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. 2021 Dec;7(3):e001987.
doi: 10.1136/rmdopen-2021-001987.

Effects of the COVID-19 pandemic on patients with inflammatory joint diseases in Sweden: from infection severity to impact on care provision

Hannah Bower  1 , Thomas Frisell  2 , Daniela di Giuseppe  2 , Bénédicte Delcoigne  2 , Gerd-Marfie Ahlenius  3 , Eva Baecklund  4 , Katerina Chatzidionysiou  5 , Nils Feltelius  6   7 , Helena Forsblad-d'Elia  8 , Alf Kastbom  9 , Lars Klareskog  5 , Elisabet Lindqvist  10 , Ulf Lindström  8 , Carl Turesson  11 , Christopher Sjowall  12 , Johan Askling  2 ; ARTIS Study Group
Collaborators, Affiliations

Effects of the COVID-19 pandemic on patients with inflammatory joint diseases in Sweden: from infection severity to impact on care provision

Hannah Bower et al. RMD Open. 2021 Dec.

Erratum in

Abstract

Objectives: To compare risks for COVID-19-related outcomes in inflammatory joint diseases (IJDs) and across disease-modifying antirheumatic drugs (DMARDs) during the first two waves of the pandemic and to assess effects of the pandemic on rheumatology care provision.

Methods: Through nationwide multiregister linkages and cohort study design, we defined IJD and DMARD use annually in 2015-2020. We assessed absolute and relative risks of hospitalisation or death listing COVID-19. We also assessed the incidence of IJD and among individuals with IJD, rheumatologist visits, DMARD use and incidence of selected comorbidities.

Results: Based on 115 317 patients with IJD in 2020, crude risks of hospitalisation and death listing COVID-19 (0.94% and 0.33% across both waves, respectively) were similar during both waves (adjusted HR versus the general population 1.33, 95% CI 1.23 to 1.43, for hospitalisation listing COVID-19; 1.23, 95% CI 1.08 to 1.40 for death listing COVID-19). Overall, biological disease-modifying antirheumatic drugs (bDMARDs)/targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) did not increase risks of COVID-19 related hospitalisation (with the exception of a potential signal for JAK inhibitors) or death. During the pandemic, decreases were observed for IJD incidence (-7%), visits to rheumatology units (-16%), DMARD dispensations (+6.5% for bDMARD/tsDMARDs and -8.5% for conventional synthetic DMARDs compared with previous years) and for new comorbid conditions, but several of these changes were part of underlying secular trends.

Conclusions: Patients with IJD are at increased risk of serious COVID-19 outcomes, which may partially be explained by medical conditions other than IJD per se. The SARS-CoV-2 pandemic has exerted measurable effects on aspects of rheumatology care provision demonstrated, the future impact of which will need to be assessed.

Keywords: COVID-19; antirheumatic agents; rheumatoid arthritis; treatment.

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Conflict of interest statement

Competing interests: JA: principal investigator for agreements between Karolinska Institutet and Abbvie, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis and Sanofi for safety monitoring of antirheumatic therapies (ARTIS). KC: consultancy fees and speaker’s honoraria from Eli Lilly, Abbvie and Pfizer. NF is employed by the Medical Products Agency (MPA), which is a governmental body. The views in this article may not represent the views of the MPA. AK: former employee of Sanofi. CT: Research grant from Bristol Myers Squibb, consultancy fees and speaker’s honorarium from Roche, and speaker’s honoraria from Abbvie and Pfizer.

Figures

Figure 1
Figure 1
Crude incidence rates of hospitalisation listing COVID-19 and death due to COVID-19 in patients with IJD and their individually matched general population comparator subjects, from January 2020 until 31 January 2021. IJD, inflammatory joint disease; RA, rheumatoid arthritis.
Figure 2
Figure 2
Incidence of rheumatoid arthritis and of the combined group of all inflammatory joint diseases in Sweden during 2020 vs 2015–2019.
Figure 3
Figure 3
Average number of visits to rheumatology or internal medicine per month (total number of visits/patients alive at the beginning of each month) for patients with RA and other IJDs in Sweden between 2015 and 2020. IJD, inflammatory joint disease; RA, rheumatoid arthritis.
Figure 4
Figure 4
Dispensations, treatment starts and treatment stops of bDMARDs/tsDMARDs and csDMARDs across 2015–2020 for all inflammatory joint diseases in Sweden. presented monthly, as a proportion of all patients at risk per month. bDMARDs/tsDMARDs: adalimumab, certolizumab pegol, golimumab, etanercept, infliximab, abatacept, anakinra, sarilumab, tocilizumab, rituximab, tofacitinib, baricitinib, upadacitinib and apremilast. csDMARDs: sulfasalazine, methotrexate, hydroxychloroquine and leflunomide. bDMARD, biological disease-modifying antirheumatic drug; csDMARD, conventional synthetic disease-modifying antirheumatic drug; tsDMARD, targeted synthetic disease-modifying antirheumatic drug.
Figure 5
Figure 5
Incidence of acute MI and malignancies in patients with all inflammatory joint diseases and matched general population comparators in Sweden, during 2020 vs 2015–2019. MI, myocardial infarction.
See this image and copyright information in PMC

References

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