COVID-19 in Patients with Systemic Autoimmune Rheumatic Diseases

April 4, 2023

To better understand the impact of COVID-19 infections in patients with Systemic Autoimmune Rheumatic Diseases (SARDs), researchers compared 185 SARD patients to a control group of over 8,000 COVID-19 cases from the Polish national database  – SARSTer (1). They evaluated the characteristics, severity, course of infection, and disease outcomes.

Patients with rheumatoid arthritis, systemic lupus erythematosus (SLE), Sjögren’s syndromePsoriasis, Type 1 Diabetes, Inflammatory Bowel Disease, and Glomerulonephritis, amongst others, were included in the study.

Compared to the control group, SARD patients experienced more prolonged hospitalizations, with longer durations of oxygen therapy, a higher need for high-flow nasal oxygen and/or noninvasive ventilation, and higher mortality. Authors noted that SARD patients often had coexisting co-morbidities, such as cardiovascular, pulmonary, and chronic kidney diseases, and were typically older than patients in the control group. Based on the data, researchers were also able to define risk factors for mortality among SARD patients affected by COVID-19; these included “the presence of cardiovascular disease, more severe conditions on admission, and higher inflammatory marker values.”

Authors also analyzed the clinical outcomes of SARD patients treated with remdesivir. Remdesivir was developed to treat infections caused by Ebola virus; it has since been adapted to treat patients with COVID-19, but its effectiveness in SARD patients infected with SARS-CoV-2 was not evaluated previously. The authors of this study analyzed mortality rates of SARD patients treated with remdesivir and compared them to SARD patients who didn’t receive remdesivir. Even though they noticed a trend suggesting remdesivir helped reduce mortality among SARD patients, this trend was not statistically significant, meaning the improvement could have happened by chance and not as a result of remdesivir treatment. 

The authors point to a few limitations of this study, for example, a small number of SARD patients. Since the number of patients in this study might have been too small to obtain statistically significant results, conducting a similar study on a bigger group of patients may give a more definitive answer. Additionally, authors did not collect patients’ vaccination status, rheumatic disease activity, which SARS-CoV-2 variant patients were infected with, or the doses of drugs used, which limit the study’s conclusions.