Duration of symptoms after onset of COVID-19 in autoimmune rheumatic diseases investigated

A prolonged duration of COVID-19 symptoms was examined in patients with systemic autoimmune rheumatic diseases (SARDs) in a study published in RMD open. While the majority of patients with SARDs had full symptom relief by day 15 after COVID-19 onset, some reported symptoms lasting at least 28 days, with 1 in 10 having symptoms for at least 90 days.

Researchers analyzed data from the COVID-19 Global Rheumatology Alliance Vaccine Survey to examine prolonged COVID-19 symptom duration in patients with SARDs. The survey was distributed to adult patients with SARDs around the world, and responses submitted between April and October 2021 were included in the analysis.

Eligible respondents had tested positive for COVID-19 at some point prior to the survey. Participants were asked to indicate the severity and duration of symptoms of COVID-19 in addition to sociodemographic and clinical data. Prolonged symptom duration was defined as one that lasted at least 28 days. Data from patients with symptoms lasting at least 90 days were also collected.

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Logistic regression was used to identify correlates of prolonged symptom duration in people infected with COVID-19. The models were adjusted for age as a continuous variable.

A total of 11,415 patients from 102 countries participated in the survey, of which 497 reported a test-confirmed diagnosis of COVID-19. After excluding patients with no known duration of symptoms, the study cohort comprised 441 patients. The mean age was 48.2 ± 12.6 years; 83.7% were women; and most respondents lived in America (63.2%) or Europe (30.5%). The most common SARD diagnoses were rheumatoid arthritis (39.5%), lupus (15.6%), inflammatory myositis (11.6%) and Sjögren’s syndrome (11.6%). Most patients (82.0%) reported taking at least 1 disease-modifying anti-inflammatory drug (DMARD) at the time of the survey. The most common comorbidities were hypertension (26.5%), obesity (23.1%), and pulmonary disease (18.1%).

The median COVID-19 symptom duration was 15 days (IQR, 7-25 days). A total of 107 (24.2%) patients had persistent symptoms lasting 28 days or more. In addition, 42 (9.8%) patients reported symptoms lasting 90 days or more.

Compared to patients with symptom duration less than 28 days, those with symptoms lasting 28 days or longer were more likely to report that COVID-19 interfered with their daily activities (age-adjusted odds ratio [aOR], 4.02; 95% CI, 2.31-7.31) during the acute phase. Hospitalization for COVID-19 was also associated with a significantly increased likelihood of prolonged symptoms (OR, 6.49; 95% CI, 3.03-14.1). Patients with COVID-19 onset between January and July 2021 had a lower likelihood of prolonged symptom duration compared to patients with onset in June 2020 or earlier (aOR, 0.42; 95% CI, 0.21-0.81). Additional correlates of prolonged symptoms were a greater number of comorbidities (aOR, 1.11 per comorbidity; 95% CI, 1.02-1.21) and a diagnosis of osteoarthritis (aOR, 2.11, 95% CI 1.01- 4:27).

The results of the study showed that around 1 in 4 patients with SARDs may have persistent COVID-19 symptoms in the month following the outbreak. In addition, 1 in 10 patients reported symptoms lasting 3 months or longer.

Study limitations included the lack of a control group, cross-sectional design, and the use of self-report data rather than medical record information.

“Future studies are needed to explore the possible relationships between immunomodulatory drugs, SARD type/flare, vaccine doses, and novel virus variants with prolonged COVID-19 symptoms and other post-acute consequences of COVID-19 in people with SARDs,” the researchers noted Celebration.

Disclosure: Several study authors declared their affiliation with biotech, pharmaceutical, and/or device companies. For a full list of authors’ disclosures, see the original reference.

Relation

DiIorio M, Kennedy K, Liew JW, et al. Longer COVID-19 symptom duration in people with systemic autoimmune rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey. RMD open. 2022;8(2):e002587. doi:10.1136/rmdopen-2022-002587