No increased risk of COVID-19 in patients with RMDs

There is no evidence so far that patients with rheumatic and musculoskeletal diseases (RMDs) are at an increased risk of COVID-19 or have a worse prognosis, says a rheumatology expert at EULAR 2021.

“At the moment, this is reassuring,” said Dr Robert Landewé from the Amsterdam Rheumatology Center and the University of Amsterdam, The Netherlands, and member of the EULAR task force that reviewed COVID-19 recommendations for RMDs.

The provisional guidance covering infection prevention, management of patients when social distancing measures are in effect, management of patients with RMDs who developed COVID-19, and prevention of infections other than SARS-CoV-2 was published by Landewé and 21 other task force members earlier. [Ann Rheum Dis 2020;79:851-858]

They reconvened in January this year and reviewed 6,665 data sets and articles (49 passed quality assessment) on COVID-19 to determine whether RMD patients are more prone to COVID-19, whether they have a worse prognosis or worse outcomes, and whether RMD drugs should be stopped in those who contracted the disease. Another question they tried to get an answer to was whether RMD patients should receive COVID-19 jabs.

Similar risk factors, prognosis

In the updated recommendations, there did not appear to be any hard evidence of any unique demographic feature or comorbidity that puts people with RMDs at increased risk for severe COVID-19 vs the general population. Risk factors such as older age, male gender, increased BMI, cardiovascular disease, diabetes, and chronic lung disease in the general population similarly apply to the rheumatology populations, Landewé reported. [EULAR 2021 Virtual, presentation 7429]

On whether RMD patients have a worse COVID-19 prognosis, his response was rather quick: “Some studies suggest a higher rate of hospitalization among patients with RMDs who developed COVID-19 vs the general population who contracted the disease.” However, taken in aggregate, the data ultimately show no worse prognosis for rheumatology populations vs those without RMDs. “Again, this a reassuring conclusion,” he highlighted.

While some signals were observed for autoinflammatory diseases or connective tissue diseases, Landewé said further investigation is warranted as the information was sourced from single-centre studies. “The associations reported were not consistently found in [other] studies.”

Continue DMARDs

About therapy, he said patients with RMDs should continue their antirheumatic medications until symptom-free. While NSAIDs and antimalarials (eg, hydroxychloroquine) pose no risk to patients, Landewé cautioned that glucocorticoids should be administered in the “lowest possible dose.”

There appears to be an increased risk for hospitalization and COVID-19–related death among patients given higher glucocorticoid doses (>10 mg daily). “This is, so to say, the elephant in the room,” he said. “The reports of additional risk could be due to glucocorticoids or to biases such as confounding by indication. So, the conclusion that we draw [is] not completely clear.”

Two studies suggested a higher risk of COVID-19–related death or severe COVID-19 in rituximab users. Not using any DMARDs* was associated with an increased risk of COVID-19 death in one study, though another found no association with severe COVID-19.

Not enough data on vaccination

As for vaccine recommendations, he said there was not enough evidence available to them at the time of the review as the various COVID-19 vaccines had only started to be widely available. “It will come in the next update.”

Meantime, mitigation strategies including shielding, case isolation, strict hand hygiene, and social distancing are advised for this vulnerable group of patients, Landewé added.