Dr. Ahmed
Arthritis after COVID-19 was seen in a significant number of patients. However, whether the arthritis will persist in the long run or not is not known.
A study published in the Annals of Internal Medicine” has focused on finding a link between long-term autoimmune inflammatory rheumatic arthritis after COVID-19.
Key points of the study:
- The study concluded, 0.98% of the 10,027,506 Korean participants from 2020-2021 had influenza, and 3.9% had COVID-19.
- Comparing COVID-19 patients to non-infected people, the former had a 25% higher risk of developing autoimmune inflammatory rheumatic disorders (AIRD) after 30 days of infection.
- This continued to be associated with a 30% greater hazard ratio than in influenza-infected patients.
- The risk of an incident AIRD was positively linked with the severity of acute COVID-19.
- The study showed a similar relationship between elevated risk of AIRD and SARS-Cov-2 infection, which was confirmed in a Japanese clinical population.
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COVID-19 and Autoimmune Rheumatic Disease:
Global communities and healthcare systems have been put to the test by the coronavirus disease 2019 pandemic.
There are certain high-risk groups, among which age is the strongest one, but obesity, cardiovascular, lung, and kidney illnesses have also been shown to be significant risk factors and associated with worse outcomes.
Patients who have inflammatory rheumatic arthritis are more at risk of infections including COVID-19.
Similarly, patients with autoimmune conditions, especially vasculitis and Rheumatoid Arthritis have more severe COVID-19 infections and require hospitalization more frequently than the general population.
However, disease-modifying antirheumatic drugs such as TNF inhibitors, Hydroxychloroquine, and Corticosteroids have little impact on COVID-19 outcomes in the general population [Ref].
High-dose glucocorticoids did worsen the outcome and prolonged the hospital stay in severe COVID-19 patients who required invasive mechanical ventilation [Ref]
The recent study also emphasized the increased risk of COVID-19 development with AIRD incidence. The greater severity of COVID-19 also increases the incidence of AIRD.
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COVID and Arthritis: Findings of the Study:
When compared to comparable individuals who were either infected with influenza or did not have SARS-CoV-2 infection, SARS-CoV-2 infections were linked to elevated risk for incident AIRD.
Greater severity of acute COVID-19 was associated with an increased incidence of AIRD (Autoimmune Inflammatory Rheumatic Diseases) [ref]
The study also demonstrated a negative correlation of Autoimmune Rheumatic Conditions with COVID-19 vaccination.
People who were vaccinated had a lower incidence of AIRD and Arthritis after COVID-19 infection.
Methodology and Analysis of the study:
This binational, longitudinal study examined the relationship between autoimmune inflammatory rheumatic disorders (AIRD) and SARS-CoV-2 infection using sizable cohorts from South Korea and Japan.
While the Japanese cohort (n=12,218,680) supplied thorough health information, the Korean cohort (n=10,027,506) combined health data with COVID-19 records. Propensity score matching balanced covariates.
Compared to those who were not infected or who had the flu, patients with COVID-19 showed a higher risk of incident AIRD, and this higher risk persisted for more than 30 days after infection.
The analysis took into account vaccination status, COVID-19 severity, and AIRD subtypes.
Subgroup studies and sensitivity analysis validated the main findings.
Results highlight the possible connection between elevated risk of AIRD and SARS-CoV-2 infection, highlighting the significance of focused therapies and long-term surveillance.
SAS and R software were used for statistical analysis, with a significance level of P <0.05.
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COVID-19 and New-Onset Rheumatoid Arthritis:
COVID-19 infection is associated with the development of autoantibodies. Antibodies of particular concern are [Ref]:
- Rheumatoid Factor
- Anti-Cyclic Citrullinated Peptide (anti-CCP antibodies)
- Anti-Carbamylated Antibodies
- Anti-cardiolipin antibodies
- Anti β2-glycoprotein, and
- ANA (antinuclear antibodies)
Rheumatoid Arthritis patients with COVID-19 infection are at risk of hospitalization, sepsis, venous thromboembolism, and death.
Patients with seropositive RA, or those who have erosive arthritis, and patients with RA-associated ILD (interstitial lung disease) are more prone to develop severe infection and have worse outcomes [Ref]
COVID-19 vaccination has been found preventable and improves COVID-19-associated outcomes.
In addition, treatments previously directed against RA were commonly used to treat severe COVID-19, especially those developing cytokine storm.
IL-6 targeted therapy was the most commonly prescribed but results were variable. Tocilizumab (Actemra) was very commonly prescribed to patients with COVID-19-associated cytokine storm.
However, the most convincing therapy was dexamethasone in combination with remdesivir (Veklury).
Lately, oral therapy with Paxlovid and Lagvrio has been recommended as oral alternatives for mild COVID-19 infection.
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In Conclusion:
Autoimmune conditions are commonly reported in patients with COVID-19 infection.
Rheumatoid arthritis and positive antibody tests without clinical arthritis have been more commonly reported than other autoimmune rheumatic conditions.
