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COVID-19 Research

Since the COVID-19 pandemic began, physicians who treat people with inflammatory or autoimmune conditions like lupus, Crohn’s disease, and rheumatoid arthritis have been trying to determine just how vulnerable these patients are to the virus. Because COVID is relatively new, many have largely based their predictions based on how this group has fared with other respiratory viruses, such as the flu. But now that it’s been eight months since coronavirus was first identified, more data about its impact is beginning to emerge.

A new research review, published in the journal Current Opinion in Rheumatology, has examined the best-available evidence to date and yields somewhat good news. The authors focused on several previously published peer-reviewed studies that specifically looked at COVID-19 incidence and outcomes in people with inflammatory-mediated immune disease (IMID). Some of these studies were in patients with rheumatic conditions (such as rheumatoid and psoriatic arthritis, axial spondyloarthritis, and lupus), some were in gastroenterology patients (such as Crohn’s disease and ulcerative colitis), and a small number were in psoriasis patients.

The authors concluded that “IMID patients are not at higher risk of developing COVID-19 than individuals without IMID and that most patients recover, including those on biologic therapies, which provides reassurance to both patients and providers.”

However, when patients with rheumatic disease do contract COVID-19, they’re more likely than people without these conditions to develop severe complications, including serious respiratory distress that requires being put on a ventilator.

Patients using glucocorticoids seem to have the highest risk of serious outcomes. As with the general population, advancing age and having a co-occurring condition like heart disease or diabetes are also extremely important risk factors.

This research review will not be the last word on how COVID-19 impacts people with inflammatory or autoimmune conditions, and the authors note that additional studies are “still urgently needed” since many of the studies they analyzed were small or otherwise limited in scope.

The authors did point out that biases in the way the studies are designed could limit overall knowledge about how patients with these conditions are affected by COVID-19. For example, if patients “have differential behavioral practices (i.e., be more likely to take preventive measures such as wearing masks, washing hands, and sheltering in place longer) than the general population due to awareness of being at higher risk of developing infections because of their disease or long-term medications, this could potentially lead to an underestimate of risk,” the authors explain.

The kind of studies that will provide such knowledge about differences between inflammatory and autoimmune patients and the general population will take more time (and require much bigger numbers of people) to collect. “Large-scale, population-based studies using nationwide registries, especially in countries with uniform COVID-19 reporting systems, may provide a better estimate of risk of COVID-19 in the IMID population, and whether differences in incidence and outcomes are present,” according to the authors.

In the meantime, most health experts recommend that IMID patients continue to pay extra attention to preventive measures such as wearing masks, avoiding extended in-person contact with people outside their household, and practicing hand hygiene.

If you develop any possible COVID-19 symptoms, contact your health care provider for guidance.

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Gianfrancesco M, et al. Epidemiology and Outcomes of Novel Coronavirus. 2019 in Patients With Immune-Mediated Inflammatory Diseases. Current Opinion in Rheumatology. September 2020. doi: https://doi.org/10.1097/BOR.0000000000000725.

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