Patients with inflammatory rheumatic disease more likely to be hospitalized with COVID-19
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Patients with inflammatory rheumatic disease exhibited a higher incidence of COVID-19 hospitalization than the general population, and those with rheumatoid arthritis are at a greater risk for severe outcomes, according to data.
“Patients with inflammatory rheumatic diseases often receive immunosuppressive treatment and some may have lung, kidney or cardiovascular disease due to inflammation,” René Cordtz, MD, of Aalborg University Hospital, in Denmark, told Healio Rheumatology. “This has naturally raised concerns on how the COVID-19 pandemic affects these patients and if changes in the management of these patients are warranted.
“In Denmark, access to health care is free and universal for all residents, which, in combination with the extensive nationwide registers, enabled us to provide real-world evidence on the risk of COVID-19 hospitalization in patients with inflammatory rheumatic disease in an unselected cohort, including all 4.8 million adult Danish residents,” he added. “We believe this study, in addition to the existing data, provide useful information for our patients, rheumatologists, and healthcare authorities as well as decision makers.”
To analyze the incidence of severe COVID-19, as well as COVID-19 hospitalizations, among patients with inflammatory rheumatic disease, including those with RA, Cordtz and colleagues conducted a population-based observational cohort study, based on several linked nationwide registers in Denmark. Focusing on the period from March 1, 2020, to Aug. 12, 2020, the researchers estimated the adjusted incidence of COVID-19 hospitalization among patients with RA, spondyloarthritis, psoriatic arthritis, connective tissue disease and vasculitides, as well as those without inflammatory rheumatic disease.
In addition, the researchers estimated the incidence of COVID-19 hospitalization specifically among patients with RA who received TNF inhibitors, hydroxychloroquine or glucocorticoids. Cordtz and colleagues also assessed the incidence of severe COVID-19 — defined as intensive care use, respiratory distress syndrome or death — among those with RA, as well as those without any inflammatory rheumatic disease, who were admitted to the hospital. In all, the researchers included 58,052 patients with inflammatory rheumatic disease, with 29,440 having RA. Patients were compared with 4.5 million members of the Danish general population.
According to the researchers, in their partially adjusted findings, patients with inflammatory rheumatic disease demonstrated an increased incidence of hospitalization with COVID-19, compared with the general population (HR = 1.46; 95% CI, 1.15-1.86). The strongest associations were for patients with RA (HR = 1.72; 95% CI, 1.29-2.3) and vasculitides (HR = 1.82; 95% CI, 0.91-3.64). Patients with RA who were hospitalized with COVID-19 admitted demonstrated a hazard ratio of 1.43 (95% CI, 0.80-2.53) for a severe outcome.
There was no association between an increased incidence of COVID-19 hospitalization and the use of TNF inhibitors, hydroxychloroquine or glucocorticoids.
“Our findings indicate that inflammatory rheumatic disease is a risk factor for COVID-19 hospitalization, and, in our opinion, strengthens the foundation for advising these patients to strict adherence to national COVID-19 preventive guidelines and get the vaccine when offered,” co-author Jesper Lindhardsen, MD, PhD, of Rigshospitalet, in Copenhagen, told Healio Rheumatology. “Another implication is that health authorities should consider including these patients in the at-risk groups of individuals to be prioritized in the vaccination programs — of course with respect to other stronger risk factor such as advanced age, severe lung disease and other conditions.
“Our study did not identify any particular risk of COVID-19 related admissions due to treatment with TNF-inhibitors, hydroxychloroquine, or glucocorticoids, and thus supports that treatments should be continued as usual,” he added. “However, this should of course be based on an individual assessment and a dialogue between the patient and rheumatologist.”
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