Impact of COVID-19 infection on rheumatic and musculoskeletal disease (RMD) patients

ABSTRACT

Background: The COVID-19 pandemic has brought challenges especially for people with rheumatic and musculoskeletal disease (RMD). The COVID-19 Global Rheumatology Alliance reported patients with RMD had higher rates of COVID-19 infection and mortality compared with general population. The data regarding the prevalence, clinical characteristics, and outcomes of COVID-19 infection among RMD patients in Malaysia are limited. Objective(s) This study describes the clinical characteristics and outcomes of COVID-19 infection on RMD patients (including factors associated with poor outcomes) at Hospital Tuanku Jaa'far Seremban (HTJS), Malaysia. Method(s) This is a retrospective cross-sectional study. All RMD patients who confirmed COVID-19 infection either with COVID-19 PCR or RTK from 1st January 2021 to 28th February 2022 were identified. Data were collected from patients' clinic notes, hospital admission notes and electronic records. Data on RMD diagnosis, comorbidities, disease activity, medication, vaccination status, clinical staging of COVID-19 infection, outcomes including hospitalization, complications from COVID-19 infection and RMD disease flare within 1 month following COVID-19 infection were analyzed. Result(s) From the 2746 patients with RMD seen from 1st January 2021 to 28th February 2022, 2.8% (n = 77) patients were reported positive for COVID-19 infection. The most common underlying RMD were rheumatoid arthritis 35.1% (n = 27) followed by systemic lupus erythematosus 22.1% (n = 17) and psoriatic arthritis 13% (n = 10). Majority of the patients had mild COVID-19 infection symptoms which categorized into stage 2 (46.8%, n = 36). 53.2% (n = 41) patients were hospitalized, and 2.6% (n = 2) patients died of severe COVID-19 pneumonia. 13% (n = 10) developed complications from COVID-19 infection in which 6 patients complicated with organizing pneumonia, 2 with pulmonary embolism, 1 with cytokine release syndrome and 1 with acute respiratory distress syndrome. 16% (n = 10) patients reported flare of RMD within 1 month post COVID-19 infection in which 6 had arthritis flare, 5 mucocutaneous flare and 1 had renal flare. Hypertension (P = 0.021) and diabetes mellitus (P = 0.005) were associated with higher rate of hospitalization. Patients who received 3 doses of COVID-19 vaccination had lower rate of hospitalization compared with those without vaccination (P = 0.026). Patients with age more than 50 years old were associated with higher rate of complications from COVID-19 infection (P = 0.037) and flare of RMD (P = 0.038). Interestingly, RMD disease activity was not associated with poorer outcome of COVID-19 infection (P > 0.05). Conclusion(s) This single center experience on RMD patients with COVID-19 infection showed co-morbidities, no vaccination, age 50 and above were associated with poorer outcomes which was consistent with previous studies. In contrary, RMD disease activity was not associated with poorer outcomes of COVID-19 infection.