Do Inflammatory and Autoimmune Rheumatic Diseases Affect COVID-19 Illness Severity?

Hospitalized COVID-19 patients with connective tissue diseases may be at risk for increased illness severity, according to a recent study, but inflammatory arthritis may not have the same effect.

“Since severe COVID-19 is associated with a hyperinflammatory process, it is of particular interest to investigate how pre-existing inflammatory diseases or the previous use of immunosuppressive agents influence COVID-19 expression,” the study authors explained.

The researchers identified PCR+COVID-19 rheumatic patients with chronic inflammatory arthritis (including rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis) or connective tissue diseases (including systemic lupus erythematosus, Sjögren’s syndrome, systemic sclerosis, polymyalgia rheumatica, and vasculitides) and compared them 1:1 to non-rheumatic controls matched based on age, sex, and PCR date. The primary outcome was severe COVID-19 (death, invasive ventilation, intensive care unit admission, or serious complications). The correlation between severe COVID-19 and potential prognostic variables was evaluated, adjusting for COVID-19 treatment.

Final analysis included 456 patients each in the rheumatic and non-rheumatic groups. Both cohorts had a mean ae of 63 years and were 41% male. In the rheumatic disease cohort, 60% of patients had inflammatory arthritis, and 40% had connective tissue disease. About three-quarters of patients (74%) were hospitalized. The risk of severe COVID-19 was 31.6% in the rheumatic cohort and 28.1% in the non-rheumatic cohort. In bivariate analysis, factors associated with increased COVID-19 severity risk in the rheumatic group were aging; male sex; and previous comorbidity including obesity, diabetes, hypertension, or cardiovascular or lung disease. Upon logistic regression analysis, the factors independently associated with severe COVID-19 disease were increased age (odds ratio [OR]=4.83; 95% confidence interval [CI], 2.78 to 8.36), male sex (OR=1.93; 95% CI, 1.21 to 3.07), and connective tissue disease (OR=1.82; 95% CI, 1.00 to 3.30).

The researchers stated in their conclusion that “among hospitalised patients with inflammatory rheumatic diseases, having a [connective tissue disease] pose[s] a significantly greater risk for poor outcomes, whereas immunosuppressive therapies do not. Previously known risk factors as ageing and male sex also apply to patients with rheumatic diseases. This observation should help to tailor recommendations to specific diagnostic and therapeutic groups of patients with rheumatic diseases during this or future coronavirus pandemics.”

The study was published in Annals of the Rheumatic Diseases.