Incidence and predictors of COVID-19 and flares in patients with rare autoimmune diseases: a systematic survey and serological study at a national reference center in France

Abstract

Background The risk of severe COVID-19 and its determinants remain largely unknown in patients with autoimmune and inflammatory rheumatic diseases. The objective of this study was to assess the prevalence of COVID-19 infection in patients followed for rare autoimmune diseases as well as the predictors of COVID-19 and disease flare-ups. Methods Cross-sectional phone survey from April 9, 2020, to July 2, 2020, during which patients with autoimmune diseases followed at the National Reference Center for Rare Autoimmune diseases of Strasbourg were systematically contacted by phone and sent a prescription for a SARS-CoV-2 serology. Results One thousand two hundred thirty-two patients were contacted. One thousand fifty-five patients with a confirmed diagnosis of systemic autoimmune disease were included (4 unreachable, 4 moves abroad, 5 deaths before pandemic, 50 without consent, and 114 without autoimmune disease). Among them, 469 (44.5%) patients were tested for SARS-CoV-2 serology. Thirty-nine patients (7.9%) had SARS-CoV-2 infection (either through chest CT-scan [n = 5], RT-PCR on nasopharyngeal swab [n = 14], or serology [n = 31]) among the 496 who underwent at least one of those 3 diagnosis modalities. Of the 39 proven cases, 33 had clinical manifestations (6 asymptomatic patients were diagnosed through systematic serology testing), 31 were managed by home care, 3 were hospitalized due to a need for oxygenation, two required admission to an intensive care unit, and one died. Among patients with confirmed SARS-CoV-2 infection, reported flares were more frequent than in uninfected patients (26.3% [10/38] vs. 7.0% [32/457], p < 0.0001). Preventive sick leave had no significant impact on the prevalence of SARS-CoV-2 infection (5.8% [3/53]) compared to work continuation (7.6% [30/397], p = 0.64). Overall, the seroprevalence of SARS-CoV-2 was 6.6% (31/469) which was numerically lower to the Grand-Est general population estimated to be 9.0%. Conclusions This systematic survey of more than 1000 patients with rare systemic autoimmune diseases reports a low prevalence of proven SARS-CoV-2 infection and very rare severe infections, probably related to good compliance with prophylactic measures in these patients.

The Flare of Rheumatic Disease After SARS-CoV-2 Vaccination: A Review

“…COVID-19 vaccine and SARS-CoV-2 infection partly shared mechanisms for triggering RD relapse (7,8). As shown above, the vaccine showed no direct association with flare, while SARS-CoV-2 infection was reported as an independent risk factor for RD flare in some studies (52)(53)(54). The flare rate of RD after SARS-CoV-2 infection presented a vastly higher flare risk than that after vaccination (52)(53)(54)(55)(56)(57)(58), with most flare rates being higher than 20% and some even higher than 40%.…”

Assessing the Impact of COVID-19 Vaccines on Sickle Cell Anaemia Patients: A Comparative Analysis of Biochemical and Haematological Parameters

“…Although the findings demonstrate a statistically significant increase in illness flare (12.5% vs. a baseline rate of 8.6%), the clinical relevance of this increase is uncertain. SARS-CoV-2 infection, on the other hand, has been demonstrated numerous times to be an independent risk factor for rheumatic illness flare, ranging from 20–40% [ 43 , 44 , 45 ]. As a result, people with inflammatory arthritis should still be advised to be vaccinated against COVID-19.…”

Should we vaccinate during an active rheumatic disease?

“…[16] Similarly, a phone survey involving 1055 AIIRD patients followed at the National Reference Center for Rare Autoimmune Diseases of Strasbourg, reported an increased prevalence of flare among the patients infected with SARS-CoV-2 than in uninfected patients (26.3% vs. 7.0%, p < 0.0001). [17].…”

“…Felten and colleagues revealed that having an exacerbation in the last year before vaccination was associated with an increased risk of SLE flare after COVID-19 vaccination (RR 5.52, 95% CI 2.17-14.03; p < 0.0001) according to Connolly and colleagues who highlighted how the use of combination therapy and exacerbations in the 6 months preceding vaccination, were associated with exacerbations. [17,23].…”