Shortly after the coronavirus pandemic began, we learned that older adults and people with certain chronic conditions such as high blood pressure or diabetes are at increased risk for severe COVID-19. One condition on this list is an immunocompromised condition (a weakened immune system). This can be due to a number of medical conditions, including an organ transplant, HIV, or taking drugs that suppress the immune system.
If you have an autoimmune disease like rheumatoid arthritis or lupus (also called systemic lupus erythematosus) you may be wondering how this affects your risk. It is believed that these conditions occur because the immune system fails and attacks organs in the body. And many people with these disorders are treated with drugs that suppress the immune system.
Two newly published studies investigate this. While the results are not final, they do offer some assurance. Most people recovered from COVID-19, and most of their previous treatments didn’t seem to make their infections worse.
Lupus and COVID-19
In the first study, 226 people participated in lupus. After comparing those who had COVID-19 with those who didn’t, they found this out
- Nearly 60% of patients with COVID-19 and lupus became sick enough to be hospitalized, and 10% were admitted to the intensive care unit.
- about 10% died.
- The risk factors for hospitalization were similar to those outside of this study who did not have lupus. For example, race (more hospitalized Hispanics or non-whites), other chronic diseases (including kidney failure, lung disease, and high blood pressure), and being overweight or obese were more common in those in need of hospitalization.
- Steroid treatment for lupus was almost twice as high in hospitalized patients (54%) as in non-hospitalized patients (29%). However, this difference was not statistically significant.
- Treatment with other immunosuppressive drugs for lupus (such as azathioprine or mycophenolate) was similar in both groups.
Inflammatory Arthritis and COVID-19
The second study included 103 people with inflammatory arthritis (including rheumatoid arthritis and related diseases) who were also diagnosed with COVID-19. Some were hospitalized with serious illness while others were treated on an outpatient basis. The study found that:
- 26% of the subjects were hospitalized.
- About 4% died.
- Risk factors for hospitalization included age 65 or older, high blood pressure, and lung disease.
- Steroid treatment for inflammatory arthritis was more common in hospitalized patients (37%) than in outpatients (about 4%).
- Biological therapy (like etanercept or infliximab) did not appear to increase the risk of severe COVID-19. Another type of treatment – JAK inhibitors, which include tofacitinib (Xeljanz) – was more common in patients who needed hospitalization. However, only a few patients took this drug.
Why these studies are not the last word
These studies only included patients with COVID-19 and either SLE or inflammatory arthritis. It was not possible to strictly compare the study participants with people without lupus or arthritis. These studies also did not include large numbers of people with lupus or arthritis who tested positive for the virus but did not have symptoms of COVID-19 (asymptomatic infection). They also did not confirm the diagnosis of COVID-19 in every suspected case. Although this research provides some new information, the real impact of lupus or arthritis on people who develop COVID-19 has not yet been determined.
After all, the lupus study was small: only 41 subjects had confirmed COVID-19. While the results on steroid treatment were not statistically significant, this may not have been the case if the observed differences had persisted in a larger study.
The final result
Public health experts often add people with autoimmune diseases to the list of those who are more likely to get a bad result if they develop COVID-19. The relatively high rate of hospital admissions for lupus patients with COVID-19 confirms an increased risk of serious illness. Other standard risk factors (such as high blood pressure or lung disease) apply, but steroid therapy can increase the risk even further. Other studies have come up with similar results (see here and here).
In these studies, there was some good news to emphasize: The survival rate for patients with lupus or inflammatory arthritis who develop COVID-19 has been relatively high. Biological therapy did not appear to worsen the prognosis for the arthritis patients either. And other immunosuppressants didn’t make the prognosis worse for people with lupus. The hospitalization rate for COVID-19 in patients with inflammatory arthritis was similar to that in people without arthritis.
These results complement what we are learning about COVID-19. Of course we have to learn more. For example, is there a dose of steroids used to treat chronic diseases that is so low that it doesn’t increase the risk of a worse prognosis with COVID-19? Are you actually taking certain medications (such as biologics)? to reduce the risk of severe COVID-19? Until we know more, it’s especially important for people with lupus and inflammatory arthritis – especially those taking steroids – to be extra vigilant about measures to prevent COVID-19.
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