ABSTRACT
Objectives: Assess and compare the rate of COVID-19 infection and SARS-CoV2 testing in patients with RA, rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA) association with their treatment and, for testing, the number of symptoms in a Swiss cohort of patients. Methods: Inclusion of patients with RA, AxSpA and PsA from the SCQM using a smartphone app (mySCQM) to record information between March and December 2020. Outcomes of interest were self-reported SARS-CoV2 testing, symptoms compatible with COVID-19 during the previous month and confirmed COVID-19 through PCR nasopharyngeal swab. Outcomes were compared between diseases groups, using logistic regression. We also evaluated the association of baseline treatment (TNF-inhibitors, b/tsDMARDs with other modes of action, no b/tsDMARDs) on the odds of symptoms and testing and the association of the number of symptoms (0-9) on the odds of testing. The analyses of SARS-CoV2 testing and COVID-19 symptoms were additionally adjusted for age, gender, glucocorticoids and csDMARDs. Confirmed cases were not adjusted for treatment and other covariates considering the low number of events. Results: We included 927 patients with RA, 805 with AxSpa and 453 with PsA. 1010 patients reported COVID-19-like symptoms (mostly fever, runny nose and cough), but only 455 of them (45%) reported being tested. 151 patients were tested without symptoms. In between March and December 2020, 7.6% of RA, 8.5% of AxSpA and 10.5% of PsA patients were tested positive for COVID-19 (p = 0.678). The odds of testing, symptoms and confirmed COVID-19 were similar between diseases and not associated with treatment for testing and. The number of symptoms was associated with the odds of testing (OR 1.43, 95%CI 1.37- 1.50 by symptom). Conclusion: Prevalence of COVID-19 symptoms and confirmed cases was similar between diseases, and for symptoms, was not associated with treatment. Despite strong advice from health authorities, less than 50% of patients with inflammatory rheumatic diseases and COVID-19 symptoms were tested. This proportion was not significantly different between diseases and not influenced by type of treatment. Efforts should be made to improve rates of SARS-CoV2 testing in patients with rheumatic diseases.
ABSTRACT
Background: Since the beginning of the pandemic in Switzerland, immunosuppressed people were strongly advised to be tested for SARS-CoV2 when symptomatic as it was conjectured that they might be more at risk for infection and/ or severe disease. While patients with autoimmune diseases might be indeed more at risk of death from COVID-191, it remains unknown, whether there are differences in infection or complication rates between patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA), and whether this relates to their disease or their treatment. Additionally, the prevalence of SARS-CoV2 testing in this population is not known. Objectives: This study aimed to assess and compare the rate of COVID-19 and SARS-CoV2 testing in patients with RA, AxSpA and PsA, the potential association with their treatment and, for testing, the number of symptoms. Methods: We included patients with RA, AxSpA and PsA from the Swiss Clinical Quality Management register (SCQM) using a smartphone app (mySCQM) to record information between March and December 2020. The outcomes of interest were self-reported SARS-CoV2 testing, symptoms compatible with COVID-19 during the previous month and confirmed COVID-19 through PCR nasopharyngeal swab. Outcomes were evaluated over the complete length of the aforementioned period (i.e. the outcome has been reported at least once during the period). Outcomes were compared between diseases groups, using logistic regression. We also evaluated the association of baseline treatment (TNF-inhibitors, b/tsDMARDs with other modes of action (OMA), no b/tsDMARDs) on the odds of symptoms and testing and the association of the number of symptoms (0-9) on the odds of testing. The analyses of SARS-CoV2 testing and COVID-19 symptoms were additionally adjusted for age, gender, glucocorticoids and csDMARDs. Confirmed cases were not adjusted for treatment and other covariates considering the low number of events. Results: We included 927 patients with RA, 805 with AxSpa and 453 with PsA (Table 1). 1010 patients reported COVID-19-like symptoms (mostly fever, runny nose and cough), but only 455 of them (45%) reported being tested. 151 patients were tested without symptoms. In between March and December 2020, 7.6% of RA, 8.5% of AxSpA and 10.5% of PsA patients were tested positive for COVID-19 (p=0.678). The odds of testing, symptoms and confirmed COVID-19 were similar between diseases and not associated with treatment for testing and symptoms (Figure 1). The number of symptoms was associated with the odds of testing (OR 1.43, 95%CI 1.37-1.50 by symptom). Conclusion: Prevalence of COVID-19 symptoms and confirmed cases was similar between diseases, and for symptoms, was not associated with treatment. Despite strong advice from health authorities, less than 50% of patients with inflammatory rheumatic diseases and COVID-19 symptoms were tested. This proportion was not significantly different between diseases and not influenced by type of treatment. Efforts should be made to improve rates of SARS-CoV2 testing in patients with rheumatic diseases.