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No heightened outcome risk for rheumatic patients with COVID-19

Presented by
Dr Naomi Serling-Boyd, Massachusetts General Hospital, USA
ACR 2020

When infected with SARS-CoV-2, the risk for a severe disease course including mechanical ventilation was not higher for patients with rheumatoid comorbidity compared to the general population.

“Early in the pandemic we observed a higher risk of mechanical ventilation in patients with rheumatic diseases compared with the general population in a small cohort study,” stated Dr Naomi Serling-Boyd (Massachusetts General Hospital, USA) [1]. However, the situation is still not entirely clear [2]. “Therefore, we conducted a comparative cohort study of patients with COVID-19 as confirmed by PCR between January and July 2020 in our multicentre healthcare system,” she further explained.

Out of 12,866 COVID-19 cases during this period, 143 patients already diagnosed with rheumatic disease (RMD) were matched by age, sex, and date of COVID-19 PCR with up to 5 comparators without RMD (n=688). Within the RMD group, mean age was 60 years, 76% were female, 52% never-smokers, and the median Charlson comorbidity index (CCI) equalled 2. In the non-RMD group mean age was 59, 76% were female, 50% never-smokers, and CCI equalled 0. The most common rheumatic diagnoses were rheumatoid arthritis (31%) and systemic lupus erythematosus (19%). The rheumatic patients had ongoing treatments with corticosteroids (36%), hydroxychloroquine (21%), conventional synthetic DMARDs (31%), and biologic DMARDs (29%).

No disparities in risk for intensive care, hospital admission, or death were found between the groups. The unadjusted results of a Cox proportional hazard model pointed to a higher risk only for mechanical ventilation with an HR of 1.75 (95% CI 1.12–2.74). Nonetheless, after adjustment for race, smoking, and CCI, this increased risk was no longer significant (HR 1.51; 95% CI 0.93–2.44). Hence, RMD and non-RMD patients had a similar outcome risk for COVID-19. “These findings provide reassurance for RMD patients, though close monitoring of patients with other comorbidities is warranted,” Dr Serling-Boyd closed her talk. As the world is in the throws of the second peak of the COVID-19 pandemic, the overall data presented in relationship to RMD and, more importantly, immunosuppressive therapy is very reassuring. Indeed, more than one class of rheumatic drug has evidence for efficacy in severe COVID-19.

  1. D’Silva KM, et al. Ann Rheum Dis. 2020;79:1156-62.
  2. Serling-Boyd N, et al. Outcomes of COVID-19 infection in patients with rheumatic diseases in a multicenter healthcare system: a comparative cohort study. L01, ACR Convergence 2020, 5-9 Nov.

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