The rate of COVID-19 infection among Latino patients with rheumatic diseases was high, particularly among those who were obese — and COVID-19 itself was a risk factor for flare of the rheumatic disease, a study from the NIH found.
In a cohort of 178 Latino patients seen from April 1 to Oct. 15, 2020, there were 32 cases of COVID-19, which represented a three-fold higher rate than was reported for the general Latino population, according to Pravitt Gourh, MD, of the Scleroderma Genomics and Health Disparities Unit at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) in Bethesda, Maryland, and colleagues.
And on a multivariate logistic regression analysis, patients whose BMI was above 30.35 had an odds ratio for COVID-19 of 3.37 (95% CI 1.5-7.7, P=0.004), they reported in Arthritis & Rheumatology.
Recognized risk factors for worse outcomes in COVID-19 include older age, obesity, and comorbidities including pulmonary disease and hypertension. Patients with rheumatic disease could be at particularly elevated risk for complications because of their aberrant immune systems and use of immunosuppressive medications, but the potential effects of the infection on the underlying disease has remained uncertain.
Latinos are a rapidly growing minority in the U.S., and have a high prevalence of risk factors such as obesity and diabetes, but many lack insurance coverage. “Latinos are more likely to work in positions considered to be essential, thus increasing their risk for exposure to infections. Such jobs often provide limited or no sick time, further perpetuating this increased risk to Latino workers,” the researchers wrote. Accordingly, COVID-19 has had a disproportionate impact on this group.
Therefore, to examine in detail the effects of COVID-19 among Latinos with rheumatic diseases, Gourh and colleagues conducted a retrospective study of patients enrolled in their observational cohort. More than 90% of the 178 Latino patients were women, and mean age was 46. The most common diagnoses were rheumatoid arthritis and systemic lupus erythematosus. The 146 Latino patients in the cohort who were not COVID-19-infected served as controls for the analysis.
Among those with confirmed COVID-19 infections, 75% were receiving hydroxychloroquine and 40.6% were on either a biologic or a small molecule therapy. Glucocorticoids were used by 21.9% of patients who were COVID-19 positive and by 38.4% of those who were COVID negative. Average daily doses were 7.4 mg and 5.5 mg, respectively.
All of the infected patients were classified as essential workers or lived in a household with an essential worker, and 78.2% lacked insurance. In almost half, antirheumatic therapies were stopped during the infection.
The incidence rate of COVID-19 was 17,978 per 100,000 among Latino rheumatic patients compared with an incidence rate of 4,689 to 5,809 per 100,000 in the general Latino population in the same Washington catchment area, and five- to 11-fold higher than the rate of 1,540 to 3,431 per 100,000 seen in the local general population.
Symptoms included cough and fever in two-thirds. Six patients required hospital admission, with two using supplemental oxygen. None of the patients were in the ICU and there were no deaths.
There was no evidence that any of the immunomodulatory treatments conferred either protection or susceptibility to the infection.
Eight patients seen during follow-up after the infection experienced a disease flare, and 10 patients reported persistent symptoms including anosmia, alopecia, and headaches. On a multivariate analysis, COVID-19 infection was associated with a more than four-fold increased risk for disease flare (OR 4.57, 95% CI 1.2-17.4, P=0.02), with flare being defined as any need for increase in immunomodulatory treatment. There was no association between stopping antirheumatic treatment and disease flare, the authors observed.
“The exact reason for the flares is unknown but we know that the COVID-19 infection leads to a proinflammatory host antiviral immune response and the mediators of this proinflammatory response can lead to a flare of the rheumatologic disease,” Gourh told MedPage Today.
None of the patients in this cohort required mechanical ventilation or died. “Possible explanations for milder disease in our patient population could include younger age, majority female, relatively mild pre-existing conditions, limited pre-infection glucocorticoid exposure, and perhaps mitigating effects of existing immunomodulatory therapy,” the researchers observed.
“We identified a three-fold higher prevalence of COVID-19 in Latino patients with rheumatic disease as compared with the general Latino population in the D.C. metropolitan area,” said co-author Alice Fike, CRNP, also of NIAMS.
“Another important finding from this study was an increased risk for rheumatic disease flare after COVID-19 infection in Latino patients. This risk was found to be independent of interruptions in immunomodulatory treatments,” she told MedPage Today.
“Future studies including marginalized populations, with larger sample sizes from different geographic locations, including younger patients, and with longer follow-up periods are warranted to confirm these findings,” the researchers concluded.
A study limitation was its observational, retrospective design.
The study was supported by the Intramural Research Programs of the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute on Minority Health and Health Disparities.