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Findings from the Second Wave of Covid-19 In England: Infections, deaths and the impact of steroids amongst people with Rare Autoimmune Rheumatic Diseases. Results from the RECORDER Project

Background

We are a team of doctors and researchers from the RECORDER project (Registration of Complex Rare Diseases Exemplars in Rheumatology), working with the University of Nottingham, Nottingham University Hospitals NHS Trust and the National Disease Registration Service at NHS England (formerly NHS Digital). We used electronic health records that cover the whole of England for this research.

Our earlier research looked at the first wave of the pandemic in England (March to July 2020). It 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 COVID-19 infection.

In this study, we did the same as the first study, but for the second wave of the COVID-19 pandemic. This wave took place between August 2020 and April 2021. We also looked at whether taking steroids affected the risk of death.

Our findings

We studied nearly 170,000 people in England with rare autoimmune rheumatic diseases. During the second wave of the COVID-19 pandemic in England, we found that:

  • 9,961 (5.92%) had COVID-19 infection (PCR test positive)
  • Taking age into account, people with rare autoimmune rheumatic diseases had a similar risk of COVID-19 infection to that of the general population
  • 1,342 (0.80%) of people living with rare autoimmune rheumatic disease died following COVID-19 infection
  • Taking age and sex into account, death following COVID-19 was 2.7x more common in people with rare autoimmune rheumatic disease compared to the general population
  • There was no evidence of an increase in deaths from other causes, such as heart attacks.

Implications for health policy

Our results show that people with rare autoimmune rheumatic diseases remained at increased risk of COVID-19-related death during the second wave of the pandemic. The risk was higher in those taking steroids, and the risk got higher as the steroid dose increased. This should form part of the decision-making process when considering starting steroid treatment.

We did not find an increase in deaths from non-COVID-19 causes such as heart attacks. However, a delayed impact due to later or missed diagnoses remains possible.

Megan Rutter, Peter C Lanyon, Matthew J Grainge, Richard Hubbard, Mary Bythell, Peter Stilwell, Jeanette Aston, Sean McPhail, Sarah Stevens, Fiona A Pearce, COVID-19 infection, admission and death and the impact of corticosteroids amongst people with rare autoimmune rheumatic disease during the second wave of covid-19 in England: results from the RECORDER Project, Rheumatology, 2023;, kead150, https://doi.org/10.1093/rheumatology/kead150