Rheumatoid arthritis sufferers are more likely to get Covid-19 and also to be hospitalized for treatment of the infection, but there is no greater risk of it getting worse from outpatient diagnosis to hospitalization or death. This is what emerges from what is considered the largest study conducted to date on the outcomes of Covid-19 in patients with rheumatoid arthritis. It was led by researchers from the University of Oxford who presented it with a poster at the last Congress of the European Alliance of Associations for Rheumatology (Eular). Also at Eular, another poster was presented with data on the Swedish population showing that the risks of serious Covid-19 are greater among people with inflammatory joint diseases. In Italy rheumatoid arthritis affects about 300 thousand people and about 5 thousand new cases are recorded every year.
Spanish research
Severe Sars-CoV-2 acute respiratory syndrome is of particular concern for people with inflammatory diseases, and it has been speculated that these patients may have a higher risk and even worse outcomes. However, the implications remain unclear at the moment. The cohort study conducted on the population registered in the Information System for Research in Primary Care (SIDIAP), which covers over 80% of the population of Catalonia, in Spain, investigated these aspects precisely. This information was linked to regional SARS-CoV-2 tests, hospital admissions and mortality data collected between March 1 and May 6, 2020. Over five and a half million people have been identified, including 16,344 with rheumatoid arthritis.
The association between AR and Covid-19
From analyzing the data, the researchers concluded that having rheumatoid arthritis is positively associated with diagnosis and hospitalization for Covid-19. However, the authors found no association between RA and the risk of worsening from outpatient diagnosis to hospitalization or death. “More research is needed to analyze the factors that link the outcomes of RA and Covid-19, including the presence of other comorbidities, the underlying activity of RA disease, and the use of immunosuppressive drugs,” he says. Arani Vivekanantham, first author of the study and head of the rheumatology department at the University of Oxford. “In fact – confirms Roberto Gerli, director of the rheumatology complex of the University of Perugia and president of the Italian Society of Rheumatology (Sir) – from the work emerges an increased risk of diagnosis and hospitalization but not of a more negative prognosis or even of mortality “.
Comorbidities and therapies
What makes these patients more exposed to the risk of infection? “It is difficult to say with the data we now have available”, replies the president of SIR who puts forward two hypotheses: “The temptation is to postpone the explanation for the use of therapies that induce immunosuppression,” notes Gerli. “A patient with drug-induced immunosuppression could be at greater risk of getting sick from Covid-19 but in a mild way, what can make the difference is the disease in the active phase that could increase the risk of becoming ill more seriously and for this reason not we must never suspend therapy “. After all, for this very reason patients with rheumatoid arthritis are considered fragile and for them, as well as for all rheumatological patients with chronic inflammatory and systemic autoimmune diseases, SIR requested that they be vaccinated as soon as possible and without interrupting the many of which – among other things – are used precisely to treat patients with Covid-19. Isn’t that a contradiction? “The fact is that we have to distinguish the moment in which these therapies are administered”, explains Gerli. “In the initial phase of the infection when viral replication is taking place, immunosuppressive therapies could be harmful, but in the second phase of the disease when the cytokine storm is in place with a state of hyperinflammation, immunosuppressive drugs work”, says the president of the Sir.
The issue of comorbidity
The second hypothesis that could explain why patients with rheumatoid arthritis are more at risk of getting Covid-19 concerns comorbidity: “Those who suffer from rheumatoid arthritis or lupus should be considered at cardiovascular risk, regardless of age and whether they are present or not. of the classic cardiovascular risk factors, such as hypercholesterolemia, diabetes, hypertension. Consequently, this could explain the greater risk of becoming ill in a more serious form than Covid-19 ”, concludes Gerli. Just recently a study published in the European Journal of Preventive Cardiology shows that there is a substantial doubling of the probability of a fatal heart attack in the over-50s who suffer from diseases such as rheumatoid arthritis, systemic lupus erythematosus or psoriasis in comparison. to the population without these pathologies.
Swedish research
Another study conducted this time in Sweden looked at all-cause mortality, absolute and relative risks of severe Covid-19 in people with chronic inflammatory joint disease, compared to both time and the general population. Using data from Artis, a Swedish national database, we analyzed data on ordinary hospitalizations, ICU admissions and deaths due to Covid-19 in 110,567 people with inflammatory joint disease, including RA, psoriatic arthritis, ankylosing spondylitis, spondyloarthritis or juvenile idiopathic and arthritis. These were compared with the results of 484,277 people within the general population.
Similar risks for those with chronic inflammatory diseases
Across all groups, the absolute risk of death from any cause in 2020 was higher than in 2015-2019, peaking in mid-April, but the relative risks of death relative to the general population remained similar. Among people with inflammatory joint disease in 2020, the risk of hospitalization, ICU admission and death from Covid-19 was 0.5%, 0.04% and 0.1%, respectively.
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