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Answering questions on how COVID-19 affects rheumatic patients

As we inch closer to a possible vaccine for COVID-19, we are finally filling in the details on how the pandemic is affecting every aspect of our patient’s lives.

Are our rheumatic patients at increased risk for poor COVID-19 outcomes? It appears that there is at least modest increased risk for a variety of short-term including hospitalization, ICU admission, mechanical ventilation, thrombosis, acute kidney injury, and heart failure (but not death) (abstract #430). This excess risk seems to mostly be explained by excess comorbidities in rheumatic conditions. However, the silver lining may be that as we are further into the pandemic, this excess risk seems to have improved similar to the general population (abstract #L01).

Are our patients more likely to adhere to risk-mitigating behaviors related to COVID-19? Yes, rheumatic patients do seem to be more likely to shelter at home, wear masks, and socially distance which may explain lack of large association with COVID-19 infection (abstract #L02).

Are patients stopping their rheumatic medications at home? Yes, there were substantial medication changes, particularly early in the pandemic and even after the ACR guidance document (abstract #L05).

How did the stress of the pandemic after rheumatic patients? At least within ankylosing spondylitis, stress was associated with increased disease activity that was not explained by medication changes (abstract #1884).

Does the type of rheumatic disease or medication affect the risk of severe COVID-19? This one is not quite answered, but there did seem to be a signal for patients with Sjogren’s syndrome and vasculitis to have a higher risk of hospitalization (abstract #0014). In particular, rituximab was associated with a very high rate of hospitalization. Further research is needed to confirm this and to understand how to mitigate the risk particularly related to SARS-CoV-2 vaccination response.

Finally, does hydroxychloroquine affect QT interval of rheumatic patients? One of the many side effects of the fervor of HCQ in COVID-19 placed a spotlight on a possible risk of arrhythmia despite its safe use for many decades in patients with rheumatic diseases. A carefully performed observational study showed that hydroxychloroquine does not prolong the QTc interval in patients with systemic lupus erythematosus or rheumatoid arthritis (abstract #0431).

While much work is still needed, we have at least begun to answer some of the important issues related to COVID-19 and rheumatic diseases at #ACR20.



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