New research has revealed that people with rare autoimmune rheumatic diseases are at an increased risk of developing Covid-19 and subsequently dying from it.
Experts found that people with these conditions were 54% more likely to test positive for a Covid-19 infection, and death related to Covid-19 was 2.4 times more likely than for people in the general population when age and sex was taken into account. Researchers say there is an urgent need to understand the effectiveness of the vaccine among people with diseases such as vasculitis and lupus.
The findings, published as a pre-print in medRxiv and currently under peer review, is the work of a team of doctors and researchers from RECORDER (Registration of Complex Rare Diseases Exemplars in Rheumatology), which is a joint project between the University of Nottingham, Nottingham University Hospitals NHS Trust and the National Disease Registration Service at Public Health England.
Research from the team earlier this year showed that people with rare autoimmune rheumatic diseases such as vasculitis, lupus, scleroderma, juvenile idiopathic arthritis, myositis and Behcet's disease were more likely to die, from any cause, during the first two months of the pandemic. However, they were not sure why this was happening.
In this latest study, funded by the British Society for Rheumatology and Vasculitis UK, the team looked at nearly 170,000 people in England with rare autoimmune rheumatic diseases. Between March and July 2020, during the first wave of the Covid-19 pandemic in England, they found:
- 1,874 people (1.11%) had Covid-19 infection (PCR test positive)
- Taking age into account, the infection rate in people with rare autoimmune rheumatic diseases was 54% higher than in the general population
- 713 (0.42%) people living with rare autoimmune rheumatic disease died related to Covid-19 infection
- Covid-19 related death was 2.4 times more common in people with rare autoimmune rheumatic disease compared to the general population (taking age and sex into account)
As far as we are aware, this is the first study to show conclusively that people with rare autoimmune rheumatic diseases are more likely to die from Covid-19 infection, and that their risk is higher than that reported for people with more common autoimmune diseases. These findings are particularly important as recently published data show that people who are immunosuppressed, which includes many people with rare autoimmune rheumatic diseases, can have lower levels of protection from Covid-19 vaccination due to a weaker immune response. It is now vital that the health of people with these conditions is made a specific priority in public health policy, particularly now all restrictions have been lifted and community infection rates are high."
Dr Sanjeev Patel, President of the British Society for Rheumatology, said: "This important work helps us to understand the risk that Covid-19 poses to people with rare autoimmune rheumatic diseases. Whilst the absolute risk of death is low for people with these conditions, the relative risk is over twice that of people without rare autoimmune rheumatic diseases. The British Society for Rheumatology will continue to support researchers to understand the impact of Covid-19 on health outcomes in people with rare rheumatic conditions."
Paul Howard, Chief Executive of LUPUS UK, said: "These findings come at an important time, when the vast majority of Covid-19 restrictions have been lifted and case numbers remain high across the UK. Many people with diseases like lupus, vasculitis and other rare autoimmune conditions are on immunosuppressant medications and are expressing anxiety about having much less support to avoid contracting the virus whilst their risk is largely unchanged from last year. We hope these findings will encourage employers and policymakers to take additional measures to safeguard people living with these diseases."
