Plain Language Summary: Patients with rheumatic and musculoskeletal diseases had higher rates of SARS-CoV-2 infection and increased odds of death.

Patients with rheumatic and musculoskeletal diseases (RMDs) may have an increased risk of poor outcomes with SARS-CoV-2 infection possibly due to their disease, the associated comorbidities and/or the treatments used to control the symptoms of these diseases. Many relatively small studies have been conducted worldwide to determine what increased risk of poor outcomes have been experienced by RMD patients with COVID-19. 

This study is the most comprehensive systematic literature review and meta-analysis to date assessing COVID-19 outcomes in people with RMDs, through February 2021. It compiles studies from 14 databases worldwide to determine if COVID-19 patients with RMDs experience worse outcomes compared to the general population. The outcomes of interest are hospitalization, use of oxygen and mechanical ventilation, or death. The majority of the studies are from European nations (63%) and the rest from Asia (14%), North America (13%), South America (1%), and others worldwide (6%). Most focus on the adult population (75%), while 14% of studies include mixed adult and pediatric populations and 1% include only pediatric populations. 

The relative risk of developing SARS-CoV-2 infection was found to be 52% higher in patients with RMDs compared to the general population. People with RMDs are also at higher odds of a poor outcome following COVID-19 infection, with a 74% increase in odds of death compared to patients without RMDs. Other measures of severity, including hospitalization, oxygenation requirements, ICU admission, and mechanical ventilation are not significantly higher among people with RMDs. These findings may relate to the smaller number of studies reporting these specific outcomes. 

Differences in outcomes based on specific RMDs, other illness factors such as comorbidities, RMD disease activity and treatment regimens are not evaluated in this study. The study focuses on RMDs as a combined group which limits applying the findings to any specific RMD or any individual with an RMD. Over time, COVID-19 outcomes have improved based on better treatment knowledge. This may limit the comparability of results at different times during the pandemic. Further study is required to more clearly decipher the factors that lead to increased risk of poor COVID-19 outcomes in people with RMDs.

Study Title

SARS-CoV-2 Infection and COVID-19 Outcomes in Rheumatic Disease: A Systematic Literature Review And Meta-Analysis

https://doi.org/10.1002/art.42030 

Authors of original paper

Richard Conway, PhD, Alyssa A Grimshaw,  Evelyn Hsieh, et al.

Lay summary contributors

Nadine Lalonde, Richard Howard, jOhn Wallace