Incidence and severeness of COVID-19 hospitalization in patients with inflammatory rheumatic disease: a nationwide cohort study from Denmark
René Cordtz, Jesper Lindhardsen, Bolette G Soussi, Jonathan Vela, Line Uhrenholt, Rasmus Westermann, Salome Kristensen, Henrik Nielsen, Christian Torp-Pedersen, Lene Dreyer
Rheumatology, doi:10.1093/rheumatology/keaa897
Objectives. To estimate the incidence of COVID-19 hospitalization in patients with inflammatory rheumatic disease (IRD); in patients with RA treated with specific DMARDs; and the incidence of severe COVID-19 infection among hospitalized patients with RA.
Methods. A nationwide cohort study from Denmark between 1 March and 12 August 2020. The adjusted incidence of COVID-19 hospitalization was estimated for patients with RA; spondyloarthritis including psoriatic arthritis; connective tissue disease; vasculitides; and non-IRD individuals. Further, the incidence of COVID-19 hospitalization was estimated for patients with RA treated and non-treated with TNF-inhibitors, HCQ or glucocorticoids, respectively. Lastly, the incidence of severe COVID-19 infection (intensive care, acute respiratory distress syndrome or death) among hospital-admitted patients was estimated for RA and non-IRD sp -individudals. Results. Patients with IRD (n ¼ 58 052) had an increased partially adjusted incidence of hospitalization with COVID-19 compared with the 4.5 million people in the general population [hazard ratio (HR) 1.46, 95% CI: 1.15, 1.86] with strongest associations for patients with RA (n ¼ 29 440, HR 1.72, 95% CI: 1.29, 2.30) and vasculitides (n ¼ 4072, HR 1.82, 95% CI: 0.91, 3.64). There was no increased incidence of COVID-19 hospitalization associated with TNF-inhibitor, HCQ nor glucocorticoid use. COVID-19 admitted patients with RA had a HR of 1.43 (95% CI: 0.80, 2.53) for a severe outcome.
Conclusion. Patients with IRD were more likely to be admitted with COVID-19 than the general population, and COVID-19 admitted patients with RA could be at higher risk of a severe outcome. Treatment with specific DMARDs did not affect the risk of hospitalization.
Supplementary data Supplementary data are available at Rheumatology online.
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'abstract': '<jats:title>Abstract</jats:title>\n'
' <jats:sec>\n'
' <jats:title>Objectives</jats:title>\n'
' <jats:p>To estimate the incidence of COVID-19 hospitalization in patients '
'with inflammatory rheumatic disease (IRD); in patients with RA treated with specific DMARDs; '
'and the incidence of severe COVID-19 infection among hospitalized patients with RA.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Methods</jats:title>\n'
' <jats:p>A nationwide cohort study from Denmark between 1 March and 12 '
'August 2020. The adjusted incidence of COVID-19 hospitalization was estimated for patients '
'with RA; spondyloarthritis including psoriatic arthritis; connective tissue disease; '
'vasculitides; and non-IRD individuals. Further, the incidence of COVID-19 hospitalization was '
'estimated for patients with RA treated and non-treated with TNF-inhibitors, HCQ or '
'glucocorticoids, respectively. Lastly, the incidence of severe COVID-19 infection (intensive '
'care, acute respiratory distress syndrome or death) among hospital-admitted patients was '
'estimated for RA and non-IRD sp - individudals.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Results</jats:title>\n'
' <jats:p>Patients with IRD (n\u2009=\u200958\xa0052) had an increased '
'partially adjusted incidence of hospitalization with COVID-19 compared with the 4.5 million '
'people in the general population [hazard ratio (HR) 1.46, 95% CI: 1.15, 1.86] with strongest '
'associations for patients with RA (n\u2009=\u200929\xa0440, HR 1.72, 95% CI: 1.29, 2.30) and '
'vasculitides (n\u2009=\u20094072, HR 1.82, 95% CI: 0.91, 3.64). There was no increased '
'incidence of COVID-19 hospitalization associated with TNF-inhibitor, HCQ nor glucocorticoid '
'use. COVID-19 admitted patients with RA had a HR of 1.43 (95% CI: 0.80, 2.53) for a severe '
'outcome.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Conclusion</jats:title>\n'
' <jats:p>Patients with IRD were more likely to be admitted with COVID-19 '
'than the general population, and COVID-19 admitted patients with RA could be at higher risk '
'of a severe outcome. Treatment with specific DMARDs did not affect the risk of '
'hospitalization.</jats:p>\n'
' </jats:sec>',
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