New research has found that people with rare autoimmune rheumatic diseases (including lupus) are at an increased risk of contracting COVID-19 and of COVID-19-related death. The findings demonstrate the urgent need to understand the effectiveness of the vaccines among people with these diseases.

Experts found that people with these conditions were 54% more likely to test positive for a COVID-19 infection, and death related to COVID-19 was 2.4 times more likely than for people in the general population (taking their age into account).

The findings, currently published as a pre-print (HERE), are the work of a team of doctors and researchers from RECORDER (Registration of Complex Rare Diseases Exemplars in Rheumatology), which is a joint project between the University of Nottingham, Nottingham University Hospitals NHS Trust and the National Disease Registration Service at Public Health England.

Research from the team earlier this year, showed that people with rare autoimmune rheumatic diseases such as vasculitis, lupus, scleroderma, juvenile idiopathic arthritis, myositis and Behcet’s disease were more likely to die, from any cause, during the first two months of the pandemic. However, they were not sure why this was happening.

In this latest study, the team looked at nearly 170,000 people in England with rare autoimmune rheumatic diseases. Between March and July 2020, during the first wave of the COVID-19 pandemic in England, they found:

• 1,874 people (1.11%) had COVID-19 infection (PCR test positive).
• Taking age into account, the infection rate in people with rare autoimmune rheumatic diseases was 54% higher than in the general population.
• The increased infection rate occurred despite shielding policies.
• 713 (0.42%) people living with rare autoimmune rheumatic disease died related to COVID-19 infection
• COVID-19 related death was 2.4 times more common in people with rare autoimmune rheumatic disease compared to the general population (taking age and sex into account)

There was no evidence of an increase in deaths from other causes, such as heart attacks, during the time period studied, although it may be too early to see any negative effects of the pandemic on the wider healthcare system.

Dr Megan Rutter, lead author of the study, from the School of Medicine at the University of Nottingham, said: “As far as we are aware, this is the first study to show conclusively that people with rare autoimmune rheumatic diseases are more likely to die from COVID-19 infection, and that their risk is higher than that reported for people with more common autoimmune diseases. Our findings confirm that the assumption made at the start of the pandemic, that people with rare autoimmune rheumatic diseases would be clinically extremely vulnerable to the effect of COVID-19 infection, were correct.

These findings are particularly important as recently published data show that people who are immunosuppressed, which includes many people with rare autoimmune rheumatic diseases, do not respond well to the COVID-19 vaccination, and many are left unprotected.

It is now vital that the health of people with these conditions is made a specific priority in public health policy, particularly now all restrictions have been lifted and community infection rates are high.”

Paul Howard, Chief Executive of LUPUS UK, said: “These findings come at an important time, when the vast majority of COVID-19 restrictions have been lifted and case numbers remain high across the UK. Many people with diseases like lupus, vasculitis and other rare autoimmune conditions are on immunosuppressant medications and are expressing anxiety about having much less support to avoid contracting the virus whilst their risk is largely unchanged from last year. We hope these findings will encourage employers and policymakers to take additional measures to safeguard people living with these diseases.”

 

It is generally recommended that adults with lupus should receive the COVID-19 vaccination. You can read more about lupus and COVID-19 vaccination in our article HERE. For more general information and guidance about the COVID-19 pandemic, take a look at our article HERE.

 

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“COVID-19 infection, hospitalisation and death Amongst People with Rare Autoimmune Rheumatic Disease in England. Results from the RECORDER Project.”
Megan Rutter, Peter C Lanyon, Matthew J Grainge, Richard Hubbard, Emily Peach, Mary Bythell, Peter Stilwell, Jeanette Ashton, Sarah Stevens, Fiona A Pearce
2020.10.09.20210237; doi: https://doi.org/10.1101/2021.08.17.21260846 

 

The RECORDER project (Registration of Complex Rare Diseases Exemplars in Rheumatology) is a joint initiative between the University of Nottingham and the National Disease Registration Service at Public Health England.