Older age, comorbidity, glucocorticoid use and disease activity are risk factors for COVID-19 hospitalisation in patients with inflammatory rheumatic and musculoskeletal diseases

Abstract

IntroductionWhether patients with inflammatory rheumatic and musculoskeletal diseases (RMD) are at higher risk to develop severe courses of COVID-19 has not been fully elucidated. Aim of this analysis was to describe patients with RMD according to their COVID-19 severity and to identify risk factors for hospitalisation.MethodsPatients with RMD with PCR confirmed SARS-CoV-2 infection reported to the German COVID-19 registry from 30 March to 1 November 2020 were evaluated. Multivariable logistic regression was used to estimate ORs for hospitalisation due to COVID-19.ResultsData from 468 patients with RMD with SARS-CoV-2 infection were reported. Most frequent diagnosis was rheumatoid arthritis, RA (48%). 29% of the patients were hospitalised, 5.5% needed ventilation. 19 patients died. Multivariable analysis showed that age >65 years (OR 2.24; 95% CI 1.12 to 4.47), but even more>75 years (OR 3.94; 95% CI 1.86 to 8.32), cardiovascular disease (CVD; OR 3.36; 95% CI 1.5 to 7.55), interstitial lung disease/chronic obstructive pulmonary disease (ILD/COPD) (OR 2.79; 95% CI 1.2 to 6.49), chronic kidney disease (OR 2.96; 95% CI 1.16 to 7.5), moderate/high RMD disease activity (OR 1.96; 95% CI 1.02 to 3.76) and treatment with glucocorticoids (GCs) in dosages >5 mg/day (OR 3.67; 95% CI 1.49 to 9.05) were associated with higher odds of hospitalisation. Spondyloarthritis patients showed a smaller risk of hospitalisation compared with RA (OR 0.46; 95% CI 0.23 to 0.91).ConclusionAge was a major risk factor for hospitalisation as well as comorbidities such as CVD, ILD/COPD, chronic kidney disease and current or prior treatment with GCs. Moderate to high RMD disease activity was also an independent risk factor for hospitalisation, underlining the importance of continuing adequate RMD treatment during the pandemic.

Direct and Indirect Impact of COVID-19 for Patients with Immune-Mediated Inflammatory Diseases: A Retrospective Cohort Study

“…This is the first study aiming to analyze both the direct and indirect impact of the COVID-19 pandemic in patients with IMIDs in Italy, integrating the data already available in other countries [ 9 , 10 , 11 , 12 ].…”

Immunogenicity and safety of anti-SARS-CoV-2 mRNA vaccines in patients with chronic inflammatory conditions and immunosuppressive therapy in a monocentric cohort

“…Indeed, biological therapies have been identified as decreasing the risk for hospitalisation due to COVID-19 in cohorts of patients with rheumatic diseases, chronic inflammatory bowel diseases and psoriasis. 1–5 The most important factors associated with a higher risk of hospitalisation and death across multiple indications and forms of immunosuppression were found to be older age, high underlying disease activity as well as high glucocorticoid dosages (at dosages equivalent to prednisolone ≥10 mg). 1 6 7 Additionally, B cell depleting drugs, that is, rituximab, might represent a risk factor.…”

“… 1–5 The most important factors associated with a higher risk of hospitalisation and death across multiple indications and forms of immunosuppression were found to be older age, high underlying disease activity as well as high glucocorticoid dosages (at dosages equivalent to prednisolone ≥10 mg). 1 6 7 Additionally, B cell depleting drugs, that is, rituximab, might represent a risk factor. 8 Until now, there is insufficient registry data for other drugs commonly used to treat patients with CID in terms of increased risk of severe COVID-19.…”

“… 8 Until now, there is insufficient registry data for other drugs commonly used to treat patients with CID in terms of increased risk of severe COVID-19. 1 9 10 However, patients have minimised their risk by sheltering in place early and reducing infection contacts (own unpublished data).…”

Deutsches Register www.Covid19-Rheuma.de

“…In der Folgepublikation mit zum damaligen Zeitpunkt 468 erfassten Patienten konnten Risikofaktoren hinsichtlich einer Hospitalisierung bei einer SARS-CoV-2-Infektion sehr viel genauer analysiert werden [ 8 ]. Hierbei wurden Patientenalter, kardiovaskuläre Komorbiditäten, chronisch interstitielle Lungenerkrankungen bzw.…”