Rheumatology Patients with COVID-19 Not More Likely to Be Hospitalized, But May Be More Likely to Need Intensive Care

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Since the COVID-19 pandemic began, many people with conditions like rheumatoid arthritis, lupus, and spondyloarthritis have worried about whether their condition puts them at high risk for getting COVID-19 or developing serious complications of the virus. While there are still many unknowns, a new study published in the Annals of the Rheumatic Diseases yields mostly good news.

According to the study, which focused on people in the Boston area — with and without rheumatic diseases — who tested positive for COVID-19 in March and early April, found that those who contracted the virus generally experienced similar symptoms (such as cough and fever), regardless of whether they had a rheumatic disease such as rheumatoid arthritis, lupus, polymyalgia rheumatica, spondyloarthritis, myositis, or vasculitis.

Also reassuring: Those with rheumatic diseases, a total of 52 patients, were not any more likely to develop severe symptoms that warranted hospitalization than those without a rheumatic condition. They were not any more likely to die from coronavirus, either.

The catch, however, is that when rheumatic disease patients did land in the hospital, they were far more likely to require major interventions.

“Those with rheumatic disease had threefold higher odds of requiring intensive care/mechanical ventilation compared with those without rheumatic disease,” the authors found.

This increased risk held steady even after the authors adjusted for the impact of certain patients having underlying coronary artery disease or lung disease. Age, body mass index (BMI), and smoking status were also factored in.

Why rheumatic disease patients who are hospitalized with COVID-19 are more likely to be admitted to the ICU and put on a ventilator is not entirely clear.

It is possible that other co-existing diseases might come into play. “Differences in exposures to immunosuppressive medications, which were commonly used in patients with rheumatic disease, are another potential explanation,” the researchers wrote. “Additional studies are needed with larger sample sizes to understand whether certain immunosuppressive medications predispose patients with rheumatic disease to respiratory failure.”

It is also worth noting that the number of rheumatic disease patients included in this study was fairly small. Out of more than 2,000 patients who tested positive for coronavirus in a large Boston-based health system, only 52 had a rheumatic disease.

Still, the authors described their findings as “concerning,” adding that “additional studies are needed to confirm and identify factors responsible for the observed differences.”

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