A pair of new reports suggests that most adults with systemic lupus erythematosus (SLE) are not an increased risk of hospitalization from coronavirus disease 2019 (COVID-19) because of medications that inhibit their immune system. In addition, most adults with more common types of arthritis, such as rheumatoid arthritis, psoriatic arthritis, and spondylarthritis, do not have a greater risk of hospitalization from COVID-19, according to the study, led by researchers from New York University's Grossman School of Medicine. 

The new studies found that for some of these patients, the use of steroid medications to reduce inflammation slighly increased the likelihood of needing hospital care for COVID-19; however, the results should be reassuring for patients overall, according to the study authors. 

The researchers also found that their patients were experiencing anxiety over concerns that their treatments made them more susceptible to the dangers of COVID-19 infection. 

In the first study, the authors evaluated 226 adult patients who were mostly Black, Hispanic, and female and were receiving treatment at NYU Langone Health clinics for mild to severe forms of lupus. All participants were surveyed by phone or email, or had their medical records checked between April 13 and June 1, 2020, when the pandemic peaked in the New York City region. 

Of the 41 patients who were formally diagnosed with COVID-19, 24 were hospitalized and 4 patients died. Meanwhile, 42 had COVID-19-like symptoms but were not formally tested, according to the study. 

In the second study, 103 women, mostly of white descent, were monitored while being treated at NYU Langone Health clinics between March 3 and May 4, 2020, for inflammatory arthritis, which unlike common osteoarthritis, does not primarily result from joint wear and tear, according to the study authors. All of the women tested positive for COVID-19 or had symptoms highly suggesting they were infected. Twenty-seven of the women were hospitalized with 4 deaths.

The researchers said their latest study findings showed that patients with lupus taking immune-suppressing medications, such as mycophenolate mofetil (CellCept) and azathioprine (Imuran), had no greater risk of hospitalization than patients with lupus not using the medications. Furthermore, hospitalization rates for people with inflammatory arthritis (26%) and COVID-19 were similar to other New Yorkers (25%).

Other findings included patients taking biologic drugs for arthritis, such as adalimumab (Humira) and etanercept (Enbrel), which are made from living cells, or the antiviral hydroxychloroquine, did not have a greater or lesser risk of hospitalization than those not taking these drugs. However, those taking glucocorticoids, even in mild doses, were upwards of 10 times more likely to be hospitalized than patients with arthritis not using steroids.  

The researchers warn that the small size of the study may overestimate the actual risk.

“Our findings represent the largest of its kind for American patients with lupus or arthritis and COVID-19, and should reassure most patients, especially those on immunosuppressant therapy, that they are at no greater risk of having to be admitted to hospital from COVID-19 than other lupus or arthritis patients,” said study investigator Ruth Fernandez-Ruiz, MD, in a press release.

The shared risk factors, which overall more than double people’s risk of hospitalization from COVID-19, are having multiple underlying health conditions, such as obesity, hypertension, and diabetes.

“Patients receiving therapy for lupus and inflammatory arthritis should not automatically stop taking their medications for fear that they would be worse off if they also caught the coronavirus,” said study investigator Rebecca Haberman, MD, in a press release. “Instead, rheumatology patients should consult with their medical provider about their overall risk factors for COVID-19 and make plans accordingly.”

The study authors said they next plan to test patients with lupus and patients with arthritis for COVID-19 antibodies to see how many study participants were infected at some point and whether any were at greater or lesser risk of infection.

REFERENCE
Most adults with lupus or common types of arthritis have similar risks of getting admitted to hospital as other patients with COVID-19. https://nyulangone.org/news/most-adults-lupus-or-common-types-arthritis-have-similar-risks-getting-admitted-hospital-other-patients-covid-19. Published August 25, 2020. Accessed August 26, 2020.