Older age, comorbidity, glucocorticoid use and disease activity are risk factors for COVID-19 hospitalisation in patients with inflammatory rheumatic and musculoskeletal diseases
Ulf Mueller-Ladner,
Hendrik Schulze-Koops,
Tim Schmeiser,
Hanns-Martin Lorenz,
Christof Specker,
Reinhard E Voll,
Anja Strangfeld,
Bimba F Hoyer,
Jutta Richter,
Alexander Pfeil,
Rebecca Hasseli,
Andreas Krause,
Anne Constanze Regierer,
Martin Schäfer
Affiliations
Ulf Mueller-Ladner
9 Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
Hendrik Schulze-Koops
6University of Munich, Munich, Germany
Tim Schmeiser
11Hospital St. Joseph, Rheumatology, Wuppertal, Germany
Hanns-Martin Lorenz
1 Medical Clinic 5. Hematology, Oncology, Rheumatology, Heidelberg University, Heildelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
Christof Specker
Klinik für Rheumatologie and Klinische Immunologie, Evangelisches Krankenhaus, Essen, Germany
Reinhard E Voll
Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
Anja Strangfeld
Programmbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum Berlin, ein Leibniz Institut, Berlin 10117, Germany
Bimba F Hoyer
Medical Department 1, Rheumatology and Clinical Immunology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
Jutta Richter
Heinrich-Heine-University, Department of Rheumatology and Hiller Research Unit, Düsseldorf, Germany
Alexander Pfeil
Department of Internal Medicine III, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
Rebecca Hasseli
1Campus Kerckhoff, Justus-Liebig-University Gießen, Dept. of Rheumatology and Clinical Immunology, Bad Nauheim, Germany
Andreas Krause
Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
Anne Constanze Regierer
Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
Martin Schäfer
Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
Introduction Whether patients with inflammatory rheumatic and musculoskeletal diseases (RMD) are at higher risk to develop severe courses of COVID-19 has not been fully elucidated. Aim of this analysis was to describe patients with RMD according to their COVID-19 severity and to identify risk factors for hospitalisation.Methods Patients with RMD with PCR confirmed SARS-CoV-2 infection reported to the German COVID-19 registry from 30 March to 1 November 2020 were evaluated. Multivariable logistic regression was used to estimate ORs for hospitalisation due to COVID-19.Results Data from 468 patients with RMD with SARS-CoV-2 infection were reported. Most frequent diagnosis was rheumatoid arthritis, RA (48%). 29% of the patients were hospitalised, 5.5% needed ventilation. 19 patients died. Multivariable analysis showed that age >65 years (OR 2.24; 95% CI 1.12 to 4.47), but even more>75 years (OR 3.94; 95% CI 1.86 to 8.32), cardiovascular disease (CVD; OR 3.36; 95% CI 1.5 to 7.55), interstitial lung disease/chronic obstructive pulmonary disease (ILD/COPD) (OR 2.79; 95% CI 1.2 to 6.49), chronic kidney disease (OR 2.96; 95% CI 1.16 to 7.5), moderate/high RMD disease activity (OR 1.96; 95% CI 1.02 to 3.76) and treatment with glucocorticoids (GCs) in dosages >5 mg/day (OR 3.67; 95% CI 1.49 to 9.05) were associated with higher odds of hospitalisation. Spondyloarthritis patients showed a smaller risk of hospitalisation compared with RA (OR 0.46; 95% CI 0.23 to 0.91).Conclusion Age was a major risk factor for hospitalisation as well as comorbidities such as CVD, ILD/COPD, chronic kidney disease and current or prior treatment with GCs. Moderate to high RMD disease activity was also an independent risk factor for hospitalisation, underlining the importance of continuing adequate RMD treatment during the pandemic.
