COVID-19 in people with rheumatic diseases: risks, outcomes, treatment considerations

Abstract

The COVID-19 pandemic has brought challenges for people with rheumatic disease in addition to those faced by the general population, including concerns about higher risks of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and poor outcomes of COVID-19. The data that are now available suggest that rheumatic disease is associated with a small additional risk of SARS-CoV-2 infection, and that outcomes of COVID-19 are primarily influenced by comorbidities and particular disease states or treatments. Despite considerable advances in our knowledge of which therapeutic agents provide benefits in COVID-19, and of what constitutes effective vaccination strategies, the specific considerations that apply to people with rheumatic disease are yet to be definitively addressed. An overview of the most important COVID-19 studies to date that relate to people with rheumatic disease can contribute to our understanding of the clinical-care requirements of this population.

Abstract

In this Review, the authors summarize the current knowledge relating to SARS-CoV-2 infection and the prevention and treatment of COVID-19 in people with rheumatic disease.

Key points

• People with immune or inflammatory rheumatic disease might have a higher risk of infection with SARS-CoV-2 after exposure than the general population, although the additional risk is probably small.

• Risk of poor COVID-19 outcomes in patients with rheumatic disease seems to be mediated by the presence of comorbidities, treatment with glucocorticoids or rituximab, and high disease activity.

• People with immune or inflammatory rheumatic disease who experience mild COVID-19 symptoms should stop taking immunomodulating medications for 1–3 weeks from the onset of disease.

• People with rheumatic disease with positive SARS-CoV-2 test results or mild COVID-19 symptoms and risk factors for poor outcomes should stop taking immunomodulating medications and consider treatment with antiviral medications.

• Most patients with treated rheumatic disease generate antibody responses to SARS-CoV-2 vaccines, but medications such as B cell-depleting therapies and mycophenolate confer a high risk of poor responses.

• People with immune or inflammatory rheumatic disease are strongly recommended to receive SARS-CoV-2 vaccination, including booster doses if recommended, despite some evidence of a diminished response in particular groups.