Outcomes following SARS-CoV-2 infection in individuals with and without inflammatory rheumatic diseases: a Danish nationwide cohort study

Abstract

ObjectiveIn a setting with an extensive SARS-CoV-2 test strategy and availability of effective vaccines, we aimed to investigate if patients with inflammatory rheumatic diseases (IRD) face greater risk of contracting SARS-CoV-2 and have a worse prognosis of increased risk of hospitalisation, assisted ventilation and death compared with the general population.MethodsThis was a nationwide, population-based register study that compared outcomes of SARS-CoV-2 infection in Danish patients with IRD (n=66 840) with matched population controls (n=668 400). The study period was from March 2020 to January 2023. Cox regression analyses were used to calculate incidence rate ratios (IRRs) for SARS-CoV-2-related outcomes.ResultsWe observed a difference in time to first and second positive SARS-CoV-2 test in patients with IRD compared with the general population (IRR 1.06, 95% CI 1.05 to 1.07) and (IRR 1.21, 95% CI 1.15 to 1.27). The risks of hospital contact with COVID-19 and severe COVID-19 were increased in patients with IRD compared with population controls (IRR 2.11, 95% CI 1.99 to 2.23) and (IRR 2.18, 95% CI 1.94 to 2.45). The risks of assisted ventilation (IRR 2.33, 95% CI 1.89 to 2.87) and COVID-19 leading to death were increased (IRR 1.98, 95% CI 1.69 to 2.33). Patients with IRD had more comorbidities compared with the general population. A third SARS-CoV-2 vaccination was associated with a reduced need for hospitalisation with COVID-19 and reduced the risk of death.ConclusionPatients with IRD have a risk of SARS-CoV-2, which nearly corresponds to the general population but had a substantial increased risk of hospitalisation with COVID-19, severe COVID-19, requiring assisted ventilation and COVID-19 leading to death, especially in patients with comorbidities.

COVID-19 prophylaxis, diagnostics, and treatment in patients with rheumatic diseases. The Polish experts panel opinion

“…In the nationwide Greek cohort study conducted in the first half of 2022, patients with rheumatoid arthritis who were infected with SARS-CoV-2 had an elevated risk of hospitalization (odds ratio [OR] = 2.02, 95% CI: 1.79-2.27) and death (OR = 1.73, 95% CI: 1.36-2.20) as compared to controls [24]. Additionally, based on the data from the Danish national registers, the risk of hospitalization of patients with RMDs in the SARS-CoV-2 Omicron era decreased compared to the pre-Omicron period; however, it remained higher than in the general population [25]. The risk of death decreased substantially after the Omicron variant became the dominating strain; however, again, it was substantially higher compared to non-RMD controls [25].…”

“…Patients with RMDs have remained at elevated risk of hospitalization due to COVID-19 since the beginning of the pandemic [23]. Even in the era of SARS-CoV-2 Omicron dominance and increased vaccination rates, RMD remains a crucial risk factor for hospitalization and death [24][25][26]. In the nationwide Greek cohort study conducted in the first half of 2022, patients with rheumatoid arthritis who were infected with SARS-CoV-2 had an elevated risk of hospitalization (odds ratio [OR] = 2.02, 95% CI: 1.79-2.27) and death (OR = 1.73, 95% CI: 1.36-2.20) as compared to controls [24].…”

“…Additionally, based on the data from the Danish national registers, the risk of hospitalization of patients with RMDs in the SARS-CoV-2 Omicron era decreased compared to the pre-Omicron period; however, it remained higher than in the general population [25]. The risk of death decreased substantially after the Omicron variant became the dominating strain; however, again, it was substantially higher compared to non-RMD controls [25]. Information about the COVID-19 burden in Polish patients with RMDs comes from a retrospective, non-interventional research program, SARSTer, conducted by the Polish Association of Epidemiologists and Infectiologists.…”

Association of COVID‐19 Vaccinations With Flares of Systemic Rheumatic Disease: A Case‐Crossover Study

“…Studies attempting to investigate this association are limited by a lack of comparator groups, recall bias, and information bias 16,18,19,21,22 . Patients with SRD can benefit from vaccination: data suggest this group may be at increased risk of hospitalization, mechanical ventilation, and death from COVID‐19, 23,24 and a recent population‐based study found the risk of severe COVID‐19 infection has persisted since the emergence of the Omicron variant 25 . As vaccination coverage expands among individuals with SRD and approaches rates in the general population, 25 an accurate estimation of flare risk following immunization is important for informing both public health guidance and individual patient care.…”