Optimal Management of Rheumatic Disease During COVID-19 - Episode 3
Amar Majjhoo, MD: The presentation by Naomi Serling-Boyd, MD, et al at the ACR Convergence [American College of Rheumatology annual meeting] was reassuring in many ways. At the beginning of the pandemic, we were all concerned that our patients with chronic autoimmune inflammatory diseases on various immunosuppressants may be at an increased risk of contracting COVID-19 [coronavirus disease 2019] and complications from the virus itself. There was an earlier report that perhaps patients with rheumatic diseases on immunosuppressant drugs were requiring mechanical ventilation more frequently than their counterparts without these diseases, without these therapies.
This was a cohort study conducted within a large health care system that comprised both academic centers and community hospitals. Patients with rheumatic diseases, mostly rheumatoid arthritis and lupus, on various therapies including corticosteroids, conventional synthetic DMARDS [disease-modifying antirheumatic drugs], biologics, and hydroxychloroquine, who had contracted COVID-19 were compared to patients who were COVID-19 positive as well, but did not have these rheumatic diseases.
The outcomes that we’re looking at were rates of hospital admission, rates of admission to the ICU [intensive care unit], requirement of mechanical ventilation, and death. And when the patients were normalized or matched for other background factors, such as age, sex, race, smoking history and other comorbidities, there was not an increased risk associated with having these rheumatic diseases and on these various therapies for those outcomes.
They were well matched, which is reassuring for us and for our patients. They also looked at and reported on the rates of requirement for mechanical ventilation in patients with rheumatic diseases who had COVID-19 early in the pandemic as opposed to later in the pandemic. The trend was similar to what we’re seeing in our clinical practices as well, that patients are requiring less mechanical ventilation, not only for the general population without these diseases, but for our patients with autoimmune diseases as well.
Transcript Edited for Clarity