Prevalence of hospital PCR-confirmed COVID-19 cases in patients with chronic inflammatory and autoimmune rheumatic diseases

Abstract

Background: The susceptibility of patients with rheumatic diseases and the risks or benefits of immunosuppressive therapies for COVID-19 are unknown.

Methods: We performed a retrospective study with patients under follow-up in rheumatology departments from seven hospitals in Spain. We matched updated databases of rheumatology patients with severe acute respiratory syndrome coronavirus 2-positive PCR tests performed in the hospital to the same reference populations. Rates of PCR+ confirmed COVID-19 were compared among groups.

Results: Patients with chronic inflammatory diseases had 1.32-fold higher prevalence of hospital PCR+ COVID-19 than the reference population (0.76% vs 0.58%). Patients with systemic autoimmune or immune-mediated disease (AI/IMID) showed a significant increase, whereas patients with inflammatory arthritis (IA) or systemic lupus erythematosus did not. COVID-19 cases in some but not all diagnostic groups had older ages than cases in the reference population. Patients with IA on targeted-synthetic or biological disease-modifying antirheumatic drugs (DMARDs), but not those on conventional-synthetic DMARDs, had a greater prevalence despite a similar age distribution.

Conclusion: Patients with AI/IMID show a variable risk of hospital-diagnosed COVID-19. Interplay of ageing, therapies and disease-specific factors seem to contribute. These data provide a basis to improve preventive recommendations to rheumatic patients and to analyse the specific factors involved in COVID-19 susceptibility.

Keywords: arthritis; autoimmune diseases; biological therapy; epidemiology.

Figure 1

Rates of hospital COVID-19 in patients with chronic arthritis, autoimmune diseases and reference population. Prevalence of hospital PCR-confirmed cases of COVID-19 infection in patients with chronic IA or AI/IMID diseases (n=26 131) in seven reference hospitals in Spain, compared with that in the reference population of the same hospitals (n=2.9 million). The AI/IMID group includes all diagnoses but PMR-CGA, and other AI/IMID of the less frequent diseases as indicated in the Patients and methods section. AI/IMID, autoimmune or immune-mediated disease; ts/bDMARD, targeted synthetic or biological disease-modifying antirheumatic drug; cDMARD, conventional disease-modifying antirheumatic drug; csDMARD, conventional-synthetic disease-modifying antirheumatic drug; IA, inflammatory arthritis; PMR-CGA, polymyalgia rheumatica or giant cell arteritis; PsA, psoriatic arthritis; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; SpA, spondyloarthritis; SS, Sjögren’s syndrome; SSc, systemic sclerosis.