Risk Factors for COVID‐19 and Rheumatic Disease Flare in a US Cohort of Latino Patients

Abstract

Objectives Latino patients are overrepresented among cases of coronavirus disease 2019 (COVID‐19) and are at an increased risk for severe disease. Prevalence of COVID‐19 in Latinos with rheumatic diseases are poorly reported. The purpose of this study was to characterize COVID‐19 clinical features and outcomes in Latino patients with rheumatic diseases. Methods This is a retrospective study of Latino patients with rheumatic diseases from an existing observational cohort in the Washington, DC area. Patients seen between April 1 to October 15, 2020 were analyzed in this study. We reviewed demographics, body mass index (BMI), comorbidities, and immunomodulatory therapies. An exploratory Classification and Regression Tree (CART) analysis along with logistic regression (LR) analyses were performed to identify risk factors for COVID‐19 and rheumatic disease flare. Results Out of 178 patients, 32 (18%) were identified with COVID‐19 and the incidence rate of infection was found to be three‐fold higher than the general Latino population. No patients required ICU level care. CART analysis and multivariable LR analysis identified BMI>30.35 as a risk factor for COVID‐19 [ P =0.004, OR=3.37, 95%CI (1.5‐7.7)]. COVID‐19 positivity was a risk factor for rheumatic disease flare [ P =0.02, OR=4.57, 95%CI (1.2‐17.4)]. Conclusion Latino patients with rheumatic diseases had a higher rate of COVID‐19 compared with the general Latino population. Obesity was identified as a risk factor for COVID‐19 and COVID‐19 itself was found to be a risk factor for rheumatic disease flare. Latino patients with risk factors should be followed closely, especially post‐COVID‐19 in anticipation of disease flare.

The Flare of Rheumatic Disease After SARS-CoV-2 Vaccination: A Review

“…COVID-19 vaccine and SARS-CoV-2 infection partly shared mechanisms for triggering RD relapse ( 7 , 8 ). As shown above, the vaccine showed no direct association with flare, while SARS-CoV-2 infection was reported as an independent risk factor for RD flare in some studies ( 52 – 54 ). The flare rate of RD after SARS-CoV-2 infection presented a vastly higher flare risk than that after vaccination ( 52 – 58 ), with most flare rates being higher than 20% and some even higher than 40%.…”

“…As shown above, the vaccine showed no direct association with flare, while SARS-CoV-2 infection was reported as an independent risk factor for RD flare in some studies (52)(53)(54). The flare rate of RD after SARS-CoV-2 infection presented a vastly higher flare risk than that after vaccination (52)(53)(54)(55)(56)(57)(58), with most flare rates being higher than 20% and some even higher than 40%. This may also encourage RD patients to receive the COVID-19 vaccination.…”

Risk and prognosis of SARS-CoV-2 infection and vaccination against SARS-CoV-2 in rheumatic and musculoskeletal diseases: a systematic literature review to inform EULAR recommendations

“…One USA-based, prospective study assessed the association of SARS-CoV-2 infection with development of a disease flare in Latin-American patients with RMDs, reporting an increased risk (OR 4.57, 95% CI 1.2 to 17.4). 9 One US-based, retrospective study in the TriNetX database compared outcomes of matched patients with inflammatory RMDs and COVID-19 in the early (January-April 2020) and late (April-July 2020) phases of the pandemic. 51 The study showed that patients with COVID-19 in the late cohort fared better than those in the early cohort, based on lower risk of COVID-19-related hospitalisation (RR 0.…”

Vasculitis flare after COVID-19: report of two cases in patients with preexistent controlled IgA vasculitis and review of the literature

“…Flares of SLE in patients with COVID-19 have been described [46]. A study in a cohort of Hispanic COVID-19 patients from United States with rheumatic diseases identified COVID-19 positivity as a risk factor for disease flares [47]. To date, we have not found publications reporting cases of relapses of previous controlled IgA vasculitis associated with COVID-19.…”