COVID-19 outcomes in patients with inflammatory rheumatic diseases: associations with disease subtypes, treatments, and vaccination status
Abstract
Background Patients with inflammatory rheumatic diseases (IRDs) may be at increased risk for adverse COVID-19 outcomes because of immune dysregulation, comorbidities, and immunomodulatory treatments. However, the effects of specific rheumatic disease subsets, treatment patterns, and vaccine types remain incompletely understood. Objective To evaluate clinical characteristics and factors associated with COVID-19 infection and hospitalization among patients with IRDs. Methods This retrospective observational cohort study included 1,024 adult patients with IRDs followed between March 2020 and January 2023. Demographic characteristics, rheumatic disease subtypes, treatments, vaccination status, COVID-19 infection, hospitalization, radiologic findings, and recovery duration were analyzed. Results Among all patients, 347 (33.9%) developed COVID-19 infection. Patients with COVID-19 were younger than those without COVID-19 (49.1 ± 13.4 vs. 51.5 ± 14.5 years, p = 0.007). Vaccination before infection was significantly more frequent in the COVID-19-negative group (92.3% vs. 23.9%, p < 0.001). Spondyloarthritis frequency was higher among COVID-19-positive patients (25.9% vs. 20.1%, p = 0.030), whereas methotrexate use was lower (14.4% vs. 22.6%, p = 0.002). Among COVID-19-positive patients, 40 (11.5%) required hospitalization. Hospitalized patients were older, had more frequent lung disease, longer rheumatic disease duration, increased radiologic involvement, and prolonged recovery duration (all p < 0.05). In univariate analyses, FMF, colchicine use, and BNT162b2 vaccination were associated with lower hospitalization rates; however, these associations were not retained after multivariable adjustment. Conclusion Older age, pulmonary comorbidity, longer disease duration, and radiologic involvement were associated with COVID-19-related hospitalization in IRDs. In contrast, FMF, colchicine use, and BNT162b2 vaccination were associated with lower hospitalization rates.