Risk Factors for Infection, Predictors of Severe Disease, and Antibody Response to COVID-19 in Patients With Inflammatory Rheumatic Diseases in Portugal—A Multicenter, Nationwide Study

Abstract

ObjectiveTo identify risk factors for SARS-CoV-2 infection and for severe/critical COVID-19, and to assess the humoral response after COVID-19 in these patients.MethodsNationwide study of adult patients with inflammatory RMDs prospectively followed in the Rheumatic Diseases Portuguese Register—Reuma.pt—during the first 6 months of the pandemic. We compared patients with COVID-19 with those who did not develop the disease and patients with mild/moderate disease with those exhibiting severe/critical COVID-19. IgG antibodies against SARS-CoV-2 were measured ≥3 months after infection and results were compared with matched controls.Results162 cases of COVID-19 were registered in a total of 6,363 appointments. Patients treated with TNF inhibitors (TNFi; OR = 0.160, 95% CI 0.099–0.260, P < 0.001) and tocilizumab (OR 0.147, 95% CI 0.053–0.408, P < 0.001) had reduced odds of infection. Further, TNFi tended to be protective of severe and critical disease. Older age, major comorbidities, and rituximab were associated with an increased risk of infection and worse prognosis. Most patients with inflammatory RMDs (86.2%) developed a robust antibody response. Seroconversion was associated with symptomatic disease (OR 13.46, 95% CI 2.21–81.85, P = 0.005) and tended to be blunted by TNFi (OR 0.17, 95% CI 0.03–1.05; P = 0.057).ConclusionsTNFi and tocilizumab reduced the risk of infection by SARS-CoV-2. Treatment with TNFi also tended to reduce rates of severe disease and seroconversion. Older age, general comorbidities and rituximab were associated with increased risk for infection and worse prognosis, in line with previous reports. Most patients with RMDs developed a proper antibody response after COVID-19, particularly if they had symptomatic disease.

Effect of disease activity on the clinical outcome of SARS CoV-2 in patients with underlying rheumatic diseases; data from global rheumatology alliance

“…Rheumatic disease patients were thought by some to be at higher risk of contracting COVID-19 and having worse outcomes, once infected 9 whereas others denied it. 10 Albeit true for some rheumatic diseases, in most of these syndromes poor outcomes may be pertinent to the severity of disease and other disease-specific or general factors rather than the diagnosis itself. The current study explored the influence of rheumatic disease activity on COVID-19 outcomes.…”

“…8 A study suggested that those with moderate disease activity (MDA) or high disease activity (HDA) had poorer outcomes 9 whereas some studies did not find any such relationship. 10 A Danish study observed that the risk of hospitalisation with COVID-19 was 46% higher for people with rheumatic disease than for the general population, but after adjustment for age, gender and comorbidities, only people with RA still had an increased risk of a poor outcome. 11 The current study was planned to conduct a multi-centre study in Pakistan to see the effect of disease activity state of various rheumatic diseases on COVID-19-related outcomes.…”

Clinical Outcomes of COVID‑19 Patients with Rheumatic and Musculoskeletal Diseases: A Single Centre Cohort Study

“…In line with other studies, we found an association between patients with COVID-19 requiring hospitalization and arterial hypertension (p = 0.01) 2 and age (p = 0.013). 5 Gout (p = 0.01) and vaccination status (p = 0.05) were also associated with a worse prognosis. In the multivariate analysis, only older patients […”