Patients with inflammatory rheumatic disease may be at higher risk for long COVID
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Key takeaways:
- Patients with inflammatory rheumatic diseases were more likely to develop long COVID.
- The researchers noted that the difference “could be partly explained by clinical manifestations in the context of underlying rheumatic diseases.”
Long COVID symptoms are more common in patients with inflammatory rheumatic disease vs. those without such conditions, according to data published in The Lancet Rheumatology.
However, the researchers cautioned that this finding may be partially explained by the fact that patients with inflammatory rheumatic disease report symptoms more commonly report symptoms are also used to define long COVID. As such, they wrote that physicians should “have a nuanced attitude” when discussing long COVID.
“Effects of inflammatory rheumatic diseases and treatment with immunosuppressive agents on the acute infection phase of SARS-CoV-2 have been extensively investigated, but there is still a paucity of data on long-term consequences of SARS-CoV-2 infection,” Laura Boekel, BSc, of the Amsterdam University Medical Center, and colleagues wrote. “Long-term consequences of COVID-19 are commonly referred to as post-COVID condition (also known as long COVID), and are currently seen as conditions that might affect a substantial proportion of the general population.”
To investigate the connection between inflammatory rheumatic diseases and symptoms consistent with long COVID, Boekel and colleagues analyzed data from an ongoing prospective study conducted in the Netherlands that aimed to compare COVID-19 outcomes between patients with and without inflammatory rheumatic diseases. Patients aged 18 years or older who were being treated for inflammatory rheumatic diseases at the Amsterdam Rheumatology and Immunology Center were invited from April 26, 2020, to March 1, 2021, to participate in the study. Individuals without inflammatory rheumatic diseases were recruited to serve as a matched comparator cohort.
The researchers collected demographic data including age, weight, smoking status and autoimmune disease type. Patients reported disease activity, medication use and any relevant details relating to COVID-19 at baseline and during follow-up. Following several months, participants completed follow-up surveys. The primary outcome was the comparison of risk for long COVID between patients with inflammatory rheumatic diseases and those without.
The analysis included 1,974 patients with inflammatory rheumatic diseases and 733 healthy control participants. In, 468 patients with inflammatory rheumatic diseases and 218 healthy control patients had a recorded case of SARS-CoV-2 omicron infection. Among these patients, 365 with inflammatory rheumatic disease and 172 of the healthy controls completed the follow-up long COVID questionnaires.
According to the researchers, 77 patients with inflammatory rheumatic disease — or 21% — met the long COVID criteria used in the WHO classification guidelines, compared with 23 — or 13% — of the health comparators (OR = 1.73; 95% CI, 1.04-2.87). After adjusting for potential confounders, the OR stood at 1.53 (95% CI, 0.90-2.59).
In participants without a history of COVID-19, patients with inflammatory rheumatic diseases were more likely to report symptoms consistent with long COVID, compared with healthy controls (OR = 2.52; 95% CI, 1.92-3.32).
Fatigue and loss of fitness were the most frequently reported symptoms in both groups. Additionally, long COVID recovery times were similar for both groups (P = .17).
“We found that 21% of patients with inflammatory rheumatic disease and 13% of healthy controls developed post-COVID condition after a SARS-CoV-2 omicron infection based on WHO-criteria,” Boeckel and colleagues wrote. “Furthermore, symptomology and recovery time from post-COVID condition were similar between patients and controls.
“We also found that more patients with inflammatory rheumatic disease than healthy controls without a history of COVID-19 reported symptoms that are also observed in post-COVID condition, and this association reached the strength that is necessary to negate the difference in post-COVID condition between patients and controls,” they added. “... Our study highlights the limitations of applying current criteria for post-COVID condition in patients with inflammatory rheumatic disease, and suggests it might be appropriate for physicians to have a nuanced attitude when communicating the long-term consequences of COVID-19 to their patients.”
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