In a nationwide, population-based register study published in the Annals of the Rheumatic Diseases, researchers explored whether patients with inflammatory rheumatic diseases (IRD) are at greater risk of contracting SARS-CoV-2 and to determine if this patient population has a worse prognosis of augmented risk of hospitalization, assisted ventilation, and mortality compared with the general population.

The authors indicated that IRD patients included a heterogeneous group of patients with antineutrophilic cytoplasmic antibody–associated necrotizing vasculitis, rheumatoid arthritis (RA), systemic lupus erythematosus, systemic sclerosis, Sjögren syndrome, giant cell arteritis, psoriasis arthritis, and spondylarthritis.

For every patient in the IRD cohort, researchers included 10 comparator individuals from the general population who were selected at random from the general Danish population matched on gender and date of birth, alive, residing in Denmark on the date of study inclusion, and who were not included in the IRD patient cohort. The study included 66,840 patients with IRD and 668,400 individuals in the matched controlled group. The IRD patient cohort included all Danish residents diagnosed with an IRD aged between 18 and 90 years on March 1, 2020.

The study period was from March 2020 to January 2023, and Cox regression analyses were employed to measure incidence rate ratios (IRRs) for SARS-CoV-2-related outcomes.

Measured outcomes for this study included the dates of the first positive SARS-CoV-2 test, the second positive test, the first hospitalization with a COVID-19 diagnosis, the first hospitalization attributed to severe COVID-19, hospitalization requiring ventilation intervention, hospitalization leading to death, and all-cause death.

The researchers observed that patients with IRDs had a shorter time to the first and second positive SARS-CoV-2 test in patients compared with the general population (IRR 1.06; 95% CI, 1.05-1.07) and (IRR 1.21; 95% CI, 1.15-1.27). Among those with IRD, the risks of hospital contact with COVID-19 and severe COVID-19 were also increased with population controls (IRR 2.11; 95% CI, 1.99-2.23) and (IRR 2.18; 95% CI, 1.94-2.45), respectively. Patients with IRDs were at greater risk of needing assisted ventilation (IRR 2.33; 95% CI, 1.89-2.87) and COVID-19 resulting in death (IRR 1.98; 95% CI, 1.69-2.33). Compared with the general population, patients with IRD had more comorbidities. The researchers also noted that obtaining a third SARS-CoV-2 vaccination was associated with a lower risk of hospitalization due to COVID-19 and diminished mortality risk.

Based on their findings, the authors concluded, “Patients with IRD have a risk of SARS-CoV-2, which nearly corresponds to the general population but had a substantially increased risk of hospitalization with COVID-19, severe COVID-19, requiring assisted ventilation and COVID-19 leading to death, especially in patients with comorbidities.”

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