Poor COVID-19 outcomes in patients with psoriasis are linked to characteristics such as age and sex – but not to the type of immune therapy – latest data from the Global Rheumatology Alliance show.

Australian and international researchers investigated associations for severe disease in 5045 patients whose details were on the C19-GRA registry, of whom 18.3% had psoriasis, 45.5% psoriatic arthritis (PsA) and 36.3% axial spondyloarthritis. Most (84%) were not hospitalised, 14.6% were hospitalised and 1.8% died.

The analysis found that being of older age was associated with more severe COVID, while more severe disease was also linked with being of male sex (OR 1.54) and having cardiovascular, respiratory, renal, metabolic and cancer comorbidities (ORs 1.25-2.89).

Higher disease activity and/or higher glucocorticoid use (ORs 1.39-2.23) was also a significant risk for more severe COVID disease, according to the research, published in the Annals of the Rheumatic Diseases (link here).

Reassuringly, the researchers noted that none of the bDMARDs typically used to treat psoriasis, PsA and axSpA, including TNF inhibitors, IL-17 inhibitors and IL-23i/IL-12+23 inhibitors, were found to worsen COVID-19 outcomes.

No biologics-specific differences were found.

The researchers said the findings reaffirmed the known risk factors for severe COVID in both the general population and among people with immune-mediated inflammatory disease, especially for cardiometabolic and pulmonary co-morbidities.

“Our findings will help clinicians, scientific societies and policy makers worldwide develop tailored management strategies for patients with psoriasis, PsA and axSpA during COVID-19 waves or similar future respiratory pandemics,” the authors noted.

Meanwhile, a separate study has found that anxiety levels due to COVID were “exceptionally high” among autoimmune disease patients during the pandemic.

The international study, published in Rheumatology Advances in Practice, investigated patterns of anxiety in 2,640 adult patients and 498 parents of children and young people with rheumatic inflammatory diseases in more than 40 countries, with participants self-rating their anxiety weekly for six months following March 2020.

The study data identified four trajectory clusters of COVID-19-related anxiety: persistent extremely high anxiety (32%, 17%, in children and adults respectively); persistent high anxiety (43%, 41%); high anxiety that marginally improved (25%, 32%); and moderate anxiety that improved (11%, 10%).

“There is a clear unmet need for anxiety management programmes or interventions for parents of [children and young people] with rheumatic diseases, whose anxiety is high despite their children being at low risk of infection or complications from COVID-19,” they wrote.

“While the study could not adjust for underlying anxiety disorders in participants, the picture of high to extreme high COVID-19-related anxiety highlights an area for mental health intervention, regardless of pre-existing diagnoses,” they said.