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      Rheumatic disease and COVID-19: epidemiology and outcomes

      brief-report
      Author(s): 1 , , 2
      Publication date (Electronic):
      Journal: Nature Reviews. Rheumatology
      Publisher: Nature Publishing Group UK
      Keywords: Rheumatology, Risk factors

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          Abstract

          Since the outset of the COVID-19 pandemic, numerous risk factors for severe disease have been identified. Whether patients with rheumatic diseases, especially those receiving DMARDs, are at an increased risk of SARS-CoV-2 infection or severe COVID-19 disease remains unclear, although epidemiological studies are providing some insight.

          Key advances

          • Patients with rheumatoid arthritis, systemic lupus erythematosus or psoriasis, when analysed as a combined group, might have a slightly increased risk of death from COVID-19 compared to those without these diseases, although the role of disease activity and treatment in this risk estimation was not taken into account 2 .

          • Treatment with cytokine inhibitors could reduce the risk of SARS-SoV-2 infection (as measured by development of SARS-CoV-2 antibodies), although the mechanisms of this protective effect are not clear 3 .

          • Chronic use of glucocorticoids at moderate or high doses (≥10 mg per day prednisolone or equivalent) is associated with hospitalization for severe COVID-19 4 .

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          Is Open Access

          OpenSAFELY: factors associated with COVID-19 death in 17 million patients

          Elizabeth J Williamson, Alex J Walker, Krishnan Bhaskaran … (2020)
          COVID-19 has rapidly impacted on mortality worldwide. 1 There is unprecedented urgency to understand who is most at risk of severe outcomes, requiring new approaches for timely analysis of large datasets. Working on behalf of NHS England we created OpenSAFELY: a secure health analytics platform covering 40% of all patients in England, holding patient data within the existing data centre of a major primary care electronic health records vendor. Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19 related deaths. COVID-19 related death was associated with: being male (hazard ratio 1.59, 95%CI 1.53-1.65); older age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared to people with white ethnicity, black and South Asian people were at higher risk even after adjustment for other factors (HR 1.48, 1.29-1.69 and 1.45, 1.32-1.58 respectively). We have quantified a range of clinical risk factors for COVID-19 related death in the largest cohort study conducted by any country to date. OpenSAFELY is rapidly adding further patients’ records; we will update and extend results regularly.
          Article 0 comments Cited 2915 times – based on 0 reviews     Review now
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            Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry

            Milena Gianfrancesco, Kimme L Hyrich, Sarah Al-Adely … (2020)
            Objectives COVID-19 outcomes in people with rheumatic diseases remain poorly understood. The aim was to examine demographic and clinical factors associated with COVID-19 hospitalisation status in people with rheumatic disease. Methods Case series of individuals with rheumatic disease and COVID-19 from the COVID-19 Global Rheumatology Alliance registry: 24 March 2020 to 20 April 2020. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Age, sex, smoking status, rheumatic disease diagnosis, comorbidities and rheumatic disease medications taken immediately prior to infection were analysed. Results A total of 600 cases from 40 countries were included. Nearly half of the cases were hospitalised (277, 46%) and 55 (9%) died. In multivariable-adjusted models, prednisone dose ≥10 mg/day was associated with higher odds of hospitalisation (OR 2.05, 95% CI 1.06 to 3.96). Use of conventional disease-modifying antirheumatic drug (DMARD) alone or in combination with biologics/Janus Kinase inhibitors was not associated with hospitalisation (OR 1.23, 95% CI 0.70 to 2.17 and OR 0.74, 95% CI 0.37 to 1.46, respectively). Non-steroidal anti-inflammatory drug (NSAID) use was not associated with hospitalisation status (OR 0.64, 95% CI 0.39 to 1.06). Tumour necrosis factor inhibitor (anti-TNF) use was associated with a reduced odds of hospitalisation (OR 0.40, 95% CI 0.19 to 0.81), while no association with antimalarial use (OR 0.94, 95% CI 0.57 to 1.57) was observed. Conclusions We found that glucocorticoid exposure of ≥10 mg/day is associated with a higher odds of hospitalisation and anti-TNF with a decreased odds of hospitalisation in patients with rheumatic disease. Neither exposure to DMARDs nor NSAIDs were associated with increased odds of hospitalisation.
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              Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and comparison with other inflammatory syndromes

              Daniel E. Leisman, Lukas Ronner, Rachel Pinotti … (2020)
              The description of a so-called cytokine storm in patients with COVID-19 has prompted consideration of anti-cytokine therapies, particularly interleukin-6 antagonists. However, direct systematic comparisons of COVID-19 with other critical illnesses associated with elevated cytokine concentrations have not been reported. In this Rapid Review, we report the results of a systematic review and meta-analysis of COVID-19 studies published or posted as preprints between Nov 1, 2019, and April 14, 2020, in which interleukin-6 concentrations in patients with severe or critical disease were recorded. 25 COVID-19 studies (n=1245 patients) were ultimately included. Comparator groups included four trials each in sepsis (n=5320), cytokine release syndrome (n=72), and acute respiratory distress syndrome unrelated to COVID-19 (n=2767). In patients with severe or critical COVID-19, the pooled mean serum interleukin-6 concentration was 36·7 pg/mL (95% CI 21·6–62·3 pg/mL; I 2=57·7%). Mean interleukin-6 concentrations were nearly 100 times higher in patients with cytokine release syndrome (3110·5 pg/mL, 632·3–15 302·9 pg/mL; p<0·0001), 27 times higher in patients with sepsis (983·6 pg/mL, 550·1–1758·4 pg/mL; p<0·0001), and 12 times higher in patients with acute respiratory distress syndrome unrelated to COVID-19 (460 pg/mL, 216·3–978·7 pg/mL; p<0·0001). Our findings question the role of a cytokine storm in COVID-19-induced organ dysfunction. Many questions remain about the immune features of COVID-19 and the potential role of anti-cytokine and immune-modulating treatments in patients with the disease.
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                Author and article information

                Contributors
                Kimme L. Hyrich:
                ORCID: http://orcid.org/0000-0001-8242-9262
                kimme.hyrich@manchester.ac.uk
                Journal
                Journal ID (nlm-ta): Nat Rev Rheumatol
                Journal ID (iso-abbrev): Nat Rev Rheumatol
                Title: Nature Reviews. Rheumatology
                Publisher: Nature Publishing Group UK (London )
                ISSN (Print): 1759-4790
                ISSN (Electronic): 1759-4804
                Publication date (Electronic): 18 December 2020
                Pages: 1-2
                Affiliations
                [1 ]GRID grid.5379.8, ISNI 0000000121662407, Centre for Epidemiology Versus Arthritis, , The University of Manchester, Manchester Academic Health Science Centre, ; Manchester, UK
                [2 ]GRID grid.83440.3b, ISNI 0000000121901201, Centre for Rheumatology & Department of Neuromuscular Diseases, , University College London, ; London, UK
                Author information
                http://orcid.org/0000-0001-8242-9262
                http://orcid.org/0000-0002-8411-7972
                Article
                Publisher ID: 562
                DOI: 10.1038/s41584-020-00562-2
                PMC ID: 7747184
                PubMed ID: 33339986
                SO-VID: ec659cee-c480-43af-82da-98fe64c721bd
                Copyright © © Springer Nature Limited 2020
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Categories
                Subject: Year in Review

                Keywords: rheumatology,risk factors
                Data availability:
                Keywords: rheumatology, risk factors

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