Risk for post-acute sequelae of COVID-19 down among patients with SARDs
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Key takeaways:
- Risk factors were similar to those of the general population.
- Patients with AAV experienced the most thromboembolism and hypoxemia, while those with lupus had the most neurologic and mental health manifestations.
Since the beginning of the COVID-19 pandemic, there has been a “significant decrease” in the risk for post-acute sequelae of COVID-19 among patients with rheumatic diseases, according to data published in The Journal of Rheumatology.
“Patients with systemic autoimmune rheumatic diseases (SARDs) often use immunosuppressive medications that can increase the risk of severe acute outcomes of [COVID-19],” Naomi J. Patel, MD, MPH, of Massachusetts General Hospital, and colleagues wrote. “Whether SARDs and their treatments contribute to an increased risk of post-acute sequelae of COVID-19 (PASC) is unclear.”
To investigate that relationship, Patel and colleagues conducted a retrospective cohort study of 2,459 adult patients at Mass General Brigham with SARDs, the most common of which was rheumatoid arthritis at 33.14%. The researchers observed patients over time through the omicron wave for instances of PASC, such as cough, fatigue, chest pain and anxiety.
The study was “the first” to use electronic health records in its definition of post-PASC in people with SARDs, Patel and colleagues wrote. In addition, they used multivariable Cox regression to estimate links between their baseline characteristics and PASC risk, followed by subgroup and sensitivity analyses to test the robustness of the results.
According to the researchers, the risk for PASC among patients with SARDs was highest from March 2020 to June 2021, before decreasing through the delta (HR = 0.63; 95% CI, 0.49-0.82) and omicron waves (HR = 0.5; 95% CI, 0.41-0.62). Baseline risk factors, such as age, obesity, comorbidity burden, race and hospitalization for COVID-19 infection were “similar to those observed in the general population,” the researchers wrote.
Patients with systemic lupus erythematosus and ANCA-associated vasculitis more commonly demonstrated cardiovascular, dermatologic and renal manifestations of PASC compared with patients with rheumatoid arthritis. Meanwhile, patients with ANCA-associated vasculitis experienced the most thromboembolism and hypoxemia, and those with SLE had the most neurologic and mental health manifestations, such as anxiety and headache, according to the researchers.
Overall, the most common PASC manifestations were cough, at 14.56%; dyspnea, at 12.36%; constipation, at 11.39%; and fatigue, at 10.70%.
“We observed significant improvements in the risk of PASC over time and that the risk of PASC may vary according to rheumatic disease,” Patel and colleagues wrote.
“As current treatment for PASC is primarily supportive based on symptoms, further work elucidating the underlying pathophysiology of PASC will be helpful to identify potential targeted treatments,” they added. “Our findings identify important avenues for future investigation, including determining the attribution of ongoing symptoms to COVID-19 infection, better elucidating the proportion with severe outcomes (eg, myocardial infarction, thromboembolism) following COVID-19 infection, and determining the risk of rheumatic disease flare following COVID-19 infection.”
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