Rheumatic Disease May Increase Risk for Severe COVID-19 Outcomes

Patients with vs without rheumatic disease are more likely to require mechanical ventilation for coronavirus disease (COVID-19) infection, according to cohort study results published in the Annals of the Rheumatic Diseases.

Investigators conducted a comparative cohort study of patients with rheumatic disease and laboratory-confirmed COVID-19 who received care at hospitals in Boston, Massachusetts. Cases diagnosed between March 1 and April 8, 2020 were eligible for inclusion in the study. Patients with rheumatic diseases were matched 1:2 with individuals without rheumatic disease by age, sex, and date of COVID-19 diagnosis. Demographics, clinical features, and outcomes of COVID-19 infection were compared between the cohorts. The primary outcomes were hospitalization, intensive care admission, mechanical ventilation, and death. Logistic regression was used to calculate the likelihood of each outcome among patient groups, expressed as odds ratios (ORs). Models were adjusted for age, body mass index, smoking history, and comorbidities.

A total of 52 patients with rheumatic disease and COVID-19 were enrolled in the study. Mean age was 63±15.1 years; 72 (69%) were women; and 30 (58%) were White. The most common rheumatic diseases observed were rheumatoid arthritis (37%), systemic lupus erythematosus (19%), polymyalgia rheumatica (13%), and spondyloarthritis (13%). The majority (75%) of patients were receiving immunosuppressive medications at the time of COVID-19 infection. Patients were matched with 104 control participants without rheumatic disease. Overall, both patients and control participants had similar manifestations of COVID-19 infection. The most common symptoms in both groups were cough, fever, shortness of breath, and myalgia. Baseline laboratory values were similar in both groups, though patients with rheumatic disease had higher white blood cell counts (P =.03).

A similar percentage of patients and control participants were hospitalized for COVID-19 infection (44% and 40%, respectively; P =.50). Mortality rates were also comparable between the 2 groups (6% vs 4%; P =.69). However, patients with vs without rheumatic disease were more likely to be admitted to intensive care and receive mechanical ventilation (48% vs 18%, respectively; odds ratio, 3.11; 95% CI, 1.07-9.05). Among patients with vs without rheumatic disease, those hospitalized were older (67 vs 59 years; P =.05), had a higher mean number of comorbidities (2 vs 1; P =.03), and more frequently had diabetes (39% vs 14%; P =.04).

These data elucidate the unique risks for COVID-19 infection among patients with rheumatic disease. While clinical and laboratory manifestations were comparable between the patient and control groups, rheumatic disease increased the risk for intensive care admission and mechanical ventilation, with older age, comorbid conditions, and diabetes intensifying these risks.

Study limitations included limited generalizability of the findings, small cohort size, and the fact that hospitalizations outside of the system may not have been recorded.

“These results are concerning and underscore the need for close monitoring of patients with rheumatic disease during the pandemic,” the investigators wrote.

Disclosure: Study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

D’Silva KM, Serling-Boyd N, Wallwork R, et al. Clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and rheumatic disease: a comparative cohort study from a US ‘hot spot’. Ann Rheum Dis. doi:10.1136/annrheumdis-2020-217888