银屑病、银屑病关节炎和中轴型脊柱关节炎患者 COVID-19 结局不良的相关特征：COVID-19 PsoProtect 和全球风湿病联盟医生报告登记处的数据。
Characteristics associated with poor COVID-19 outcomes in people with psoriasis, psoriatic arthritis and axial spondyloarthritis: data from the COVID-19 PsoProtect and Global Rheumatology Alliance physician-reported registries.
机构信息
Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.
出版信息
Ann Rheum Dis. 2023 May;82(5):698-709. doi: 10.1136/ard-2022-223499. Epub 2023 Feb 14.
OBJECTIVES
To investigate factors associated with severe COVID-19 in people with psoriasis (PsO), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA).
METHODS
Demographic data, clinical characteristics and COVID-19 outcome severity of adults with PsO, PsA and axSpA were obtained from two international physician-reported registries. A three-point ordinal COVID-19 severity scale was defined: no hospitalisation, hospitalisation (and no death) and death. ORs were estimated using multivariable ordinal logistic regression.
RESULTS
Of 5045 cases, 18.3% had PsO, 45.5% PsA and 36.3% axSpA. Most (83.6%) were not hospitalised, 14.6% were hospitalised and 1.8% died. Older age was non-linearly associated with COVID-19 severity. Male sex (OR 1.54, 95% CI 1.30 to 1.83), cardiovascular, respiratory, renal, metabolic and cancer comorbidities (ORs 1.25-2.89), moderate/high disease activity and/or glucocorticoid use (ORs 1.39-2.23, vs remission/low disease activity and no glucocorticoids) were associated with increased odds of severe COVID-19. Later pandemic time periods (ORs 0.42-0.52, vs until 15 June 2020), PsO (OR 0.49, 95% CI 0.37 to 0.65, vs PsA) and baseline exposure to TNFi, IL17i and IL-23i/IL-12+23i (OR 0.57, 95% CI 0.44 to 0.73; OR 0.62, 95% CI 0.45 to 0.87; OR 0.67, 95% CI 0.45 to 0.98; respectively; vs no disease-modifying antirheumatic drug) were associated with reduced odds of severe COVID-19.
CONCLUSION
Older age, male sex, comorbidity burden, higher disease activity and glucocorticoid intake were associated with more severe COVID-19. Later pandemic time periods, PsO and exposure to TNFi, IL17i and IL-23i/IL-12+23i were associated with less severe COVID-19. These findings will enable risk stratification and inform management decisions for patients with PsO, PsA and axSpA during COVID-19 waves or similar future respiratory pandemics.
目的
探讨银屑病（PsO）、银屑病关节炎（PsA）和中轴型脊柱关节炎（axSpA）患者发生严重 COVID-19 的相关因素。
方法
从两个国际医生报告的登记处获取了成年人的人口统计学数据、临床特征和 COVID-19 严重程度结局。定义了 COVID-19 严重程度的三分位 ordinal 量表：无住院、住院（无死亡）和死亡。使用多变量 ordinal 逻辑回归估计比值比（OR）。
结果
在 5045 例患者中，18.3%患有 PsO，45.5%患有 PsA，36.3%患有 axSpA。大多数（83.6%）未住院，14.6%住院，1.8%死亡。年龄较大与 COVID-19 严重程度呈非线性相关。男性（OR 1.54，95%CI 1.30-1.83）、心血管、呼吸、肾脏、代谢和癌症合并症（OR 1.25-2.89）、中度/高度疾病活动度和/或糖皮质激素使用（OR 1.39-2.23，与缓解/低度疾病活动度和无糖皮质激素相比）与严重 COVID-19 的可能性增加相关。更晚的大流行时期（OR 0.42-0.52，与截至 2020 年 6 月 15 日相比）、PsO（OR 0.49，95%CI 0.37-0.65，与 PsA 相比）和基线时接受 TNFi、IL17i 和 IL-23i/IL-12+23i 治疗（OR 0.57，95%CI 0.44-0.73；OR 0.62，95%CI 0.45-0.87；OR 0.67，95%CI 0.45-0.98；分别；与无疾病修正抗风湿药物相比）与严重 COVID-19 的可能性降低相关。
结论
年龄较大、男性、合并症负担、更高的疾病活动度和糖皮质激素摄入与更严重的 COVID-19 相关。较晚的大流行时期、PsO 和接受 TNFi、IL17i 和 IL-23i/IL-12+23i 治疗与 COVID-19 较轻相关。这些发现将有助于对 PsO、PsA 和 axSpA 患者进行风险分层，并为 COVID-19 浪潮或类似未来呼吸道大流行期间的患者管理决策提供信息。
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