COVID-19 FAQs: Recovery and Outcomes

Learn if and how having arthritis may affect your recovery if you are infected with the novel coronavirus. 

UPDATED 8/31/2020

Question: Am I more likely to have severe disease or be hospitalized with a COVID-19 infection if I have autoimmune or inflammatory arthritis?

A: Research is ongoing but current data finds that people with well-controlled inflammatory arthritis do not have a higher risk for serious complications than the general population. But these factors are more common in people (including patients with rheumatic disease) who experience severe disease or require hospitalization:

  • Having a comorbid condition. According to COVID-19 hospitalization data reported by the CDC, approximately 90% of hospitalized patients identified through COVID-NET had one or more underlying conditions, the most common being obesity, hypertension, chronic lung disease, diabetes and cardiovascular disease.
  • Taking corticosteroids at a dose of10 milligrams or more.
  • Being 65 years or older.

Since SARS-CoV-2 is such a new virus, studies of rheumatology patients have been small. The results of one study of 123 rheumatology patients (average age of 70 years) published in the Annals of Rheumatic Disease in August 2020 validated the risk factors for disease severity and hospitalization noted above. It also was noted that female study participants “were at significantly lower risk of hospitalization than men." However, study authors acknowledged study limitations due to the small number of patients and cautioned that more research was needed. 

Question: How are people with autoimmune disease faring when hospitalized with COVID-19?

A: Since the virus is so new, research is ongoing, and studies are small. A study published in the Annals of Rheumatic Disease in August 2020 about 123 elderly rheumatology patients (average age of 70 years) with COVID-19 reported this data:

  • 44% were hospitalized.
  • These patients had one or more of the following comorbidities (diabetes, various forms of heart disease, lung disease or liver disease).
  • Their length of stays ranged from 6 days to 14 days.
  • Twelve patients died.

Study authors acknowledged study limitations due to the small number of patients and cautioned that “the data are not generalized to other patients with autoimmune and inflammatory arthritis.” 

A larger study (2,154 patients) published in the Annals of Rheumatic Disease in May 2020 reported that the 52 rheumatology patients were not more likely than patients without rheumatic disease to require hospitalization and receive oxygen therapy. However, being on prednisone at doses of 10 mg per day or higher does increase the risk of more severe disease and being hospitalized with COVID-19. Mortality rates were similar between rheumatology patients and those without rheumatic diseases.

Question: Are people with osteoarthritis more likely to be hospitalized when they have a COVID-19 infection?

A: People with OA are at the same risk as the general population. Comorbid diseases frequently occurring in patients with OA such as diabetes and obesity put patients at higher risk.

Question: Are people with autoimmune or inflammatory arthritis who have COVID-19 infections more likely to die than people who have COVID-19 infections but no autoimmune disease?

A: Data regarding rheumatology patients are limited because the virus is so new.  An analysis of existing studies was reported in an article published in the Journal of Infection in September 2020.

Drawing from a review of five studies representing 2091 patients, study authors reported that autoimmune disease was associated with:

  • A 1.21-fold increased risk of severe COVID-19 disease
  • A 1.31-fold increased risk of mortality in patients with COVID-19.

That means people with autoimmune diseases and COVID-19 infections are slightly more likely than people without autoimmune diseases and a COVID-19 infections to have severe disease and die.

Study authors say that the results should be interpreted with caution since the sample size of patients is small, and five of the six studies are from China. They acknowledge that more, high-quality studies are needed.

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