Table 2:
Rheumatic disease characteristics of SARD patients with COVID-19 over time
| Time period | ||||||
|---|---|---|---|---|---|---|
| Early COVID-19 | Early treatment | Early vaccination | Additional vaccination and Delta wave | Omicron wave | ||
| Overall (n = 1449) | March 1 2020 - June 30 2020 (n = 261) | July 1 2020 - Jan 31 2021 (n = 492) | Feb 1 2021 - June 30 2021 (n = 123) | July 1 2021 - Dec 16 2021 (n = 172) | Dec 17 2021 - Jan 31 2022 (n = 401) | |
| Rheumatic disease diagnosis, n (%) | ||||||
| Rheumatoid arthritis | 491 (33.9%) | 90 (34.5%) | 174 (35.4%) | 48 (39.0%) | 45 (26.2%) | 134 (33.4%) |
| Psoriatic arthritis and spondyloarthritis | 213 (14.7%) | 31 (11.9%) | 75 (15.2%) | 17 (13.8%) | 32 (18.6%) | 58 (14.5%) |
| Systemic lupus erythematosus | 190 (13.1%) | 39 (14.9%) | 64 (13.0%) | 16 (13.0%) | 21 (12.2%) | 50 (12.5%) |
| Other inflammatory arthritis* | 106 (7.3%) | 19 (7.3%) | 38 (7.7%) | 4 (3.3%) | 13 (7.6%) | 32 (8.0%) |
| PMR and/or GCA | 101 (7.0%) | 23 (8.8%) | 31 (6.3%) | 7 (5.7%) | 14 (8.1%) | 26 (6.5%) |
| ANCA-associated vasculitis | 68 (4.7%) | 11 (4.2%) | 21 (4.3%) | 7 (5.7%) | 12 (7.0%) | 17 (4.2%) |
| Other vasculitis** | 33 (2.3%) | 8 (3.1%) | 7 (1.4%) | 4 (3.3%) | 2 (1.2%) | 12 (3.0%) |
| Sjogren’s syndrome | 36 (2.5%) | 2 (0.8%) | 13 (2.6%) | 3 (2.4%) | 5 (2.9%) | 13 (3.2%) |
| Systemic sclerosis | 35 (2.4%) | 6 (2.3%) | 11 (2.2%) | 5 (4.1%) | 3 (1.7%) | 10 (2.5%) |
| Inflammatory myopathy | 33 (2.3%) | 6 (2.3%) | 13 (2.6%) | 1 (0.8%) | 6 (3.5%) | 7 (1.8%) |
| Other connective tissue diseases† | 37 (2.6%) | 9 (3.4%) | 8 (1.6%) | 3 (2.4%) | 3 (1.7%) | 14 (3.5%) |
| Sarcoidosis | 43 (3.0%) | 9 (3.4%) | 22 (4.5%) | 1 (0.8%) | 4 (2.3%) | 7 (1.8%) |
| Multiple rheumatic diagnoses | 35 (2.4%) | 6 (2.3%) | 9 (1.8%) | 4 (3.3%) | 4 (2.3%) | 12 (3.0%) |
| Other diagnoses‡ | 28 (1.9%) | 2 (0.8%) | 6 (1.2%) | 3 (2.4%) | 8 (4.7%) | 9 (2.2%) |
| Disease activity, n (%) | ||||||
| Remission or low activity | 1074 (74.1%) | 181 (69.3%) | 365 (74.2%) | 91 (74.0%) | 131 (76.2%) | 306 (76.3%) |
| Moderate or severe activity | 259 (17.9%) | 50 (19.2%) | 100 (20.3%) | 23 (18.7%) | 27 (15.7%) | 59 (14.7%) |
| Unknown | 116 (8.0%) | 30 (11.5%) | 27 (5.5%) | 9 (7.3%) | 14 (8.1%) | 36 (9.0%) |
| Rheumatic disease medications at time of infection, n (%) | ||||||
| Glucocorticoids | 377 (26.0%) | 80 (30.7%) | 125 (25.4%) | 29 (23.6%) | 42 (24.4%) | 101 (25.2%) |
| None | 1072 (74.0%) | 181 (69.3%) | 367 (74.6%) | 94 (76.4%) | 130 (75.6%) | 300 (74.8%) |
| Low dose (1 – 10mg) | 317 (21.9%) | 70 (26.8%) | 106 (21.5%) | 26 (21.1%) | 36 (20.9%) | 79 (19.7%) |
| Moderate/high dose (>10 mg) | 53 (3.7%) | 10 (3.8%) | 18 (3.7%) | 3 (2.4%) | 4 (2.3%) | 18 (4.5%) |
| Unknown dose | 7 (0.5%) | 0 (0.0%) | 1 (0.2%) | 0 (0.0%) | 2 (1.2%) | 4 (1.0%) |
| Conventional synthetic DMARDs and immunosuppressants | ||||||
| Methotrexate | 319 (22.0%) | 49 (18.8%) | 108 (22.0%) | 21 (17.1%) | 38 (22.1%) | 103 (25.7%) |
| Antimalarials | 314 (21.7%) | 58 (22.2%) | 102 (20.7%) | 20 (16.3%) | 36 (20.9%) | 98 (24.4%) |
| Sulfasalazine | 31 (2.1%) | 5 (1.9%) | 8 (1.6%) | 2 (1.6%) | 3 (1.7%) | 13 (3.2%) |
| Leflunomide | 54 (3.7%) | 12 (4.6%) | 23 (4.7%) | 1 (0.8%) | 5 (2.9%) | 13 (3.2%) |
| Mycophenolate mofetil | 101 (7.0%) | 13 (5.0%) | 27 (5.5%) | 13 (10.6%) | 17 (9.9%) | 31 (7.7%) |
| Azathioprine | 27 (1.9%) | 9 (3.4%) | 6 (1.2%) | 4 (3.3%) | 2 (1.2%) | 6 (1.5%) |
| Calcineurin inhibitor | 19 (1.3%) | 4 (1.5%) | 5 (1.0%) | 5 (4.1%) | 3 (1.7%) | 2 (0.5%) |
| Cyclophosphamide | 4 (0.3%) | 3 (1.2%) | 0 (0%) | 0 (0%) | 1 (0.6%) | 0 (0%) |
| Biologic DMARDs | ||||||
| TNF inhibitors | 292 (20.2%) | 32 (12.3%) | 90 (18.3%) | 26 (21.1%) | 40 (23.3%) | 104 (25.9%) |
| Rituximab | 133 (9.2%) | 17 (6.5%) | 33 (6.7%) | 18 (14.6%) | 25 (14.5%) | 40 (10.0%) |
| Belimumab | 20 (1.4%) | 4 (1.5%) | 1 (0.2%) | 1 (0.8%) | 3 (1.7%) | 11 (2.7%) |
| Abatacept | 31 (2.1%) | 4 (1.5%) | 6 (1.2%) | 3 (2.4%) | 3 (1.7%) | 15 (3.7%) |
| IL-6 inhibitors | 45 (3.1%) | 3 (1.2%) | 18 (3.7%) | 3 (2.4%) | 5 (2.9%) | 16 (4.0%) |
| IL-17, IL-12/23, and IL-23 inhibitors | 36 (2.5%) | 8 (3.1%) | 16 (3.3%) | 2 (1.6%) | 3 (1.7%) | 7 (1.7%) |
| IL-1 inhibitors | 6 (0.4%) | 0 (0%) | 0 (0%) | 0 (0%) | 3 (1.7%) | 3 (0.8%) |
| Targeted synthetic DMARDs | ||||||
| JAK inhibitors | 55 (3.8%) | 8 (3.1%) | 21 (4.3%) | 4 (3.3%) | 7 (4.1%) | 15 (3.7%) |
| Apremilast | 5 (0.4%) | 0 (0%) | 2 (0.4%) | 0 (0%) | 0 (0%) | 3 (0.8%) |
| IVIG | 19 (1.3%) | 2 (0.8%) | 7 (1.4%) | 2 (1.6%) | 4 (2.3%) | 4 (1.0%) |
SARD, systemic autoimmune rheumatic disease; COVID-19, coronavirus disease 2019; PMR, polymyalgia rheumatica; GCA, giant cell arteritis; ANCA, antineutrophil cytoplasmic antibody; TNF, tumor necrosis factor; IL, interleukin; JAK, Janus kinase; IVIG, intravenous immune globulin
*
Includes juvenile idiopathic arthritis, other unspecified inflammatory arthritis
**
Includes Takayasu’s arteritis, Kawasaki disease, Behcet’s disease, polyarteritis nodosa, other vasculitis
†
Includes undifferentiated connective tissue disease, mixed connective tissue disease, antiphospholipid syndrome (without concurrent SLE)
‡
Includes relapsing polychondritis, IgG4-related disease, sclerosing mediastinitis, periodic fever syndromes, adult-onset Still’s disease