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COVID-19 arthritic patients taking steroids have worse outcomes

It is thought that infection with COVID-19 leads to a cytokine storm and that the resultant hyperinflammation can be managed to some extent with immunosuppressants.

In this new study by a team from the Division of Rheumatology, New York University School of Medicine, the authors speculated that patients with inflammatory arthritis (IA), prescribed immunosuppressants may be protected to some extent against the worse outcomes for COVID-19, that is, the need for hospitalisation and/or mechanical ventilation. They recruited patients with a range of IA including rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, ankylosing spondylitis or inflammatory bowel disease-associated arthritis. All patients had either confirmed COVID-19 (based on a positive test result) or were strongly suspected of being infected, based on having a new fever or known positive contact plus one or more respiratory symptoms.

A total of 103 patients, of whom 80 had confirmed COVID-19 infection were included in the analysis. All were followed for a mean of 42 days from the time of symptom onset which was established through a series of on-line questionnaires, telephone calls or a review of medical records and hospital charts. The mean age of participants was 53 years (72% women) and in terms of their disease state prior to the onset of COVID-19, nearly a quarter (23%) said that their disease was in remission and 38% stated that they had mild and 34% moderate disease severity with the remainder having severe disease. Overall, 26% of patients required hospitalisation due to COVID-19 and 4% (4/103) of patient died. Interestingly, chronic use of corticosteroids was significantly more common among those hospitalised (37% vs 4%, p < 0.001) compared to those on maintenance anti-cytokine therapies. In addition, older patients with comorbidities such as hypertension, were more likely to be hospitalised.

In conclusion, the authors called for further studies to determine whether immunomodulatory therapy can prevent COVID-19 or ameliorate its clinical outcomes.

Haberman RH et al. COVID-19 in patients with inflammatory arthritis: a prospective study on the effects of comorbidities and DMARDS on clinical outcomes. Arthritis Rheumatol 2020; doi: 10.1002/ART.41456