ACR Convergence 2020 Kicks Off: Plenary session speakers highlight racial differences in lupus & COVID-19-related findings

The team also found that when they purified the IgG fractions from COVID-19 patients with antiphospholipid antibodies, it triggered NET release in healthy control neutrophils, similar to the way this occurs in fractions isolated from people with established antiphospholipid syndrome.

Dr. Zuo also discussed the team’s work in mouse thrombosis models, which also showed that purified injected antiphospholipid antibodies from COVID-19 patients accelerated thrombus formation and the formation of NETs.

“In summary, our data suggest that some patients with COVID-19 do become at least transiently positive for antiphospholipid antibodies, and these antibodies are potentially pathogenic,” concluded Dr. Zuo.

Outcomes in Rheumatology Patients with COVID-19 Infection
Kristin M. D’Silva, MD, a research fellow at Massachusetts General Hospital, Boston, discussed a study suggesting  patients with systemic autoimmune rheumatic diseases may have greater risk of complications from COVID-19 compared to the general population.

Dr. D’Silva

“Patients with rheumatic diseases and their providers continue to have concerns about a potentially increased risk of poor COVID-19 outcomes due to immunosuppression, a chronic inflammatory state, comorbidities and racial, ethnic and socioeconomic disparities,” she noted.

Studies out of Wuhan, China, and Boston have reported up to a three-fold higher risk of need for mechanical ventilation in COVID-19 patients with rheumatic diseases. Dr. D’Silva also remarked on a study from the COVID-19 Global Rheumatology Alliance that reported no higher rates of hospitalization for rheumatic patients taking any type of disease-modifying anti-rheumatic drug or biologic, compared to those who were not. The study had, however, reported a higher risk of hospitalization in rheumatic patients who had who had more comorbid conditions.¹

Unlike the study from the Global Rheumatology Alliance, which had solely analyzed outcomes from rheumatic disease patients, Dr. D’Silva and colleagues designed their analysis to determine differences in COVID-19 outcomes in patients with systemic autoimmune rheumatic disease, compared to people in the general population who had been matched based on age, sex, race and ethnicity.

The group used electronic health data from a multicenter research network encompassing over 52 million patients across the U.S. They used International Classification of Diseases (ICD) codes or positive COVID-19 testing to assess COVID-19 status. The rheumatic diseases studied included a wide variety of types of inflammatory arthritis, connective tissue diseases and systemic vasculitides, with rheumatoid arthritis and lupus being the most common.

In their extended analysis at six months, a total of 2,379 patients with systemic autoimmune rheumatic disease were matched to an equivalent number of comparators and used to create a risk ratio for various medical outcomes. The patients with systemic autoimmune rheumatic disease had higher prevalence of several medical morbidities, including hypertension, diabetes, chronic kidney disease and asthma.