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Hispanic and Latinx Rheumatic Patients with COVID-19

It became clear early in the coronavirus pandemic that COVID-19 was disproportionately affecting Hispanic and Latinx Americans. Recent data from the U.S. Centers for Disease Control and Prevention showed that Hispanic or Latinx patients with COVID-19 had four times the rate of being hospitalized as white patients and nearly three times the rate of death.

There are many different factors thought to play a role in this increased risk, which include:

  • Having multiple risk factors for severe COVID-19, such as obesity, diabetes, and kidney disease.
  • Being less likely to be covered by health insurance or have access to preventive care
  • Being more likely to work in essential positions that increase the risk of exposure to the coronavirus

Researchers know much less about how Hispanic and Latinx patients with rheumatic diseases have fared during the pandemic, but there has been concern that they may be more even more vulnerable than the general Hispanic and Latinx population due to having an altered immune system and the use of medications that affect immune system function.

Researchers from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (part of the National Institutes of Health) sought to study this in a group of 178 patients in the Washington, D.C. area who were seen between April 1 and October 15, 2020. They had health conditions like rheumatoid arthritis, lupus, or another rheumatic disease. Most (91 percent) were female with an average age of 46. Most were taking medications that affect immune system function, such as disease-modifying antirheumatic drugs (DMARDs).

Their study, published in the journal Arthritis & Rheumatology, found that there was a higher rate of COVID-19 infections in Hispanic and Latinx rheumatic disease patients when compared with Hispanic and Latinx patients in the general population. Having a COVID-19 infection was also a trigger for rheumatic disease flares.

Here is more about what the researchers learned:

Rheumatic disease and risk of infection

The researchers found that the incidence of COVID-19 infection was three-fold higher in Hispanic and Latinx rheumatic disease patients than in the general Hispanic and Latinx population. (There were 32 cases of COVID-19 among the 178 people in the study.) They were anywhere from five times to 11 times more likely to get the coronavirus when compared with the general population.

All of the patients who developed COVID-19 were essential workers or lived in a household with essential workers.

The role of obesity

Obesity compounded the problem. People with a body mass index (BMI) of 30.35 or more had more than triple the odds of being infected versus those with a lower BMI. (A BMI of 30 marks the threshold between overweight and obese.) In fact, obesity turned out to be a main risk factor for contracting COVID-19. Age was another, with people over 39.5 years more at risk than those who were younger.

Outcomes and role of immunomodulating medication

Thankfully, none of the 32 people who developed COVID-19 needed intensive care and there were no deaths. Six patients were hospitalized. “There was no evidence that any of the immunomodulatory treatments conferred either protection or susceptibility to the infection,” the study authors wrote.

In other words, patients’ rheumatic disease medications did not seem to increase or decrease risk of infection.

As for why these COVID-19 patients seemed to mostly fare well, researchers posited a few explanations, which could include “younger age, majority female, relatively mild pre-existing conditions” and limited use of glucocorticoids before getting sick with COVID-19.

They also suggested there could possibly be “mitigating effects” of taking immunomodulating therapy, even though the study didn’t prove this.

Other research has suggested that commonly used rheumatic disease medications (such as anti-TNF biologics, the JAK inhibitor baricitinib, or IL-6 inhibitor biologics) could help prevent COVID-19 complications because of the way they reduce out-of-control inflammation.

Rheumatic disease flares

In the study, the relationship between COVID-19 and rheumatic disease worked both ways. People who were infected were 4.5 times more likely to have a flare than those who did not have COVID-19. Eight of 27 COVID-19 patients had a flare (which was defined as needing to move to a higher dose of immunomodulating therapy). This makes sense, say the authors, given that viruses are known to trigger disease flares.

Because of this connection with COVID-19 and disease flares, the researchers suggest that “rheumatologists should follow patients reporting COVID-19 closely during the post-infection period in anticipation of a potential rheumatic disease flare.”

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COVID-19 Hospitalization and Death by Race/Ethnicity. COVID-19. U.S. Centers for Disease Control and Prevention. November 30, 2020. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html.

Fike A, et al. Risk factors for COVID‐19 and rheumatic disease flare in a US cohort of Latino patients. Arthritis & Rheumatology. January 17, 2021. doi: https://doi.org/10.1002/art.41656.