ABSTRACT
OBJECTIVES: To investigate Covid-19-associated risk of hospitalization and death in rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) in comparison with the general population during pandemic's first year and compare their overall mortality with 2019. METHODS: Interlinking nation-wide electronic registries, we recorded confirmed Covid-19-associated infections, hospitalizations and deaths, and all-cause deaths between 1-March-2020 and 28-February-2021 in all adults with RA, AS, PsA, SLE, and SSc under treatment (n = 74 970, median age 67.5, 51.2, 58.1, 56.2, 62.2 years, respectively) and in matched (1:5) on age, sex, and region of domicile random comparators from the general population. Deaths from all causes during 2019 were also recorded. RESULTS: Compared with the general population incidence rates (IR) for Covid-19-associated hospitalization were higher in RA [IR ratio (IRR):1.71(1.50-1.95)], SLE [2.0(1.4-2.7)] and SSc [2.28(1.29-3.90)], while Covid-19-associated death rates were higher in RA [1.91(1.46-2.49)]. When focusing only on SARS-CoV-2 infected subjects, after adjusting for age and gender, the odds ratio for Covid-19 associated death was higher in RA [1.47(1.11- 1.94)] and SSc [2.92(1.07-7.99)] compared with the general population. All-cause mortality rate compared with the general population increased in RA during the first pandemic year (IRR : 0.71) with reference to 2019 (0.59) and decreased in SSc (IRR : 1.94 vs 4.36). CONCLUSION: Covid-19 may have more severe impact in patients with systemic rheumatic disease than the general population. Covid-19-related mortality is increased in subgroups of patients with specific rheumatic diseases, underscoring the need for priority vaccination and access to targeted treatments.
ABSTRACT
OBJECTIVES: To compare current all-cause mortality rates in rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) versus general population. METHODS: In this population-based, retrospective cohort study, anonymised data on 11 186 586 citizens, including all patients with RA (42 735, 79% female), AS (9707, 43% female), PsA (13 779, 55% female), SLE (10 440, 89% female) and SSc (2277, 88% female), (median age of 64/47/54/53/59 years at study entry, respectively), under prescribed treatment between 2015 and 2019, were extracted from the electronic database covering nearly 99% of the Greek population. RESULTS: After 1:5 (patients:general population) matching for gender/age, we found that survival was worse in SSc, followed by SLE and inflammatory arthritis. Compared with the general population HRs for death increased from the first 3 years to 5 years of observation possibly due to increases in disease duration: RA (from 0.63 to 1.13 (95% CI: 1.05 to 1.22), AS (from 0.62 to 1.01, (95% CI: 0.76 to 1.33)), PsA (from 0.68 to 1.06, (95% CI: 0.88 to 1.28)), SLE (from 1.52 to 1.98, (95% CI: 1.67 to 2.33)) and SSc (from 2.27 to 4.24, (95% CI: 3.19 to 5.63)). In both SLE and SSc mortality was increased in men than women and in patients younger than 50 years. CONCLUSIONS: Survival rates over 5 years in inflammatory arthritis under treatment are currently becoming comparable (AS/PsA) or slightly higher (RA) than those of the general population. However, all-cause mortality is almost twofold and fourfold higher in SLE and SSc, respectively, being even higher for male and younger patients.