Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry

Ann Rheum Dis. 2020 Jul;79(7):859-866. doi: 10.1136/annrheumdis-2020-217871. Epub 2020 May 29.

Abstract

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.

Keywords: arthritis, rheumatoid; hydroxychloroquine; lupus erythematosus, systemic; methotrexate; tumor necrosis factor inhibitors.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antimalarials / therapeutic use*
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Psoriatic / complications
  • Arthritis, Psoriatic / drug therapy
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / drug therapy
  • Betacoronavirus
  • Biological Products / therapeutic use
  • COVID-19
  • Coronavirus Infections / complications
  • Coronavirus Infections / mortality
  • Coronavirus Infections / therapy*
  • Female
  • Glucocorticoids / therapeutic use*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Janus Kinase Inhibitors / therapeutic use
  • Lupus Erythematosus, Systemic / complications
  • Lupus Erythematosus, Systemic / drug therapy
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pandemics
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / therapy*
  • Prednisone / therapeutic use
  • Protective Factors
  • Registries
  • Rheumatic Diseases / complications
  • Rheumatic Diseases / drug therapy*
  • Risk Factors
  • SARS-CoV-2
  • Severity of Illness Index
  • Spondylarthropathies / complications
  • Spondylarthropathies / drug therapy
  • Tumor Necrosis Factor Inhibitors / therapeutic use*
  • Vasculitis / complications
  • Vasculitis / drug therapy
  • Young Adult

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Antimalarials
  • Antirheumatic Agents
  • Biological Products
  • Glucocorticoids
  • Janus Kinase Inhibitors
  • Tumor Necrosis Factor Inhibitors
  • Prednisone