Novel coronavirus disease-2019 (COVID-19) in people with rheumatic disease: Epidemiology and outcomes

Abstract

There is concern that people with rheumatic disease, often treated with immunosuppressive or immunomodulatory medication, may be at increased risk of poor outcomes of novel coronavirus disease-2019 (COVID-19). However, hyperinflammation is a major cause of morbidity and mortality in COVID-19 and treatment with glucocorticoids has been shown to improve outcomes in patients with severe COVID-19. Therefore, uncertainty exists about continuing or withholding immune therapies with risk of infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review covers the current knowledge with respect to risk of infection, and outcomes and risk factors for poor outcomes in patients with rheumatic disease. We also discuss data from other immune mediated diseases and its relevance to patients with rheumatic disease. In addition, we cover the limitations of the research efforts to date and how the current knowledge translates into practice guidance. Finally, we discuss our vision of the future research agenda.

Willingness to get the COVID-19 vaccine among patients with rheumatic diseases, healthcare workers and general population in Turkey: a web-based survey

“…Whether patients with RD, especially those receiving DMARDs, are at an increased risk for severe COVID-19 infection remains unclear [14]. So far, rheumatic diseases are not listed among the comorbidities that carry increased risk for severe COVID-19 [15].…”

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

“…However, current limitations should be taken into account in the interpretation of studies and case reports. In particular selection bias and confounding are important to consider [39]. We want to acknowledge that our recommendations are based on the aforementioned and currently available data and evidence, and that it has to be updated based on ongoing data.…”

“…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]. However, since medication use and outcomes are most likely associated [31], GC administration per se already has many unfavorable The risk for a severe course of disease or death due to COVID-19 was as well analyzed in studies of patients with chronic inflammatory diseases (Table 1).…”

Coronavirus Disease 2019 (COVID-19) and Immune-mediated Rheumatic Diseases. Recommendations of the Association of Rheumatologists of Russia

“…1). У пациентов с ИВРЗ пожилой возраст, неконтролируемое воспаление и иммуносупрессия, исходно необратимое повреждение внутренних органов, коморбидная патология (встречается чаще, чем в популяции) [76,77], генетические и другие факторы потенциально могут приводить к увеличению восприимчивости к SARS-CoV-2 (и сопутствующим вирусным и бактериальным инфекциям), нарастанию риска тяжелого течения COVID-19, снижению эффективности терапии как ИВРЗ, так и COVID-19 [78][79][80][81][82][83][84][85][86]. Кроме того, инфекция SARS-CoV-2 потенциально способна индуцировать обострение иммуновоспалительного процесса [69] или развитие «новой» аутоиммунной патологии.…”