Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, 751024, India.
Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, West Midlands, UK.
Rheumatol Int. 2021 Feb;41(2):243-256. doi: 10.1007/s00296-020-04764-5. Epub 2021 Jan 3.
Comorbidities in rheumatic and musculoskeletal diseases (RMDs) not only increase morbidity and mortality but also confound disease activity, limit drug usage and increase chances of severe infections or drug-associated adverse effects. Most RMDs lead to accelerated atherosclerosis and variable manifestations of the metabolic syndrome. Literature on COVID-19 in patients with RMDs, and the effects of various comorbidities on COVID-19 was reviewed. The initial data of COVID-19 infections in RMDs have not shown an increased risk for severe disease or the use of different immunosuppression. However, there are some emerging data that patients with RMDs and comorbidities may fare worse. Various meta-analyses have reiterated that pre-existing hypertension, cardiovascular disease, stroke, diabetes, chronic kidney disease, heart failure, lung disease or obesity predispose to increased COVID-19 mortality. All these comorbidities are commonly encountered in the various RMDs. Presence of comorbidities in RMDs pose a greater risk than the RMDs themselves. A risk score based on comorbidities in RMDs should be developed to predict severe COVID-19 and death. Additionally, there should be active management of such comorbidities to mitigate these risks. The pandemic must draw our attention towards, and not away from, comorbidities.
风湿和肌肉骨骼疾病（RMDs）中的合并症不仅增加发病率和死亡率，还会混淆疾病活动度、限制药物使用并增加严重感染或与药物相关的不良反应的机会。大多数 RMDs 会导致动脉粥样硬化加速和代谢综合征的各种表现。本文回顾了 RMDs 患者中的 COVID-19 文献以及各种合并症对 COVID-19 的影响。RMD 患者 COVID-19 感染的初始数据并未显示出严重疾病或使用不同免疫抑制药物的风险增加。然而，有一些新出现的数据表明，患有 RMD 和合并症的患者可能病情更糟。各种荟萃分析一再强调，先前存在的高血压、心血管疾病、中风、糖尿病、慢性肾脏病、心力衰竭、肺部疾病或肥胖会增加 COVID-19 的死亡率。所有这些合并症在各种 RMDs 中都很常见。RMDs 中的合并症比 RMDs 本身带来更大的风险。应该开发一种基于 RMDs 合并症的风险评分来预测严重 COVID-19 和死亡。此外，应积极管理这些合并症以降低这些风险。大流行必须引起我们对合并症的关注，而不是将其忽视。
