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Meta-Analysis
. 2022 May;74(5):766-775.
doi: 10.1002/art.42030. Epub 2022 Mar 28.

SARS-CoV-2 Infection and COVID-19 Outcomes in Rheumatic Diseases: A Systematic Literature Review and Meta-Analysis

Richard Conway  1 , Alyssa A Grimshaw  2 , Maximilian F Konig  3 , Michael Putman  4 , Alí Duarte-García  5 , Leslie Yingzhijie Tseng  6 , Diego M Cabrera  6 , Yu Pei Eugenia Chock  6 , Huseyin Berk Degirmenci  7 , Eimear Duff  8 , Bugra Han Egeli  9 , Elizabeth R Graef  10 , Akash Gupta  6 , Patricia Harkins  8 , Bimba F Hoyer  11 , Arundathi Jayatilleke  12 , Shangyi Jin  13 , Christopher Kasia  4 , Aneka Khilnani  14 , Adam Kilian  15 , Alfred H J Kim  16 , Chung Mun Alice Lin  17 , Candice Low  18 , Laurie Proulx  19 , Sebastian E Sattui  20 , Namrata Singh  21 , Jeffrey A Sparks  22 , Herman Tam  23 , Manuel F Ugarte-Gil  24 , Natasha Ung  25 , Kaicheng Wang  26 , Leanna M Wise  27 , Ziyi Yang  13 , Kristen J Young  28 , Jean W Liew  10 , Rebecca Grainger  29 , Zachary S Wallace  30 , Evelyn Hsieh  31 ; COVID-19 Global Rheumatology Alliance
Affiliations
Meta-Analysis

SARS-CoV-2 Infection and COVID-19 Outcomes in Rheumatic Diseases: A Systematic Literature Review and Meta-Analysis

Richard Conway et al. Arthritis Rheumatol. 2022 May.

Abstract

Objective: The relative risk of SARS-CoV-2 infection and COVID-19 disease severity among people with rheumatic and musculoskeletal diseases (RMDs) compared to those without RMDs is unclear. This study was undertaken to quantify the risk of SARS-CoV-2 infection in those with RMDs and describe clinical outcomes of COVID-19 in these patients.

Methods: We conducted a systematic literature review using 14 databases from January 1, 2019 to February 13, 2021. We included observational studies and experimental trials in RMD patients that described comparative rates of SARS-CoV-2 infection, hospitalization, oxygen supplementation/intensive care unit (ICU) admission/mechanical ventilation, or death attributed to COVID-19. Methodologic quality was evaluated using the Joanna Briggs Institute critical appraisal tools or the Newcastle-Ottawa scale. Risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated, as applicable for each outcome, using the Mantel-Haenszel formula with random effects models.

Results: Of the 5,799 abstracts screened, 100 studies met the criteria for inclusion in the systematic review, and 54 of 100 had a low risk of bias. Among the studies included in the meta-analyses, we identified an increased prevalence of SARS-CoV-2 infection in patients with an RMD (RR 1.53 [95% CI 1.16-2.01]) compared to the general population. The odds of hospitalization, ICU admission, and mechanical ventilation were similar in patients with and those without an RMD, whereas the mortality rate was increased in patients with RMDs (OR 1.74 [95% CI 1.08-2.80]). In a smaller number of studies, the adjusted risk of outcomes related to COVID-19 was assessed, and the results varied; some studies demonstrated an increased risk while other studies showed no difference in risk in patients with an RMD compared to those without an RMD.

Conclusion: Patients with RMDs have higher rates of SARS-CoV-2 infection and an increased mortality rate.

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Figures

Figure 1
Figure 1
Flow chart of the methods used for identification of studies in patients with rheumatic and musculoskeletal diseases in which comparative rates of SARS–CoV‐2 infection, hospitalization, oxygen supplementation, intensive care unit admission, mechanical ventilation, and death attributed to COVID‐19 are reported. The flow chart is designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Color figure can be viewed in the online issue, which is available at http://onlinelibrary.wiley.com/doi/10.1002/art.42030/abstract.
Figure 2
Figure 2
Studies identified in the systematic literature review and meta‐analysis in which the risk of COVID‐19 among populations of patients with rheumatic and musculoskeletal diseases (RMDs) compared to those without RMDs was reported. The risk of COVID‐19 is assessed as risk ratios (RRs) with 95% confidence intervals (95% CIs). Color figure can be viewed in the online issue, which is available at http://onlinelibrary.wiley.com/doi/10.1002/art.42030/abstract.
Figure 3
Figure 3
Studies showing the likelihood of hospitalization (Hosp.) (A), intensive care unit (ICU) admission (B), and mechanical ventilation (MechVet) (C) following the development of COVID‐19 among populations of patients with RMDs relative to those without RMDs. Values are the odds ratios (ORs) with 95% CIs. See Figure 2 for other definitions. Color figure can be viewed in the online issue, which is available at http://onlinelibrary.wiley.com/doi/10.1002/art.42030/abstract.
Figure 4
Figure 4
Studies showing the likelihood of death occurring following the development of COVID‐19 among populations of patients with RMDs relative to those without RMDs overall (A) and among populations limited to hospitalized patients only (B). Values are the odds ratios (ORs) with 95% CIs. See Figure 2 for other definitions. Color figure can be viewed in the online issue, which is available at http://onlinelibrary.wiley.com/doi/10.1002/art.42030/abstract.
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