Glucocorticoids Linked to Increase in COVID-19 Hospital Admissions in Patients with RA

Both heart disease and glucocorticoids were associated with COVID-19-related hospital admissions in patients with rheumatoid arthritis (RA), according to a study published in Advances in Rheumatology.¹

“The COVID-19 pandemic has raised additional concerns for rheumatologists, especially related to health care for patients with immune-mediated rheumatic diseases (IMRDs),” investigators stated. “Notably, immunosuppression resulting from disease or treatment itself is considered a relevant risk factor for higher infection susceptibility and more severe outcomes.”

A multicenter, prospective cohort study was performed using adult patients with a clinical RA diagnosis enrolled in the ReumaCoV Brazil registry. Of the 489 patients included in the study between May 2020 and January 2021, 269 patients tested positive for COVID-19 and were compared with a control cohort of 200 patients who tested negative. Patient data were obtained via the Research Electronic Data Capture database and included sociodemographic information, disease activity, laboratory data, concomitant medications, comorbidities, and the clinical manifestations, outcomes, and treatment of COVID-19 infection.

Most patients were female (90.6%) with a mean age of 53 years. A total of 20.1% who tested positive for COVID-19 were hospitalized. A final regression model reported that patients with heart disease (OR = 4.61, 95% CI 1.06–20.02. P < 0.001) and those with current glucocorticoids usage (OR = 20.66, 95% CI 3.09–138. P < 0.002) were at an increased risk of hospitalization. Other risk factors associated with hospitalization were shortness of breath (OR 6.12; 95% CI 2.34–16.06, P < 0.001) and vomiting (OR 4.06; 95% CI 1.4–11.79, P < 0.01). Hospitalized patients tended to be older with 1 or more comorbidities, particularly hypertension and diabetes mellitus, when compared with those receiving outpatient treatment.

Conversely, those with anosmia had a lower risk of hospitalization (OR = 0.26; 95% CI 0.10–0.67, P < 0.005) as well as patients receiving tumor necrosis factor (TNF) therapy.

Limitations included the number of patients, the cross-sectional study design of an ongoing prospective cohort, missing disease activity information, and the small number of patients receiving rituximab. However, the national sample comprised of a homogeneous rate of community viral transmission, immunization, and social distancing information strengthened the study.

“Our data showed traditional risk factors, including heart disease as a comorbidity, and the current use of glucocorticoids are more involved with hospitalizations for COVID-19 in patients with RA than the underlying IMRDs alone,” investigators concluded.

Reference:

Gomides APM, de Albuquerque CP, da Mota LMH, et al. Factors associated with hospitalizations for Covid-19 in patients with rheumatoid arthritis: data from the Reumacov Brazil registry. Adv Rheumatol. 2022;62(1):13. Published 2022 May 3. doi:10.1186/s42358-022-00244-5