Incidence and severeness of COVID-19 hospitalisation in patients with inflammatory rheumatic disease: a nationwide cohort study from Denmark
Incidence and severeness of COVID-19 hospitalisation in patients with inflammatory rheumatic disease: a nationwide cohort study from Denmark
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炎症性风湿病患者 COVID-19 住院的发生率和严重程度：丹麦的一项全国性队列研究
作者：
R. Cordtz;J. Lindhardsen;B. Soussi;J. Vela;L. Uhrenholt;R. Westermann;S. Kristensen;H. Nielsen;C. Torp‐Pedersen;L. Dreyer
摘要目的评估炎症性风湿病（IRD）患者的COVID-19住院率;接受特定DMARD治疗的类风湿性关节炎（RA）患者的COVID-19住院率;以及RA住院患者的严重COVID-19感染率。方法2020年3月1日至8月12日在丹麦进行的全国性队列研究。估计了以下患者的COVID-19住院调整发生率：RA;脊柱关节炎，包括银屑病关节炎;结缔组织病;血管炎;和非IRD个体。此外，分别估计了接受TNF抑制剂、羟氯喹或糖皮质激素治疗和未接受TNF抑制剂、羟氯喹或糖皮质激素治疗的RA患者的COVID-19住院率。最后，对RA和非IRD个体的住院患者中的（重症监护、急性呼吸窘迫综合征或死亡）风险进行了估计。结果IRD患者（n = 58，052）与一般人群的450万人相比，部分调整后的COVID-19住院发生率增加（HR 1.46，95%CI 1.15至1.86），与RA患者的相关性最强（n = 29，440，HR 1.72，95%CI 1.29至2.30）和血管炎（n = 4072，HR 1.82，95%CI 0.91至3.64）。使用TNF抑制剂、羟氯喹或糖皮质激素均未增加COVID-19住院的发生率。2019冠状病毒病住院RA患者的重度结局HR为1.43（95% CI 0.80至2.53）。结论IRD患者比普通人群更有可能因COVID-19入院，而COVID-19住院的RA患者可能有更高的严重结局风险。特定DMARD治疗不影响住院风险。
Abstract Objectives To estimate the incidence of COVID-19 hospitalisation in patients with inflammatory rheumatic disease (IRD); in patients with rheumatoid arthritis (RA) treated with specific DMARDs; and the incidence of severe COVID-19 infection among hospitalised patients with RA. Methods A nationwide cohort study from Denmark between 1 March to 12 August 2020. The adjusted incidence of COVID-19 hospitalisation was estimated for patients with RA; spondyloarthritis including psoriatic arthritis; connective tissue disease; vasculitides; and non-IRD individuals.Further, the incidence of COVID-19 hospitalisation was estimated for patients with RA treated respectively non-treated with TNF-inhibitors, hydroxychloroquine, or glucocorticoids.Lastly, the incidence of severe COVID-19 infection (intensive care, acute respiratory distress syndrome, or death) among hospital-admitted patients was estimated for RA and non-IRD individudals. Results Patients with IRD (n = 58,052) had an increased partially adjusted incidence of hospitalisation with COVID-19 compared with the 4.5 million people in the general population (HR 1.46, 95%CI 1.15 to 1.86) with strongest associations for patients with RA (n = 29,440, HR 1.72, 95%CI 1.29 to 2.30) and vasculitides (n = 4072, HR 1.82, 95%CI 0.91 to 3.64). There was no increased incidence of COVID-19 hospitalisation associated with TNF-inhibitor, hydroxychloroquine nor glucocorticoid use. COVID-19 admitted patients with RA had a HR of 1.43 (95% CI 0.80 to 2.53) for a severe outcome. Conclusion Patients with IRD were more likely to be admitted with COVID-19 than the general population, and COVID-19 admitted patients with RA could be at higher risk of a severe outcome. Treatment with specific DMARDs did not affect the risk of hospitalisation.