…”

COVID-19 vaccination in patients with rheumatic diseases leads to a high seroconversion rate and reduced self-imposed isolation and shielding behaviour

“…We found no change in the number of patients with symptoms of depression (21.8–23.6%) and anxiety (7.7–6.1%) after vaccination despite reduced isolation, fear of COVID-19, pain, and increased physical ability. Previously published data from this cohort collected at the start of the pandemic in May 2020 reported similar values for depression (19.0%) and anxiety (5.2%), while blood donors scored significantly lower for depression (6.8%, P < .001) but not anxiety (4.9%, P = .83) [ 18 ]. It is well established that patients with RDs have an increased prevalence of depression (15–38%) and anxiety (14–62%) depending on the method of case definition [ 24–27 ].…”