Title:COVID-19 Mortality in Patients with Rheumatic Diseases: A Real
Concern
Volume: 18
Issue: 3
Author(s): Nasra K. Al-Adhoubi*, Maha Ali, Humaid Al Wahshi, Issa Al Salmi, Farida Al-Balushi, Talal Al Lawati, Abeer Mohammed, Ahmed Al Muqbali, Hilal Al Kalbani, Safiya Al-Abrawi and Faryal Khamis
Affiliation:
- Rheumatology Unit, Royal Hospital, Muscat, Oman
Keywords:
Rheumatic diseases, COVID-19, SARS-CoV-2, viral infection, autoimmune diseases, mortality, immunosuppressive therapy, comorbidities.
Abstract:
Background: Coronavirus disease 2019 (COVID 19) is a worldwide pandemic that has
devastated the world in a way that has not been witnessed since the Spanish Flu in 1918. In this
study, we aim to investigate the outcomes of patients with rheumatic diseases infected with
COVID-19 in Oman.
Methods: A multi-center retrospective cohort study included patients with underlying rheumatological
conditions and COVID-19 infection. Data were collected through the electronic record system
and by interviewing the patients through a standard questionnaire.
Results: 113 patients with different rheumatic diseases were included with the following rheumatological
diagnoses: rheumatoid arthritis (40.7%), systemic lupus erythematosus (23.1%), psoriatic
arthritis (8%), Behcet's disease (7%), ankylosing spondylitis (6.2%), other vasculitides, including
Kawasaki disease (4.4%), and other diagnoses (10.6%). The mean (SD) age of patients was 43 (14)
years, and 82.3% were female. The diagnosis of COVID-19 was confirmed by PCR test in 84.1% of
the patients.
The most common symptoms at the time of presentation were fever (86%), cough (81%), headache
(65%), and myalgia (60%). Hospitalization due to COVID-19 infection was reported in 24.1% of
the patients, and 52.2% of these patients had received some form of treatment.
In this cohort, the intake of immunosuppressive and immunomodulating medications was reported
in 91.1% of the patients. During the COVID-19 infection, 68% of the patients continued taking their
medications. Comorbidities were present in 39.8% of the patients. Pregnancy was reported in 2% of
the patients. The 30 days mortality rate was found to be 3.5%. Diabetes, obesity, and interstitial
lung diseases (ILD) were the strongest risk factor for mortality (p-value 0.000, 0.000, and 0.001, respectively).
Rituximab was given in 3.8% of the patients, and it was significantly associated with
increased mortality among the patients (p-value <0.001).
Conclusion: COVID-19 infection in patients with rheumatic diseases have an increased mortality
rate in comparison to the general population, with diabetes, morbid obesity, chronic kidney diseases,
interstitial lung disease, cardiovascular disease, obstructive lung disease, and liver diseases as
comorbidities being the most severe risk factors associated with death. Greater care should be provided
to this population, including the prompt need for vaccination.
