Indian Journal of Rheumatology (Jan 2021)

Do all patients with rheumatic Diseases have a higher risk of COVID 19? Initial results from the Karnataka Rheumatology Association COVID 19 Cohort Study (KRACC)

  • Vineeta Shobha,
  • K Chanakya,
  • Vikram Haridas,
  • Sharath Kumar,
  • Pramod Chebbi,
  • Benzeeta Pinto,
  • Vikramraj Jain,
  • Subramaniam Ramaswamy,
  • Shiv Prasad,
  • Abhishek Patil,
  • Vijay K Rao,
  • G C Yathish,
  • B G Dharmanand,
  • Ramesh Jois,
  • Ashwini Kamath,
  • Chethana Dharmapalaiah,
  • K N Sangeeta,
  • Ramya Janardana,
  • C Srinivasa,
  • A S Harshini,
  • Nagaraj Srinivasulu,
  • Yogesh Preet Singh,
  • Shweta Singhai,
  • K M Mahendranath,
  • S Chandrashekara

DOI
https://doi.org/10.4103/injr.injr_261_20
Journal volume & issue
Vol. 16, no. 2
pp. 164 – 168

Abstract

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Background: Patients with autoimmune rheumatic diseases (AIRD) may be at an increased risk for COVID-19 infection and poorer outcomes when compared with the general population. We undertook this study to estimate the risk of COVID-19 infection in our AIRD population and determine parameters which contribute to its occurrence. Methods: We prospectively recruited all consecutive AIRD patients on immunosuppressive therapy from 14 specialist rheumatology centers across south Indian state of Karnataka during current COVID-19 pandemic and followed them longitudinally. Results: Among 3807 participants, the majority were women (2.9:1), mean age was 43.8 (+14.3) years, rheumatoid arthritis (52.1%), and systemic lupus erythematosus (14.8%) were the most frequent diagnosis. Twenty-three (0.6%) patients contracted SARS-CoV-2 infection. Age >60 years (P = 0.01), diabetes (P = 0.009), hypertension (P = 0.001), preexisting lung disease (P = 0.0002), current prescription of either angiotensin-converting enzyme inhibitor or angiotensin receptor blockers (P = 0.01), and higher glucocorticoids dosage (P = 0.002) were identified as potential risk factors in our cohort. The past use of cyclophosphamide (P = 0.0001) or mycophenolate mofeti (P = 0.003) or biologics (P = 0.001) also had a significant association with COVID-19 infection. Hydroxychloroquine use did not influence occurrence or outcome. The presence of underlying lung disease (relative risk - 3.08, 95% confidence interval - 1.21, 8.44, P = 0.029) was the only independent risk factor associated with the risk of COVID positivity in the multivariate analysis. Incidence rate of COVID-19 infection was similar to that of the general population (P = 0.22). Conclusions: The incidence of SARS CoV-2 infection in AIRD population is comparable to the general population. Underlying lung disease was the most important risk factor apart from older age, diabetes, hypertension, and a higher glucocorticoid dosage.

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