Plain Language Summary
The risk of severe COVID-19 outcomes for people with vasculitis or polymyalgia rheumatica.
Outcomes of COVID-19 infection in patients with primary systemic vasculitis or polymyalgia rheumatica: Results from the COVID-19 Global Rheumatology Alliance Physician Registry
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Authors of original paper
Sebastian E. Sattui, MD, Richard Conway, PhD, et al.
Lay summary contributors
Nadine Lalonde, Richard Conway, PhD, Sebastian E. Sattui, MD, Mithu Maheswaranathan, MD
The ongoing pandemic has had a significant impact on people suffering from rheumatic diseases. The novel coronavirus has challenged the scientific community to determine appropriate treatment, control, and prevention strategies. Initial research focused on the general population leaving those suffering from rheumatic diseases to question how all aspects of the coronavirus pandemic affects them. This study observes COVID-19 illness outcomes in people with primary systemic vasculitis (PSV) or polymyalgia rheumatica (PMR). This is the largest study to date for COVID-19 in patients with primary systemic vasculitis or polymyalgia rheumatica and the first study to evaluate a large and well-characterised population of COVID-19 patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV).
Why is this important?
Research regarding COVID-19 has mainly been focused on the general population. Patients with vasculitis or polymyalgia rheumatica and their caregivers need to understand their vulnerability with COVID-19 to help with prevention and treatment efforts aimed at reducing the risks of poor outcomes.
This disease-specific analysis of data from the C19-GRA physician registry describes the severity of COVID-19 outcomes among patients with PSV and PMR, and tries to identify factors associated with poor COVID-19 outcomes.
What was done?
- The study determined outcomes of COVID-19 for patients suffering from PSV including AAV (29%), Giant Cell Arteritis (GCA) (15%), Behçet’s syndrome (9%) and other vasculitides (15%), and patients suffering from PMR (31%).
- Data was collected during 12/March/2020 to 12/April/2021.
- The severity scale for COVID-19 illness was categorized as requiring: No hospitalisation, hospitalisation without oxygenation, hospitalisation with any oxygenation or mechanical ventilation, and death.
- Treatment before the onset of COVID-19 included conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDS i.e., antimalarials, Cyclophosphamide, Methotrexate, etc.), Biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDS i.e., Abatacept, Rituximab, Tocilizumab, etc.), and Glucocorticoid (GC i.e., Prednisolone-equivalent dose of 0 mg/day to > 10 mg/day). Overall, 53% of patients were taking DMARDs and 63% were taking GC.
- Variables including sex, age, GC use, season, number of additional illnesses/conditions (comorbidities), smoking, obesity, disease activity and region (continent) were considered as factors affecting the outcomes.
- Comorbidities included high blood pressure (47%), cardiovascular disease (19%), diabetes (18%), lung disease/interstitial lung disease (18%) and chronic kidney disease (13%).
- The majority of patients were in remission (43%) or had minimal or low disease activity (36%) at the time of COVID-19 infection.
What was found?
- Overall, 50% were not hospitalised, 11% were hospitalised with no oxygen, 23% required ventilation or oxygenation, and 15% died.
- The factors that increased the risk of poor outcomes varied among disease subtypes and one that held true for all the groups was older age, as with the general population. Other factors affecting outcomes in variable amounts were: male sex, number of comorbidities, some specific comorbidities such as kidney disease, higher rheumatic disease activity, residing in a region other than Europe or North America, taking 10 mg/day or more of GC and/or having received treatment with Rituximab or Cyclophosphamide.
- In this study, people with AAV and GCA had worse outcomes.
- The majority of people with Behcet’s did not require hospitalisation.
- Hospitalisation and death rates in PMR were lower than most subtypes of PSV.
- Overall, cases submitted later in the analysis period had a lower rate of poor outcomes than those from earlier. Although not specifically known, it may be related to more experience in the medical community with managing COVID-19 as the pandemic evolved.
What does this mean?
- These results inform physicians regarding risk factors for poor COVID-19 outcomes in patients with vasculitis or polymyalgia rheumatica. They also assist in directing public health measures, risk mitigation, vaccination prioritization and COVID-19 treatment.
- The results from the C-19 GRA Physician Registry are consistent with findings from other data sources verifying the information collected and the interpretation of the results in this study.
- Further studies should address the reasons for the concerning outcomes in patients with PSV who develop COVID-19.
Some limitation of this study
- The results may be subject to selection bias toward more severe cases, potentially over-estimating the true risk among patients with PSV who develop COVID-19.
- Despite thorough analysis, other unforeseen factors may have affected the results.