SARS-CoV-2 Infection and COVID-19 Outcomes in Rheumatic Diseases: A Systematic Literature Review and Meta-Analysis

Area of Science:

• Rheumatology
• Infectious Diseases
• Epidemiology

Background:

• The impact of SARS-CoV-2 infection on patients with rheumatic and musculoskeletal diseases (RMDs) remains incompletely understood.
• Quantifying the relative risk of infection and disease severity in RMD patients is crucial for clinical management and public health strategies.

Purpose of the Study:

• To systematically review and quantify the risk of SARS-CoV-2 infection in individuals with RMDs.
• To describe the clinical outcomes, including hospitalization, intensive care unit (ICU) admission, mechanical ventilation, and mortality, of COVID-19 in RMD patients.

Main Methods:

• A systematic literature review was performed across 14 databases from January 2019 to February 2021.
• Included studies were observational or experimental, focusing on comparative rates of SARS-CoV-2 infection and COVID-19 outcomes in RMD patients.
• Meta-analyses calculated risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (CIs) using random effects models.

Main Results:

• The review included 100 studies, with 54 having a low risk of bias.
• Patients with RMDs exhibited an increased prevalence of SARS-CoV-2 infection (RR 1.53 [95% CI 1.16-2.01]).
• Hospitalization, ICU admission, and mechanical ventilation rates were similar between RMD patients and controls, but mortality was significantly higher in RMD patients (OR 1.74 [95% CI 1.08-2.80]).

Conclusions:

• Patients diagnosed with rheumatic and musculoskeletal diseases have a demonstrably higher incidence of SARS-CoV-2 infection.
• The findings indicate an elevated mortality rate associated with COVID-19 among individuals with RMDs, highlighting a vulnerable population.