National registry for patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 in Germany (ReCoVery): a valuable mean to gain rapid and reliable knowledge of the clinical course of SARS-CoV-2 infections in patients with IRD

Abstract

ObjectivesPatients with inflammatory rheumatic diseases (IRD) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be at risk to develop a severe course of COVID-19. The influence of immunomodulating drugs on the course of COVID-19 is unknown. To gather knowledge about SARS-CoV-2 infections in patients with IRD, we established a registry shortly after the beginning of the pandemic in Germany.MethodsUsing an online questionnaire (www.COVID19-rheuma.de), a nationwide database was launched on 30 March 2020, with appropriate ethical and data protection approval to collect data of patients with IRD infected with SARS-CoV-2. In this registry, key clinical and epidemiological parameters—for example, diagnosis of IRD, antirheumatic therapies, comorbidities and course of the infection—are documented.ResultsUntil 25 April 2020, data from 104 patients with IRD infected with SARS-CoV-2 were reported (40 males; 63 females; 1 diverse). Most of them (45%) were diagnosed with rheumatoid arthritis, 59% had one or more comorbidities and 42% were treated with biological disease-modifying antirheumatic drugs. Hospitalisation was reported in 32% of the patients. Two-thirds of the patients already recovered. Unfortunately, 6 patients had a fatal course.ConclusionsIn a short time, a national registry for SARS-CoV2-infected patients with IRD was established. Within 4 weeks, 104 cases were documented. The registry enables to generate data rapidly in this emerging situation and to gain a better understanding of the course of SARS-CoV2-infection in patients with IRD, with a distinct focus on their immunomodulatory therapies. This knowledge is valuable for timely information of physicians and patients with IRD, and shall also serve for the development of guidance for the management of patients with IRD during this pandemic.

A multidisciplinary registry of patients with autoimmune and immune-mediated diseases with symptomatic COVID-19 from a single center

“…Those patients under glucocorticoid treatment had a 5-fold higher risk of admission, while patients under biologic DMARDs and specifically, those receiving anti-TNF had lower rates of admission [ 37 ]. In a national registry for patients with inflammatory rheumatic diseases in Germany, hospitalized patients were more often treated with glucocorticoids while bDMARDs were used less often [ 38 ]. A cohort from New York [ 39 ] including patients with inflammatory arthritis reported higher admission rates in patients receiving glucocorticoids after adjusting for body mass index and comorbidities.…”

Older age, comorbidity, glucocorticoid use and disease activity are risk factors for COVID-19 hospitalisation in patients with inflammatory rheumatic and musculoskeletal diseases

“…For this reason, a national registry was established allowing a rapid and timely collection of RMD cases with confirmed SARS-CoV-2 infections in Germany in order to analyse the clinical course of COVID-19 in patients with RMD and to develop guidance for the management of patients with RMD during the COVID-19 pandemic. 19 The aim of this analysis was to identify risk factors for hospitalisation, comparing non-hospitalised patients with RMD to hospitalised patients, stratified by the need for invasive ventilation.…”

Updated recommendations of the German Society for Rheumatology for the care of patients with inflammatory rheumatic diseases in times of SARS-CoV-2—methodology, key messages and justifying information

“…(LoE IV, LoA 10.0) It is likely that the known risk factors for infections in patients with an IRD also apply to SARS-CoV-2. Validated risk factors for infections in patients with an IRD include older age, obesity, multimorbidity (especially pre-existing lung disease, pre-existing cardiovascular disease, diabetes), a history of previous serious infections, long-term therapy with GCs (especially >5 mg/day), therapy with DMARDs and other immunosuppressive drugs (exceptions are hydroxychloroquine, sulfasalazine), high activity of the underlying rheumatic disease, current or previous (up to 8 weeks) therapy with cyclophosphamide and acquired or congenital immunodeficiencies (in particular Ig deficiency <4 g/dl IgG, lymphopenia < 500 cells/µl, CD4 T cell count <200/µl) [ 1 , 11 , 18 ]. It is likely that the known risk factors for severe COVID-19 disease also apply to patients with an IRD [ 11 , 18 ].…”