Connective tissue disease may be risk factor for severe COVID-19
medwireNews: Among people with inflammatory rheumatic diseases and SARS-CoV-2 infection, having a connective tissue disease (CTD), but not inflammatory arthritis, is associated with an increased risk for severe COVID-19, Spanish researchers report.
Jose Pablos (Instituto de Investigación Hospital 12 de Octubre, Madrid) and colleagues used the RIER database to compare the COVID-19 outcomes of 228 patients with rheumatic diseases – 60% with inflammatory arthritis and 40% with CTDs – and the same number of patients without rheumatic disease who were matched by age and sex. All patients had confirmed SARS-CoV-2 infection.
In all, 57% of patients with rheumatic diseases were taking conventional DMARDs prior to developing COVID-19, while 40% were taking glucocorticoids, 23% biologics, and 12% other immunosuppressants. With the exception of one individual receiving glucocorticoids, none of the patients in the control group were taking any of these agents.
Overall, 31.6% of patients with rheumatic disease experienced a severe COVID-19 disease course – defined as death, intensive care unit admission, intratracheal intubation or serious COVID-19 complications – compared with 28.1% of those in the control group, giving a nonsignificant between-group difference of 3.5%.
However, when the rheumatic disease cohort was divided into patients with CTDs and those with inflammatory arthritis, individuals with CTDs had an elevated risk for severe COVID-19 relative to the control group, with an odds ratio (OR) of 1.82 on multivariable analysis. On the other hand, there was no association between inflammatory arthritis or prior use of immunosuppressive medication and the risk for COVID-19.
“These findings have important implications to guide COVID-19 recommendations to specific groups of patients with rheumatic diseases and to provide evidence-based advice on the importance of maintaining therapies,” write Pablos et al in the Annals of the Rheumatic Diseases.
The researchers note that CTDs and inflammatory arthritis both “include a heterogeneous group of patients with different diagnostics,” and therefore they carried out a subgroup analysis “with more homogeneous categories in terms of clinical or pathophysiological characteristics.”
The CTD group was separated into two subgroups, specifically systemic lupus erythematosus plus related CTD (n=34), and vasculitidies including polymyalgia rheumatica and giant cell arteritis (n=32), while the inflammatory arthritis group was divided into rheumatoid arthritis (n=65) and spondyloarthropathies including psoriatic arthritis (n=71).
On multivariable analysis, these four groups “showed a similar association as [inflammatory arthritis] or CTD groups where they had been included,” say the study authors.
Nevertheless, they concede that “[w]hether specific diagnostics within the heterogeneous CTD group may have a different risk cannot be ruled out.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group
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