Study confirms fears about COVID-19 impact in people with rare autoimmune rheumatic diseases

New findings from the UK have confirmed fears that people with rare autoimmune rheumatic diseases (RAIRD) are extremely vulnerable to the effects of COVID-19 infection.

COVID-19-related deaths among people with RAIRD such as vasculitis were more than twice that of the general population during the first wave or SARS-CoV2 infections, the UK RECORDER (Registration of Complex Rare Diseases Exemplars in Rheumatology) project has shown.

People with lupus, vasculitis, scleroderma, juvenile idiopathic arthritis, myositis and Behcet’s disease were also found to have had a 54% increased risk of COVID-19 infection despite shielding advice, according to the registry data.

The research team, led by Dr Megan Rutter from the School of Medicine at the University of Nottingham, said the findings have important implications for people with RAIRD, clinicians and public health policy.

“They confirm at whole population-level that the assumptions at the start of the pandemic, that many people with RAIRD would be clinically extremely vulnerable to the effect of COVID-19(31), were correct … Protecting the health of people with RAIRD needs specific public health prioritisation, to reduce both their risk of acquiring COVID-19 infection and mortality.”

For the study, which is yet to be peer reviewed, researchers identified a cohort of 168,680 people with RAIRD between March and July 2020, of whom 1,874 (1.11%) had a positive COVID-19 PCR test.

Taking age into account, they found that the infection rate was 1.54 times higher in the RAIRD group than in the general population, while the age-sex-standardised mortality rate for COVID-19-related death was 2.41 times higher. The rate of deaths within 28 days of a COVID-19 positive test were 2.71 times higher for people with RAIRD compared to the general population.

The data suggest a similar risk for COVID-19 related death across the RAIRD cohort, though the authors noted that people with giant cell arteritis (GCA) were at slightly reduced risk, possibly because it is often a self-limiting disease that does not require lifelong immunosuppression.

And compared to previous years when there were around 2500 deaths/year in people with a RAIRD, the data also showed an additional 500 deaths among people with RAIRD in 2020, with the excess deaths attributable to COVID-19.

Paul Howard, Chief Executive of LUPUS UK, said the findings come at an important time when most COVID-19 restrictions have been lifted in the UK and daily infection rates remain high.

“Many people with diseases like lupus, vasculitis and other rare autoimmune conditions are on immunosuppressant medications and are expressing anxiety about having much less support to avoid contracting the virus whilst their risk is largely unchanged from last year. We hope these findings will encourage employers and policymakers to take additional measures to safeguard people living with these diseases.”

The authors also highlighted the urgent need to analyse the real-world effectiveness of vaccines in people with RAIRD, as evidence indicates that they may respond less well to vaccination.

“This will have crucial implications for their ongoing health protection needs, including deciding the optimal vaccination schedule to maximise protection,” they said.

Already a member?

Login to keep reading.

Email me a login link

© 2022 the limbic