Table 3.
Studies of coronavirus disease 2019 (COVID-19) course and outcomes in rheumatic disease patients.
| Study | Cohort | Result |
|---|---|---|
| Case control studies comparing rheumatic COVID-19 positive versus non-rheumatic COVID-19 positive | ||
| D’Silva et al. ( 54 ) | US; 52 rheumatic pts. (19 RA, 10 SLE, 7 PMR, 15 other) positive for COVID-19 and 104 age and sex matched non-rheumatic COVID-19 positive comparators | Similar symptoms, manifestations, and outcome, similar % of hospitalization (44% SARD vs. 42% control), similar mortality; more often intensive care admission/mechanic ventilation is SARD (48 vs. 18%). |
| Pablos et al. ( 50 ) | Spain; 228 rheumatic pts. with confirmed COVID-19 (60% inflammatory arthritis (RA; PsA, SpA), 40% CTD (SLE, SjS, SSc, vasculitis), and 228 age and sex matched non-rheumatic controls | Risk for severe COVID was not increased in rheumatic group; risk was increased with age and male sex and in CTD pts. versus inflammatory arthritis (OR 1.82 95% CI 1.02–3.30) Therapy was not associated with risk for severe COVID-19. |
| Ansarin et al. ( 51 ) | Iran; 30 COVID-19 positive with autoimmune disease (14 RA, 4 SSc, 3 SLE, 9 other) versus 381 COVID-19 positive immunomodulatory drug naive pts. | The frequency of clinical manifestations (malaise, dyspnea, myalgia, anosmia, and taste loss) were significantly higher in pts. treated with immunomodulatory drugs compared with immunomodulatory drugs-naïve pts. No significant differences were observed in the admission level, time interval between the onset of symptoms and intubation, duration of intubation, duration of admission in ICU, and number of deceased pts. in the two groups. |
| Fredi et al. ( 53 ) | Italy; 26 rheumatic musculoskeletal disease pts. versus 62 controls | No significant differences between cases and controls in duration of COVID-19 symptoms before admission, duration of stay in hospital, or the local chest X-ray scoring system. |
| Ye et al. ( 52 ) | China, 21 pts. COVID-19 with rheumatic disease (8 RA, 4 SLE, 3 SjS, 2 CTD, 2 PMR, 1 JIA, 2 AS) versus 2,301 COVID-19 positive pts. | No statistical difference in hospitalization time, significantly more respiratory failure (38 vs. 10%) and no different mortality rate. 4 rheumatic pts. undergone flare of rheumatic disease (pain in joints, back pain, rash, hemolytic anemia, muscle aches). |
| Studies including only autoimmune COVID-19 positive group | ||
| Gianfrancesco et al. ( 55 ) | COVID-19 Global Rheumatology Alliance registry; 600 COVID-19 positive in people with rheumatic disease (38% RA, 14% SLE, 12% PsA) | 46% confirmed cases were hospitalized; 9% died. The use of non-steroidal anti-inflammatory drugs, antimalarials, conventional DMARD alone, or in combination with biologics/JAK inhibitors was not associated with hospitalization due to COVID-19. Glucocorticoid exposure of ≥10 mg/day was associated with a higher odds of hospitalization and anti-TNF with a decreased odds of hospitalization in pts. with rheumatic disease. |
| Haberman et al. ( 56 ) | US; 103 inflammatory arthritis (RA, SpA, PsA) pts. with confirmed/highly susceptive COVID-19 – (80 confirmed, 23 highly susceptive for COVID-19) | 26% pts. required hospitalization, 4% died. Pts. needing hospitalization were older, with hypertension, COBP. Pts. on glucocorticoids more likely to be admitted to hospital, while those on anti-cytokine therapy no association was found. |
| Winthrop et al. ( 57 ) | US, Canada; 77 cases using immunomodulatory drugs (24% RA, 6% UC, 6% sarcoidosis) | 81% pts. were hospitalized, 35% required mechanical ventilation; 11% died. Pts. with anti-TNF had lowest hospitalization rate, admittance to intensive care unit and none died. |
| Fredi et al. ( 53 ) | Italy, 1,525 rheumatic and musculoskeletal disease pts. | 65 confirmed COVID-19, 52 suggestive pts.; of confirmed cases 47 (72%) admitted to hospital and 12 pts. died (deceased older than survivors). |
| Scire et al. ( 58 ) | Italy; 232 pts. (34% RA, 26% SpA 21% CTD, 11% vasculitis) | 70% hospitalized, 19% death Clinical presentation of COVID-19 was typical, with systemic symptoms (fever and asthenia) and respiratory symptoms (64% pneumonia), males worse prognosis. Immunomodulatory treatments were not significantly associated with an increased risk of intensive care unit admission/mechanical ventilation/death. |
| Flood et al. ( 59 ) | Ireland; 40 community acquired COVID-19 in inflammatory rheumatic diseased (14 RA, 4 SLE, 4 AS, 2 JIA, 2 SjS, 5 CTD, 2 other) | 15% of hospitalization; hospitalization less likely in those on bDMARD (0% hospitalized pts. used bDMARD vs. 47% non-hospitalized pts. using bDMARD). |
| Mathian et al. ( 60 ) | 17 SLE with SARS-CoV-2; all pts. but one with quiescent SLE, median treatment on HCQ time 7.5 years; 12 pts. receiving prednisolone | Viral pneumonia in 13 (76%) pts., complications due to respiratory failure in 11 (65%), acute respiratory distress syndrome in 5 (29%), 3 acute renal failure, 2 requiring hemodialysis. Five (36%) discharged from the hospital, two (50%) remained hospitalized, and two (14%) died. Except one pt. with active tenosynovitis at the onset of SARS-CoV-2 infection, none of the pts. showed clinical signs of lupus. Hydroxychlorokine does not seem to prevent COVID-19, at least its severe forms in pts. with SLE. |
| Freites Nunez et al. ( 61 ) | Spain; 123 pts. with AIRD (50 RA, 18 AS, 6 PsA, 8 inflammatory polyarthritis, 8 SLE, 6 PMR, 6 MCTD, 9 SjS, 12 other) and symptomatic COVID-19 | 54 (44%) pts. were hospitalized, 20 developed relevant complications, 12 patients died (PCR test not performed in 75% non-admitted and 19% admitted patients). After adjusting for comorbidities and age and sex only systemic autoimmune condition (opposed to inflammatory arthritis OR 3.55; 95% CI 1.3–9.7) and age (OR 1.08; 95% CI 1.04–1.13) remained significant contributors to hospitalization, no effects of SARD therapy observed. |
| Studies of pts. with rheumatic diseases hospitalized due COVID-19 | ||
| Santos et al. ( 62 ) | Spain; 38 COVID-19 pts. with rheumatic and musculoskeletal disease admitted to hospital (16 RA, 8 PMR, 5 SLE, 2 AS, 7 other) | 10 pts. died of COVID-19, death associated with age, hypertension, diabetes, with moderate/high index of rheumatic disease activity; no association with background therapy (glucocorticoids, MTX) or symptoms before admission in deceased and survivors. |
| Zhao et al. ( 63 ) | China; 29 rheumatic disease pts. with COVID-19 that were hospitalized (15 RA, 5 SLE, 9 other) | Lower prevalence of mechanical ventilation needed in rheumatic pts. than in D’Silva paper (54) (here 5%); 1/29 died (3%). |
| Sanchez-Piedra et al. ( 64 ) | Spain registry of SARD; 41 pts. had COVID-19 (21 with RA, 12 SpA, 8 other) | 28 (68%) pts. hospitalized and 3 (7%) patient died; in general population hospitalization rate 53% and mortality rate 12%. |
APS, antiphospholipid syndrome; AS, ankylosing spondylitis; CTD, connective tissue disease; DMARDs, disease-modifying antirheumatic drugs; JIA, juvenile idiopathic arthritis; PMR, polymyalgia rheumatica; PsA, psoriatic arthritis; Pts., patients; RA, rheumatoid arthritis; SjS, Sjögren syndrome; SLE, systemic lupus erythematosus; SpA, spondyloarthritis; SSc, systemic sclerosis; UC, ulcerative colitis).