Background & objectives: Patients with rheumatic and musculoskeletal diseases (RMDs) may be at an increased risk of SARS-CO-V2 infection as a result of underlying disease, associated comorbidities and use of potentially immunosuppressive treatments. Further, concern exists regarding whether individuals with rheumatic diseases potentially experience more severe COVID-19 and poorer outcomes. This study was undertaken to quantify the risk of SARS-CoV-2 infection in those with RMDs and describe clinical outcomes of COVID-19 in these patients.
Methods: Conway et al. conducted a systematic literature review using 14 databases from Jan. 1, 2019, to Feb. 13, 2021. They included observational studies and experimental trials in RMD patients that described comparative rates of SARS-CoV-2 infection, hospitalization, oxygen supplementation/intensive care unit (ICU) admission/mechanical ventilation or death attributed to COVID-19. Methodologic quality was evaluated using the Joanna Briggs Institute critical appraisal tools or the Newcastle-Ottawa scale. Risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated, as applicable for each outcome, using the Mantel-Haenszel formula with random effect models.
Results: Of the 5,799 abstracts screened, 100 studies met the criteria for inclusion in the systematic review, and 54 of 100 had a low risk of bias. Among the studies included in the meta-analyses, the researchers identified an increased prevalence of SARS-CoV-2 infection in patients with an RMD (RR 1.53 [95% CI 1.16–2.01]) compared with the general population. The odds of hospitalization, ICU admission and mechanical ventilation were similar in patients with and those without an RMD, whereas the mortality rate was increased in patients with RMDs (OR 1.74 [95% CI 1.08–2.80]). Fewer studies reported adjusted RRs for outcomes and, as a result, some were more likely to demonstrate no difference in risk.
Conclusion: Patients with RMDs have higher rates of SARS-CoV-2 infection and an increased mortality rate.
For full study details, including source material, refer to the full article.
Excerpted and adapted from:
Conway R, Grimshaw AA, Konig MF, et al. SARS-CoV-2 infection and COVID-19 outcomes in rheumatic diseases: A systematic literature review and meta-analysis. Arthritis Rheumatol. 2022 May;74(5).