At the beginning of the pandemic there were concerns that people with rheumatic and musculoskeletal diseases (RMDs) may be at an increased risk of severe covid infections.
Now, over 18 months in, rheumatologists discussed the lessons learnt in Europe at the APLAR Congress.
EULAR established a partnership with the Global Rheumatology Alliance to set up a global registry of patients with RMDs and covid. The registry has collected data from over 20,000 patients in seven European countries.
Registry data showed that older age and comorbidities put patients with RMDs at a higher risk of hospitalisation and death, with men more likely to die from covid than women, comparable to what is observed in the general population.
People with moderate to high disease activity were more likely to die than those with low disease activity or in remission.
Medications also affected patient outcomes. Most DMARDs did not increase the likelihood of hospitalisation and anti-TNF therapy was associated with reduced risk. However, sulfasalazine and rituximab were associated with a higher incidence of covid deaths in patients with inflammatory joint diseases, rheumatoid arthritis and connective tissue diseases across all ages.
Moderate to high doses of glucocorticoids (≥ 10 mg/day) was associated with a higher risk of hospitalisation and death across all RMDs. But Associate Professor Pedro Machado, a rheumatologist at the University College London, said this association might be driven by confounding factors such as steroids often being prescribed in patients with higher disease activity levels.
He said data showed that when patients were in remission, there was no association with covid-related death irrespective of the steroid dose. However, when patients had moderate to high disease activity, this association was present regardless of the steroid dose.
The safety of covid vaccines has been monitored by the EULAR COVAX Registry, which included over 5,000 patients with RMDs. The vast majority of patients tolerated the vaccination well, with reports of inflammatory RMD flare in just 4% of cases and short-term side effects similar to those observed in the general population.
But covid vaccines were tested in people whose immune systems were normal and who were not receiving immunomodulatory therapeutics, said Professor Iain McInnes, a rheumatologist at the University of Glasgow who is leading the OCTAVE trial.
This UK multi-centre trial is evaluating the humoral and T cell responses to covid vaccines in people who have a chronic disease or an acquired secondary immune deficiency.
Professor Ori Elkayam, head of the department of rheumatology at the Tel Aviv Medical Center, presented a study from Israel that looked at almost 700 patients with RMDs and treated with various drugs. All patients received the Pfizer vaccine, but only 86% of them developed antibodies against covid with antibody titres significantly lower than the general population. Rituximab, glucocorticoids, MMF and abatacept, she said, were associated with a significantly reduced immunogenicity.