Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School.
Hellenic Ministry of Health.
Rheumatology (Oxford). 2023 Mar 1;62(3):1047-1056. doi: 10.1093/rheumatology/keac422.
To investigate coronavirus disease 2019 (COVID-19)-associated risk of hospitalization and death in RA, AS, PsA, SLE and SSc in comparison with the general population during the first year of the pandemic, and compare their overall mortality with 2019.
Interlinking nationwide 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 and 62.2 years, respectively) and in random comparators from the general population matched (1:5) on age, sex and region of domicile. Deaths from all causes during 2019 were also recorded.
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 severe acute respiratory syndrome coronavirus 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. The all-cause mortality rate compared with the general population increased in RA during the first year of the pandemic (IRR 0.71) with reference to 2019 (0.59), and decreased in SSc (IRR 1.94 vs 4.36).
COVID-19 may have a more severe impact in patients with systemic rheumatic disease than in 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.
在大流行的第一年，调查 COVID-19 相关的住院和死亡风险在类风湿关节炎、强直性脊柱炎、银屑病关节炎、系统性红斑狼疮和系统性硬化症患者中与普通人群相比的情况，并与 2019 年的情况进行比较。
通过全国电子登记系统，我们记录了 2020 年 3 月 1 日至 2021 年 2 月 28 日期间所有接受治疗的成年类风湿关节炎、强直性脊柱炎、银屑病关节炎、系统性红斑狼疮和系统性硬化症患者（n=74970，中位年龄 67.5、51.2、58.1、56.2 和 62.2 岁）中与 COVID-19 相关的感染、住院和死亡以及所有原因死亡，以及在年龄、性别和居住地方面与普通人群相匹配（1:5）的随机对照者。还记录了 2019 年所有原因的死亡人数。
与普通人群相比，COVID-19 相关住院的发病率（IR）在类风湿关节炎（IRR1.71[1.50-1.95]）、系统性红斑狼疮（2.0[1.4-2.7]）和系统性硬化症（2.28[1.29-3.90]）中更高，而 COVID-19 相关死亡率在类风湿关节炎中更高（1.91[1.46-2.49]）。当仅关注严重急性呼吸综合征冠状病毒 2 感染的患者时，调整年龄和性别后，与普通人群相比，COVID-19 相关死亡的比值比在类风湿关节炎中更高（1.47[1.11-1.94]）和系统性硬化症中更高（2.92[1.07-7.99]）。与普通人群相比，类风湿关节炎患者在大流行的第一年的全因死亡率增加（IRR0.71，参考 2019 年为 0.59），而系统性硬化症患者的死亡率降低（IRR1.94 比 4.36）。
COVID-19 可能对系统性风湿病患者的影响比普通人群更严重。COVID-19 相关死亡率在特定风湿性疾病患者亚组中增加，这突出表明需要优先接种疫苗和获得针对性治疗。
