SARS-CoV-2 Infection and COVID-19 Outcomes in Rheumatic Diseases: A Systematic Literature Review and Meta-Analysis

Richard Conway, St. James's Hospital and Trinity College, Dublin, Ireland.
Alyssa A. Grimshaw, Yale University, New Haven, Connecticut.
Maximilian F. Konig, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Michael Putman, The Medical College of Wisconsin, Milwaukee.
Alí Duarte-García, Mayo Clinic, Rochester, Minnesota.
Leslie Yingzhijie Tseng, Yale School of Medicine, New Haven, Connecticut.
Diego M. Cabrera, Yale School of Medicine, New Haven, Connecticut.
Yu Pei Chock, Yale School of Medicine, New Haven, Connecticut.
Huseyin Berk Degirmenci, Tufts University School of Medicine, Boston, Massachusetts.
Eimear Duff, St. James's Hospital, Dublin, Ireland.
Bugra Han Egeli, Boston University School of Medicine, Boston, Massachusetts and University of Southern California, Los Angeles.
Elizabeth R. Graef, Boston University School of Medicine, Boston, Massachusetts.
Akash Gupta, Yale School of Medicine, New Haven, Connecticut.
Patricia Harkins, St. James's Hospital, Dublin, Ireland.
Bimba F. Hoyer, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
Arundathi Jayatilleke, Temple University, Philadelphia, Pennsylvania.
Shangyi Jin, Chinese Academy of Medical Sciences and Peking Union Medical College and National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China.
Christopher Kasia, The Medical College of Wisconsin, Milwaukee.
Aneka Khilnani, George Washington University School of Medicine and Health Sciences, Washington, DC.
Adam Kilian, Saint Louis University School of Medicine, St. Louis, Missouri.
Alfred H. Kim, Washington University School of Medicine, St. Louis, Missouri.
Chung Mun Lin, National Institute of Health Research and Newcastle University, Newcastle-upon-Tyne, UK.
Candice Low, St. Vincent's University Hospital, Dublin, Ireland.
Laurie Proulx, Canadian Arthritis Patient Alliance, Ottawa, Ontario, Canada.
Sebastian E. Sattui, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Namrata Singh, University of Washington, Seattle.
Jeffrey A. Sparks, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Herman Tam, Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.
Manuel F. Ugarte-Gil, Universidad Cientifica del Sur and Hospital Guillermo Almenara Irigoyen, Seguro Social de Salud del Peru, Lima, Peru.
Natasha Ung, Campbelltown Hospital, Campbelltown and University of Western Sydney, New South Wales, Australia.
Kaicheng Wang, Yale School of Medicine and Yale School of Public Health, New Haven, Connecticut.
Leanna M. Wise, University of Southern California, Los Angeles.

Document Type

Journal Article

Publication Date

5-1-2022

Journal

Arthritis & rheumatology (Hoboken, N.J.)

Volume

74

Issue

5

DOI

10.1002/art.42030

Abstract

OBJECTIVE: The relative risk of SARS-CoV-2 infection and COVID-19 disease severity among people with rheumatic and musculoskeletal diseases (RMDs) compared to those without RMDs is unclear. 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: We conducted a systematic literature review using 14 databases from January 1, 2019 to February 13, 2021. We 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 effects 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, we identified an increased prevalence of SARS-CoV-2 infection in patients with an RMD (RR 1.53 [95% CI 1.16-2.01]) compared to 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]). In a smaller number of studies, the adjusted risk of outcomes related to COVID-19 was assessed, and the results varied; some studies demonstrated an increased risk while other studies showed no difference in risk in patients with an RMD compared to those without an RMD. CONCLUSION: Patients with RMDs have higher rates of SARS-CoV-2 infection and an increased mortality rate.

Department

School of Medicine and Health Sciences Student Works

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