Coronavirus Disease-2019 Infection among Asians with Autoimmune Rheumatic Diseases—Single Centre Experience in Malaysia
Authors:   Department of Internal Medicine, Rheumatology Unit, Raja Perempuan Zainab II Hospital, Kota Bharu, Kelantan 15586, Malaysia, Ng Kiah L. , Mahadevan Tara ,   Department of Internal Medicine, Rheumatology Unit, Raja Perempuan Zainab II Hospital, Kota Bharu, Kelantan 15586, Malaysia and Malaysian Society of Rheumatology, Petaling Jaya, Selangor 47410, Malaysia, Nordin Mohd H. ,   Department of Internal Medicine, Rheumatology Unit, Raja Perempuan Zainab II Hospital, Kota Bharu, Kelantan 15586, Malaysia and Malaysian Society of Rheumatology, Petaling Jaya, Selangor 47410, Malaysia, Ismail Asmahan M. ,   Department of Internal Medicine, Rheumatology Unit, Raja Perempuan Zainab II Hospital, Kota Bharu, Kelantan 15586, Malaysia and Malaysian Society of Rheumatology, Petaling Jaya, Selangor 47410, Malaysia
Published: March 2024

Objectives The coronavirus disease-2019 (COVID-19) pandemic had swiped through the globe since March 2020, claiming many lives. Patients with autoimmune rheumatic diseases (ARD) are potentially at high-risk for severe infection and poor outcome, due to concomitant co-morbidities, disease activity, and immunosuppressive (IS) therapy. We conducted a retrospective observational study to examine the severity and outcome of COVID-19 infection among the Asian population. Materials and Methods The cases were identified through our local healthcare network and patients’ own narration, from March 2020 until April 2022. The data were analyzed with both parametric and non-parametric tests using StatPlus, which included Kruskal-Wallis ANOVA and logistic regression. Results A total 71 cases of COVID-19 infection were recorded, with 9 recurrent infections. All patients were South East Asians and the majority (95.8%) were female. Their median age was 39-years-old. The most common diagnosis was systemic lupus erythematosus (SLE) (56.5%), followed by rheumatoid arthritis (RA) (27.4%). Most patients (54.9%) attained remission and low disease activity for ARD prior to infection. As per treatment, 56.3% of patients were prescribed at least one IS. Fifty-nine point two percent (59.2%) had used steroids, with a mean dose of 6.8±10.5 mg once daily. The COVID-19 infection was asymptomatic and mild in most cases (81.7%). Twelve point seven percent (12.7%) of patients were in severe and critical stages. The case fatality rate was 4.2%. Prior to infection, only 57.7% of patients had a complete vaccination (≥2 doses). Seventy-seven point five percent (77.5%) had at least 1 risk factor portending severe infection. Univariate logistic regression (LR) analyses showed severe COVID-19 infection could be predicted by number of vaccines received, ARD activity and COVID-19 variant type. The use of IS could be associated with better infection outcomes (full recovery without sequelae) and reduced fatality. The type of IS used might affect the infection outcomes too. In patients with complete vaccination, active ARD could predict severe infection. Better infection outcomes could be associated with use of IS. In contrary, risk of fatality could be higher in patients with active ARD and use of high-dose steroids. Further multivariate LR analyses however, did not reveal any predictive factors associated with severe infection, poor infection outcomes and case fatality. Conclusion Our study showed that ARD patients are potentially at risk of severe COVID-19 infection and poor outcomes especially in active ARD state. IS use may be associated with better infection outcomes, perhaps through immunomodulatory effects. In patients with complete vaccination, active ARD and high-dose steroids could be the significant confounding factors. The limitations of this study are the small sample size, and potential bias and error.