COVID-19: Control of inflammation ‘seems to be key’ in patients with rheumatic diseases
medwireNews: Findings from the Euro-COVIMID study suggest that the seroprevalence and effects of SARS-CoV-2 infection in patients with rheumatic diseases are in line with those in the general population, and inflammation may be a risk factor for developing symptomatic COVID-19.
David Saadoun (Sorbonne Université, Paris, France) and colleagues analyzed data from 3028 patients with rheumatoid arthritis (29%), axial spondyloarthritis (22%), systemic lupus erythematous (20%), Sjögren’s syndrome (17%), or giant cell arteritis (12%) from six European countries who completed a questionnaire between June and December 2020. Participants were aged a median of 58 years and 74% were women.
The team found that COVID-19 epidemiology in the study population “resembled that of the general population.” Specifically, 5.5% of the 3018 patients with available serologic data had antibodies against SARS-CoV-2, while 4.0% of respondents reported having symptomatic COVID-19. Of these 122 individuals, 19.7% were admitted to hospital with COVID-19 and 3.3% died.
In a multivariable analysis, higher levels of C-reactive protein were associated with an increased risk for developing symptomatic COVID-19, with a significant odds ratio (OR) of 1.18 for each 10 mg/L increase. Disease flares were also a significant predictor of symptomatic infection, at an OR of 1.27 for each additional flare reported.
On the other hand, Saadoun and team report that the use of conventional or biologic DMARDs “appeared to be protective” against symptomatic COVID-19, with an OR of 0.51 versus no use.
Taken together with previous data from the COVID-19 Global Rheumatology Alliance demonstrating a significant association between disease activity and COVID-19 mortality risk in patients with rheumatic diseases, “these findings suggest that the inflammatory status might play a part in the development of COVID-19 and its outcomes,” say the researchers in The Lancet Rheumatology.
They add that “[r]ather than a specific biological DMARD, the control of the overall inflammatory response seems to be key in whether a patient develops symptomatic COVID-19.”
Writing in an accompanying comment, Daniel Wallace (Cedars-Sinai Medical Center, Los Angeles, California, USA) says that the Euro-COVIMID study addressed “two of the most important outstanding questions” about rheumatology and COVID-19, namely “whether patients with rheumatic disease are more or less likely to become infected with SARS-CoV-2, and whether the severity of illness in these patients was different to that in the public at large.”
“In other words, after hearing about many cases, we finally have a denominator so comparisons can be made,” he remarks.
Wallace notes, however, that the study had a number of drawbacks, including single SARS-CoV-2 tests in the majority of participants, and likely “limited” racial and ethnic diversity “as established European rheumatology cohorts are overwhelmingly white.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
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