Q. I have an autoimmune condition, a variant of rheumatoid arthritis, and recently started medications to suppress my immune response. Am I at increased risk of getting sick and dying from Covid-19?
A. Autoimmune conditions such as rheumatoid arthritis or lupus occur when the immune system mistakenly attacks normal body tissues. Treatments that suppress the immune system in an effort to thwart the damage to normal tissues may leave patients more susceptible to infections. It stands to reason that a person with an immune system disorder thus might be more likely to get infected with Covid-19 and die from the virus. But that may not be the case.
In one study out of Italy, 1 percent of almost 2,300 patients hospitalized with Covid-19 had autoimmune rheumatologic conditions such as rheumatoid arthritis or lupus. Most of these patients had been treated with corticosteroids or other drugs that can suppress the immune system before that admission. When compared to other patients without autoimmune conditions who were admitted to the same hospital, there did not appear to be any difference overall in Covid-19 symptom duration, the length of the hospital stay, or the likelihood of dying.
A small study out of New York, also conducted in patients with autoimmune rheumatologic conditions who had Covid-19, found a hospitalization rate similar to that of the general population in New York City.
Another study examining electronic health records in the United States compared Covid-19 patients who had a different immune-mediated condition, inflammatory bowel disease, to Covid-19 patients without I.B.D. The investigators found no difference in Covid-19 severity or death between the two groups, though in this study patients previously treated with corticosteroids may have had a higher risk of severe Covid-19 infections.
In all three of these studies, older patients were more likely to have severe Covid-19 or die, which is true of the population as a whole. In two of the studies, those with accompanying medical conditions such as hypertension and obesity were also at higher risk of dying, which is also true of the general population.
It is possible that patients with autoimmune conditions, and particularly those receiving immunosuppressive therapy, are particularly rigorous with infection prevention practices such as social distancing, wearing masks and hand washing. Such measures may have contributed to improved outcomes from Covid-19 infection in this group compared to what might have been expected in an immunosuppressed population, therefore affecting the overall results of these studies. But in general, doctors have not observed a greatly increased risk of severe Covid-19 infections or death in those with autoimmune disorders.
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Dr. Mikkael Sekeres (@MikkaelSekeres) is director of the leukemia program at the Cleveland Clinic and author of the book “When Blood Breaks Down: Life Lessons From Leukemia.”
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