Risk and clinical outcomes of COVID-19 in patients with rheumatic diseases compared with the general population: a systematic review and meta-analysis

Abstract

Patients with rheumatic diseases are often more susceptible to different bacteria and viruses because of immune impairment, but it is not clear whether there is a higher risk of infection and a more serious course of disease for novel coronavirus (SARS-CoV-2). We performed this systematic review and meta analysis to assess the risk and clinical outcomes of COVID-19 in patients with rheumatic diseases compared with the general population. We searched PubMed, EMBASE, Scopus and Web of Science databases from January 1, 2020 to October 20, 2020 to determine epidemiological information related to patients with rheumatic diseases and COVID-19, including clear risk estimate or data that could be converted and extracted. We included 26 observational studies, totaling about 2000 patients with rheumatic diseases of whom were infected with COVID-19. Meta-analysis showed that the risk of COVID-19 infection in rheumatic patients was significantly higher than that in the general population (OR = 1.53, 95% CI 1.24–1.88, P = 0.000). In terms of hospitalization and severe clinical outcomes associated with COVID-19, we found that rheumatic patients showed similar results to the reference population (hospitalization OR = 1.36, 95% CI 0.81–2.29, P = 0.247; admitted to ICU OR = 1.94, 95% CI 0.88–4.27, P = 0.098; death OR = 1.29, 95% CI 0.84–1.97, P = 0.248). The presence of comorbidities, hypertension, lung diseases were significantly associated with the increased risk of COVID-19-related hospitalization in rheumatic patients and anti-TNF drugs were associated with lower hospitalization risk. Older age was related to severe COVID-19. Our meta-analysis indicated that rheumatic patients were at a higher risk of COVID-19 infection but might not lead to a more serious disease process. Supplementary Information The online version contains supplementary material available at 10.1007/s00296-021-04803-9.

Predictors of hospitalization for COVID-19 in patients with autoimmune rheumatic diseases: results from a community cohort follow-up

“…By contrast, in a study from China, a higher incidence of COVID-19 in the general population as compared to ARD patients (0.0142 vs 0.0126%) [ 22 ] was found. Finally, a systematic review and meta-analysis of 26 observational studies showed that patients with ARD had an increased risk of developing COVID-19 compared with the general population [ 23 ]. In addition, although the possible role of ethnicity per se cannot be discarded, our higher rates could be explained by the fact that we identified cases over a longer period of time and we also included patients from the community many of whom had a mild COVID-19 disease [ 24 ].…”

“…Concerning previously described predictors of adverse course of COVID-19, we were able to corroborate the role of older age and chronic comorbidities (hypertension and neoplasm) as previously reported [ 15 , 26 , 31 – 36 ]. A recent meta-analysis found comorbidities (OR = 2.41, 95%; CI = 1.04–5.61; p = 0.041), hypertension (OR = 3.69; 95% CI = 1.41–9.69; p = 0.008), and lung diseases (OR = 2.93; 95% CI = 1.64–5.23; p = 0.000) significantly associated with hospitalizations [ 23 ]. We identified predictors of hospitalization; however, we were unable to do the same analysis for lethality due to the relatively small sample size.…”

Safety of the ChAdOx1 nCoV-19 and the BBV152 vaccines in 724 patients with rheumatic diseases: a post-vaccination cross-sectional survey

“…Thus, they may be at higher risk of COVID-19 [ 2 ]. Higher rheumatic disease activity can be a risk for severe disease [ 3 , 4 ]. Also, patients with RMDs have higher comorbidities or multi-morbidity that puts them at higher risk for COVID-19 [ 5 ].…”

Exercise, infection and rheumatic diseases: what do we know?

“…These findings may be of particular clinical value for individuals with autoimmune inflammatory rheumatic diseases (AIIRD) who by virtue of complex dysfunctional immune changes from their underlying diseases compounded by immunosuppressive therapies and a high prevalence of comorbidities appear to be at increased risk of infectious complications including acute respiratory viral infections and severe outcomes in COVID-19. 24 25 Importantly, the role of relative physical inactivity as a risk factor potentially contributing to these risks remains unexplored.…”