Does lupus or arthritis affect your prognosis if you get COVID-19? – Harvard Health Blog

Shortly after the onset of the coronavirus pandemic, we learned that the elderly and those with certain chronic conditions, such as high blood pressure or diabetes, are at increased risk of severe COVID-19. One condition on this list is an immunocompromised state (a weakened immune system). This can be due to a number of conditions, including organ transplantation, HIV, or taking drugs that suppress the immune system.

If you have an autoimmune disease such as rheumatoid arthritis or lupus (also known as systemic lupus erythematosus) you may be wondering how this affects your risk. These conditions are believed to occur because the immune system malfunctions and attacks organs in the body. And many people with these disorders are treated with drugs that suppress the immune system.

Two recently published studies examine this. Although the results are not final, they do provide some assurance. Most people have recovered from COVID-19 and most of their previous treatments did not appear to make their infections worse.

Lupus and COVID-19

In the first study, researchers recruited 226 people with lupus. After comparing those who had COVID-19 with those who did not, they found that

  • nearly 60% of people with COVID-19 and lupus became ill enough to be hospitalized, and 10% were admitted to the intensive care unit.
  • about 10% died.
  • risk factors for hospitalization were similar to those reported in people outside this study who did not have lupus. For example, race (more hospitalizations among Hispanic and non-white people), other chronic conditions (including kidney failure, lung disease, and hypertension), and overweight or obesity were more common in people requiring hospitalization.
  • steroid treatment for lupus was almost twice as high in hospitalized patients (54%) than in those who were not hospitalized (29%). However, this difference was not statistically significant.
  • treatment with other immunosuppressive drugs taken 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 (which includes rheumatoid arthritis and related conditions) who were also diagnosed with COVID-19. Some were hospitalized with serious illness, while others were treated on an outpatient basis. Here’s what the study found.

  • 26% of study subjects were hospitalized.
  • About 4% died.
  • Risk factors for hospitalization included being 65 years of age or older, high blood pressure, and lung disease.
  • Steroid therapy for inflammatory arthritis was more common in inpatients (37%) than in outpatients (approximately 4%).
  • Biologic treatment (such as 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 requiring hospitalization. However, few patients were taking this drug.

Why these studies are not the last word

These studies only included patients with COVID-19 and SLE or inflammatory arthritis. It was not possible to rigorously compare study participants to people without lupus or arthritis. Additionally, these studies did not include a large number of people with lupus or arthritis who tested positive for the virus, but who did not have symptoms of COVID-19 (asymptomatic infection). They also did not confirm the diagnosis of COVID-19 in each suspected case. So, while this research offers new information, the true impact of lupus or arthritis on people who develop COVID-19 has not yet been determined.

Finally, the lupus study was small: only 41 subjects had confirmed COVID-19. Although the results on steroid treatment were not statistically significant, this might not have been true if the observed differences persisted in a larger study.

The bottom line

Public health experts often include people with autoimmune disease on the list of those who are more likely to have a poor outcome if they develop COVID-19. The relatively high hospitalization rate of 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 corticosteroid therapy may further increase the risk. Other studies have come to similar conclusions (see here and here).

There was good news to highlight in these trials: The survival rate of patients with lupus or inflammatory arthritis who develop COVID-19 was relatively high. In addition, biologic therapy does not appear to worsen the prognosis of patients with arthritis. And other immunosuppressants have not worsened the prognosis for people with lupus. And, the hospitalization rate for COVID-19 in patients with inflammatory arthritis was similar to what has been reported for people without arthritis.

These findings add to what we are learning about COVID-19. Obviously, we need to know more. For example, is there a dose of steroids to treat chronic disease that is so low that it does not increase the risk of a worse prognosis with COVID-19? Certain drugs (such as biologics) reduce the risk of severe COVID-19? Until we know more, it remains especially important for people with lupus and inflammatory arthritis – especially those who take steroids – to be especially vigilant about measures to avoid COVID-19.

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Jothi Venkat

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