Asian patients with autoimmune inflammatory rheumatic disease appeared to be at an increased risk of worse outcomes after infection with COVID-19.
Patients with autoimmune inflammatory rheumatic disease have been considered to have a higher risk of a poor prognosis if infected with COVID-19. However, the evidence from studies to date is somewhat equivocal, with some suggesting an increased risk whereas others have found that while those with rheumatic diseases had a greater requirement for mechanical ventilation, mortality was similar those without rheumatic disease. Although there have been suggestions that ethnicity might represent an important factor in the context of COVID-19, little is known about the outcomes for patients with autoimmune rheumatic disease who become infected with COVID-19. Hence a team from the Department of Paediatrics, CHA Gangnam Medical Centre, Seoul, South Korea, did an exposure-driven, propensity score-matched study using a nationwide South Korean cohort. The team sought to determine the outcomes, in terms the risk of infection with COVID-19, severe outcomes and COVID-19-related deaths, among patients with autoimmune inflammatory rheumatic diseases. Using the national database, the team identified all individuals aged 20 years and older who had been tested for COVID-19. The database was linked to patient’s medical records and this allowed the team to identify both regular treatments prescribed and diagnostic codes, focusing on inflammatory arthritis, which included rheumatoid arthritis, psoriatic arthritis or spondylarthritis and connective tissue diseases e.g., systemic lupus erythematosus, Sjogren’s syndrome, systemic sclerosis, polymyalgia rheumatica. The primary endpoints for the study were a positive COVID-19 test, infection requiring hospitalisation, intensive care admission, application of invasive ventilation and COVID-19-related death.
Findings
A total of 133,609 patients (52.4% female) were included with 8297 (6.2%) who had an autoimmune inflammatory rheumatic disease, 7140 (5.3%) an inflammatory arthritis and 1953 (1.5%) with a connective tissue disease. From the whole sample, 4365 (3.3%) tested positive for COVID-19. After propensity matching, patients with an autoimmune inflammatory rheumatic disease showed an increased likelihood of testing positive for COVID-19 (odds ratio, OR = 1.20, 95% CI 1.03–1.40, p = 0.020), severe COVID-19 (OR = 1.27) and COVID-19-related mortality (OR = 1.81). Similar order of magnitude odds ratio was found for those with connective tissue disorders. For example, the odds of COVID-19-related mortality was 1.87. Among patients receiving a high dose (> 10mg daily) of systemic corticosteroids, there was an increased risk of testing positive (OR = 1.47), severe COVID-19 (OR = 1.76) and mortality (OR = 3.34).
The authors discussed how their data indicated how patients with an autoimmune inflammatory rheumatic disease had an increased risk of not only testing positive for COVID-19, but of more severe outcomes including death. While other studies have suggested no association between autoimmune inflammatory rheumatic disease and severe outcomes after infection with COVID-19, the current study only included patients of Asian ethnicity though the authors were unable to account for the increased risk for worse outcomes.
Citation
Shin YH et al. Autoimmune inflammatory rheumatic diseases and COVID-19 outcomes in South Korea: a nationwide cohort study. Lancet 2021
