Background/Purpose: Early studies published at the beginning of COVID-19 pandemic suggested lower risk of COVID-19 and less severe disease course in patients with rheumatic diseases (RD). Subsequent studies have been published worldwide since the onset of the COVID-19 pandemic with studies showing mixed results. We thus conducted a systematic review and meta-analysis on the prevalence and outcomes of COVID-19 in patients with rheumatic diseases.

Methods: PubMed/Medline and Scopus were systematically searched from January 1, 2020 to April 31, 2021 to identify observational and case-control studies that reported prevalence and outcomes of confirmed SARS-CoV-2 infection (by polymerase chain reaction or serologies) among patients with inflammatory and autoimmune rheumatic diseases (RD). The secondary outcomes measured were hospitalization, admission to Intensive Care Unit (ICU), use of mechanical ventilation, and death. Additional information including demographics and medication use were obtained from each of the studies. Medications were classified by conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD), biologic/targeted synthetic DMARD (b/tsDMARD), and glucocorticoids (GC).

Results: Our meta-analysis included 35 observational studies composed of 68,537 patients with rheumatic disease. The pooled prevalence of COVID-19 was 0.016 (95% CI 0.008-0.031). The hospitalization rate was 0.54 (95% CI 0.46-0.62); admission to ICU was 0.12 (95% CI 0.09-0.17); death was 0.12 (95% CI 0.10-0.15). Both csDMARDs (OR 2.21 (95% CI 1.55-3.14) and glucocorticoids (OR 2.55 (95% CI 1.13-3.61) were associated with increased risk for hospitalization. Patients on biologic/targeted synthetic DMARDs had decreased risk for hospitalization (OR 0.56, 95% CI 0.40-0.78). Meta-analysis of 16 case control studies showed that RD patients were at increased risk for COVID-19 infection compared to general population (OR 1.57, 95% CI 1.35-1.82). The risk for hospitalization was not increased compared to controls (OR 1.01, 95% CI 0.62-1.63). However, among those hospitalized, patients with RD—compared to non-RD controls—were at increased risk for admission to intensive care unit (OR 1.05, 95% CI 0.75-1.48), use of mechanical ventilation (OR 1.20, 95% CI 0.80-1.80) and death (OR 1.17, 95% CI 1.01-1.36).

Conclusion: In this systematic review and meta-analysis, patients with rheumatic diseases had similar rate of COVID-related hospitalization as non-RD controls. However, hospitalized RD patients had poorer in-hospital outcomes and higher mortality. The poor in-hospital outcomes in RD population with COVID-19 may—at least in part—reflect the use of immunomodulating medications such as glucocorticoids and csDMARDs. A counterintuitive finding from our meta-analysis is the association of b/tsDMARDs with lower risk for hospitalization due to COVID-19. Future studies are necessary to closely examine the risk and protective factors for severe outcomes in RD patients with COVID-19.

« Back to ACR Convergence 2021

ACR Meeting Abstracts - https://acrabstracts.org/abstract/covid-19-infection-and-outcomes-in-patients-with-rheumatic-diseases-a-systematic-review-and-meta-analysis/