Prolonged COVID-19 symptom duration in people with systemic autoimmune rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey

Michael DiIorio; Kevin Kennedy; Jean W Liew; Michael S Putman; Emily Sirotich; Sebastian E Sattui; Gary Foster; Carly Harrison; Maggie J Larché; Mitchell Levine; Tarin T Moni; Lehana Thabane; Suleman Bhana; Wendy Costello; Rebecca Grainger; Pedro M Machado; Philip C Robinson; Paul Sufka; Zachary S Wallace; Jinoos Yazdany; Monique Gore-Massy; Richard A Howard; More A Kodhek; Nadine Lalonde; Laura-Ann Tomasella; John Wallace; Akpabio Akpabio; Deshiré Alpízar-Rodríguez; Richard P Beesley; Francis Berenbaum; Inita Bulina; Eugenia Yupei Chock; Richard Conway; Alí Duarte-García; Eimear Duff; Tamer A Gheita; Elizabeth R Graef; Evelyn Hsieh; Lina El Kibbi; David Fl Liew; Chieh Lo; Michal Nudel; Aman Dev Singh; Jasvinder A Singh; Namrata Singh; Manuel F Ugarte-Gil; Jonathan S Hausmann; Julia F Simard; Jeffrey A Sparks

doi:10.1136/rmdopen-2022-002587

Prolonged COVID-19 symptom duration in people with systemic autoimmune rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey

RMD Open. 2022 Sep;8(2):e002587. doi: 10.1136/rmdopen-2022-002587.

Authors

Michael DiIorio^{1

2

3}, Kevin Kennedy⁴, Jean W Liew⁵, Michael S Putman⁶, Emily Sirotich⁷, Sebastian E Sattui⁸, Gary Foster⁹, Carly Harrison¹⁰, Maggie J Larché¹¹, Mitchell Levine¹², Tarin T Moni¹³, Lehana Thabane¹², Suleman Bhana¹⁴, Wendy Costello¹⁵, Rebecca Grainger¹⁶, Pedro M Machado^{17

18}, Philip C Robinson^{19

20}, Paul Sufka²¹, Zachary S Wallace^{2

22}, Jinoos Yazdany²³, Monique Gore-Massy²⁴, Richard A Howard²⁵, More A Kodhek²⁶, Nadine Lalonde²⁷, Laura-Ann Tomasella²⁸, John Wallace²⁹, Akpabio Akpabio³⁰, Deshiré Alpízar-Rodríguez³¹, Richard P Beesley³², Francis Berenbaum³³, Inita Bulina³⁴, Eugenia Yupei Chock³⁵, Richard Conway³⁶, Alí Duarte-García³⁷, Eimear Duff³⁸, Tamer A Gheita³⁹, Elizabeth R Graef⁴⁰, Evelyn Hsieh^{41

42}, Lina El Kibbi⁴³, David Fl Liew^{44

45}, Chieh Lo⁴⁶, Michal Nudel⁴⁷, Aman Dev Singh^{48

49}, Jasvinder A Singh^{50

51}, Namrata Singh⁵², Manuel F Ugarte-Gil^{53

54}, Jonathan S Hausmann^#^{55

56}, Julia F Simard^#^{57

58}, Jeffrey A Sparks^#^{59

2

3}

Affiliations

¹ Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
² Medicine, Harvard Medical School, Boston, Massachusetts, USA.
³ Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁴ Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
⁵ Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA.
⁶ Division of Rheumatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁷ Medicine, McMaster University, Hamilton, Ontario, Canada.
⁸ Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
⁹ Department of Health Research Methods, Evidence and Impact (HEI); Medicine, McMaster University, Hamilton, Ontario, Canada.
¹⁰ LupusChat, New York, New York, USA.
¹¹ Divisions of Clinical Immunology and Allergy/Rheumatology, McMaster University Department of Medicine, Hamilton, Ontario, Canada.
¹² Department of Health Research Methods, Evidence and Impact (HEI), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
¹³ Department of Biochemistry & Biomedical Sciences, McMaster University Faculty of Science, Hamilton, Ontario, Canada.
¹⁴ Rheumatology, Crystal Run Healthcare, Middletown, New York, USA.
¹⁵ N/A, Irish Children's Arthritis Network (iCAN), Tipperary, Ireland.
¹⁶ Department of Medicine, University of Otago Wellington, Wellington, New Zealand.
¹⁷ MRC Centre for Neuromuscular Diseases, University College London, London, UK.
¹⁸ Rheumatology, University College London Centre for Rheumatology, London, UK.
¹⁹ Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
²⁰ Metro North Hospital & Health Service, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia.
²¹ Rheumatology, HealthPartners, St Paul, Minnesota, USA.
²² Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA.
²³ Medicine/Rheumatology, University of California, San Francisco, California, USA.
²⁴ Lupus Foundation of America Inc, Washington, District of Columbia, USA.
²⁵ Spondylitis Association of America, Van Nuys, California, USA.
²⁶ Lupus Foundation of Kenya, Nairobi, Kenya.
²⁷ Patient Board, Covid-19 Global Rheumatology Alliance, London, Ontario, Canada.
²⁸ Arthritis Kids South Africa, Johannesburg, South Africa.
²⁹ Rheumatology, Autoinflammatory UK, Edinburgh, UK.
³⁰ Internal Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria.
³¹ Research Unit, Mexican College of Rheumatology, Coyoacan, Mexico.
³² Juvenile Arthritis Research, European Network for Childhood Arthritis (ENCA), Tonbridge, UK.
³³ Rheumatology, Sorbonne Université, Paris, France.
³⁴ Rheumatology, Paul Stradins Clinical University Hospital, Riga, Latvia.
³⁵ Section of Rheumatology, Yale School of Medicine, New Haven, Connecticut, USA.
³⁶ Department of Rheumatology, Saint James's Hospital, Dublin, Ireland.
³⁷ Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.
³⁸ Rheumatology, Saint James's Hospital, Dublin, Ireland.
³⁹ Rheumatology and Clinical Immunology, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁴⁰ Rheumatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁴¹ Division of Rheumatology, Yale School of Medicine, New Haven, Connecticut, USA.
⁴² Rheumatology, VA Connecticut Healthcare System-West Haven Campus, West Haven, Connecticut, USA.
⁴³ Internal Medicine Department, Division of Rheumatology, Specialized Medical Center Hospital, Riyadh, Saudi Arabia.
⁴⁴ Rheumatology, Austin Health, Heidelberg West, Victoria, Australia.
⁴⁵ Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, Victoria, Australia.
⁴⁶ Rheumatology, I-Shou University College of Medicine, Yanchau Sheng, Taiwan.
⁴⁷ N/A, The Israeli Association for RMDs patients "Mifrakim Tz'eirim", Haifa, Israel.
⁴⁸ Department of Community Medicine, Government Medical College Amritsar, Amritsar, Punjab, India.
⁴⁹ Rajindra Hospital Patiala, Patiala, Punjab, India.
⁵⁰ Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁵¹ Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA.
⁵² Medicine, Division of Rheumatology, University of Washington, Seattle, Washington, USA.
⁵³ School of Medicine, Universidad Cientifica del Sur, Lima, Peru.
⁵⁴ Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru.
⁵⁵ Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA.
⁵⁶ Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁵⁷ Epidemiology and Population Health and Department of Medicine, Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA.
⁵⁸ Department of Medicine, Clinical Epidemiology Unit, Sweden.
⁵⁹ Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA jsparks@bwh.harvard.edu.

^# Contributed equally.

Abstract

Objective: We investigated prolonged COVID-19 symptom duration, defined as lasting 28 days or longer, among people with systemic autoimmune rheumatic diseases (SARDs).

Methods: We analysed data from the COVID-19 Global Rheumatology Alliance Vaccine Survey (2 April 2021-15 October 2021) to identify people with SARDs reporting test-confirmed COVID-19. Participants reported COVID-19 severity and symptom duration, sociodemographics and clinical characteristics. We reported the proportion experiencing prolonged symptom duration and investigated associations with baseline characteristics using logistic regression.

Results: We identified 441 respondents with SARDs and COVID-19 (mean age 48.2 years, 83.7% female, 39.5% rheumatoid arthritis). The median COVID-19 symptom duration was 15 days (IQR 7, 25). Overall, 107 (24.2%) respondents had prolonged symptom duration (≥28 days); 42/429 (9.8%) reported symptoms lasting ≥90 days. Factors associated with higher odds of prolonged symptom duration included: hospitalisation for COVID-19 vs not hospitalised and mild acute symptoms (age-adjusted OR (aOR) 6.49, 95% CI 3.03 to 14.1), comorbidity count (aOR 1.11 per comorbidity, 95% CI 1.02 to 1.21) and osteoarthritis (aOR 2.11, 95% CI 1.01 to 4.27). COVID-19 onset in 2021 vs June 2020 or earlier was associated with lower odds of prolonged symptom duration (aOR 0.42, 95% CI 0.21 to 0.81).

Conclusion: Most people with SARDs had complete symptom resolution by day 15 after COVID-19 onset. However, about 1 in 4 experienced COVID-19 symptom duration 28 days or longer; 1 in 10 experienced symptoms 90 days or longer. Future studies are needed to investigate the possible relationships between immunomodulating medications, SARD type/flare, vaccine doses and novel viral variants with prolonged COVID-19 symptoms and other postacute sequelae of COVID-19 among people with SARDs.

Keywords: COVID-19; inflammation; patient reported outcome measures; vaccination.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Arthritis, Rheumatoid* / complications
Arthritis, Rheumatoid* / epidemiology
COVID-19 Vaccines
COVID-19* / epidemiology
COVID-19* / prevention & control
Female
Humans
Male
Middle Aged
Rheumatology*
Surveys and Questionnaires

Substances

COVID-19 Vaccines

Abstract

Publication types

MeSH terms

Substances

Grants and funding