Does lupus or arthritis have an effect on your prognosis if you happen to get COVID-19?
Quickly after the coronavirus pandemic started, we realized that older adults and folks with certain chronic conditions, corresponding to hypertension or diabetes, are at elevated threat for extreme COVID-19. One situation on that listing is an immunocompromised state (a weakened immune system). This may be as a result of quite a lot of circumstances, together with having had an organ transplant, having HIV, or taking drugs that suppress the immune system.
You probably have an autoimmune situation corresponding to rheumatoid arthritis or lupus (additionally referred to as systemic lupus erythematosus), you might marvel how this impacts your threat. It’s thought that these circumstances happen as a result of the immune system misfires and assaults organs within the physique. And many individuals with these problems are handled with drugs that suppress the immune system.
Two newly printed research study this. Whereas the outcomes should not definitive, they do present some reassurance. Most individuals recovered from COVID-19, and most of their prior remedies didn’t appear to worsen their infections.
Lupus and COVID-19
Within the first study, researchers enrolled 226 folks with lupus. After evaluating those that had COVID-19 with those that didn’t, they discovered that
- almost 60% of these with COVID-19 and lupus turned sick sufficient to be hospitalized, and 10% have been admitted to the intensive care unit.
- about 10% died.
- threat elements for hospitalization have been much like these reported in folks outdoors of this research who didn’t have lupus. For instance, race (extra hospital admissions amongst those that have been Hispanic or nonwhite), different continual illnesses (together with kidney failure, lung illness, and hypertension), and being chubby or overweight have been extra frequent amongst these needing hospital admission.
- steroid remedy for lupus was almost two instances increased amongst hospitalized sufferers (54%) in contrast with those that weren’t hospitalized (29%). Nevertheless, this distinction was not statistically vital.
- remedy with different immune-suppressing drugs taken for lupus (corresponding to azathioprine or mycophenolate) was related in each teams.
Inflammatory arthritis and COVID-19
The second study included 103 folks with inflammatory arthritis (which incorporates rheumatoid arthritis and associated circumstances) who have been additionally recognized with COVID-19. Some have been hospitalized with extreme illness, whereas others have been handled as outpatients. Right here’s what the research discovered.
- 26% of research topics have been hospitalized.
- About 4% died.
- Threat elements for hospital admission included being 65 or older, hypertension, and lung illness.
- Steroid remedy for inflammatory arthritis was extra frequent amongst these hospitalized (37%) than these handled as outpatients (about 4%).
- Biologic remedy (corresponding to etanercept or infliximab) didn’t seem to extend the chance of extreme COVID-19. One different kind of remedy — JAK inhibitors, which embrace tofacitinib (Xeljanz) — was extra frequent amongst these requiring hospital admission. Nevertheless, few sufferers have been taking this remedy.
Why these research aren’t the final phrase
These research solely included sufferers with COVID-19 and both SLE or inflammatory arthritis. It wasn’t doable to scrupulously examine the research members to folks with out lupus or arthritis. Additionally, these research didn’t embrace massive numbers of individuals with lupus or arthritis who examined constructive for the virus, but didn’t have signs of COVID-19 (asymptomatic an infection). Nor did they verify the prognosis of COVID-19 in each suspected case. So, whereas this analysis gives some new data, the true affect of lupus or arthritis on individuals who develop COVID-19 hasn’t but been decided.
Lastly, the lupus research was small: solely 41 topics had confirmed COVID-19. Though the findings on steroid remedy weren’t statistically vital, that may not have been true if the variations noticed continued in a bigger research.
The underside line
Public well being specialists typically embrace folks with autoimmune illness on the listing of those that usually tend to have a nasty final result in the event that they develop COVID-19. The comparatively excessive charge of hospital admission for lupus sufferers with COVID-19 confirms an elevated threat for extreme illness. Different commonplace threat elements (corresponding to hypertension or lung illness) apply, however steroid remedy could improve threat even additional. Different research have come to related conclusions (see here and here).
There was some excellent news to emphasise in these trials: the survival charge amongst sufferers with lupus or inflammatory arthritis who develop COVID-19 was comparatively excessive. Additionally, biologic remedy didn’t seem to worsen prognosis for the arthritis sufferers. And different immune suppressants didn’t worsen prognosis for these with lupus. And, the hospitalization charge for COVID-19 amongst sufferers with inflammatory arthritis was much like what has been reported for folks with out arthritis.
These findings add to what we’re studying about COVID-19. Clearly, we have to be taught extra. For instance, is there a dose of steroids to deal with continual sickness that’s so low that it doesn’t improve the chance of a worse prognosis with COVID-19? Do sure drugs (corresponding to biologics) really scale back the chance of extreme COVID-19? Till we do know extra, it stays notably essential for folks with lupus and inflammatory arthritis — particularly these taking steroids — to be particularly vigilant about measures to avoid COVID-19.
Observe me on Twitter @RobShmerling
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