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Understanding the risk factors, such as a gout diagnosis and long-term glucocorticoid use, can help inform patients and clinicians regarding the continued management of patients with rheumatic disease during the COVID-19 pandemic.
Patients with rheumatic and musculoskeletal diseases (RMD) who were older in age, had cardiovascular or pulmonary disease, a history of smoking or long-term glucocorticoid use, or a gout diagnosis were more likely to experience hospitalization or death during the first 2 years of the COVID-19 pandemic, according to a study published in Springer.1 Understanding these factors can help inform patients and clinicians regarding the management of this population.
“As public health restrictions lessen and increased interpersonal interactions occur in work and social settings, it becomes of increased importance to report data that people with RMD can use to understand the potential health implications,” investigators explained. “Exploration of the outcomes of COVID-19 in people with RMD and the associations with disease and individual specific factors may facilitate more precise/accurate risk assessments.”
Investigators used data entered into the COVID-19 Global Rheumatology Alliance (C19-GRA) provider registry between March 2020 and March 2022 to analyze COVID-19 outcomes for people with RMD living in Ireland. The differences in the likelihood of hospitalization and mortality according to clinical and demographic variables, including age, sex, RMD diagnosis, disease activity, comorbidities, and smoking status, were determined.
A total of 237 cases were included in the analysis. Over half (59.9%) were female, 65% (n – 154) had inflammatory arthritis, 24.1% (n = 57) were placed in the connective tissue diseases/vasculitis/others category, and 14.8% (n = 35) had a gout diagnosis. Most patients (46.5%) were in remission and 2.2% reported high disease activity.
During the 2-year study period, 41.3% (n = 95) were hospitalized and 9.3% (n = 22) died. The risk of hospitalization and death was elevated in patients with gout, older patients, those with comorbidities, a history of smoking or long-term glucocorticoid use, and those with cardiovascular or pulmonary disease. Mortality risk increased in obese patients and hospitalization increased in patients with cancer.
Patients with inflammatory arthritis and those receiving biologic disease-modifying antirheumatic drugs (bDMARDs) were less likely to be hospitalized. Death was also less frequent in patients with inflammatory arthritis. Hospitalization was more common in patients with either high disease activity or in remission.
Although this is the largest study of patients with COVID-19 and RMD living in Ireland, the low number of cases limited the statistical power and eliminated the option of multivariable analyses. Selection bias and unmeasured confounders are possible limitations of the C19-GRA registry and results should be interpreted in that light. However, overall results align with previously reported data from the TRACR study, which alleviates some of the potential selection bias concerns. As the data is physician-entered, there is a possibility that doctors may have been more likely to report the more severe cases only. Lastly, due to the design of the C19-GRA, comparisons could not be made between patients with RMD without COVID-19 or with a control population.
“We have identified both shared features with the general population and RMD-specific factors which are over-represented among patients with severe COVID-19 outcomes,” investigators concluded. “These factors may aid early identification of patients with RMDs with poor prognosis when prioritizing booster vaccination and when prescribing COVID-19 antiviral therapy.”
Conway R, Nikiphorou E, Demetriou CA, et al. Outcomes of COVID-19 in people with rheumatic and musculoskeletal disease in Ireland over the first 2 years of the pandemic [published online ahead of print, 2023 Jan 9]. Ir J Med Sci. 2023;1-6. doi:10.1007/s11845-022-03265-7