COVID-19 outcomes in giant cell arteritis and polymyalgia rheumatica versus rheumatoid arthritis: A national, multicenter, cohort study

J Autoimmun. 2022 Oct;132:102868. doi: 10.1016/j.jaut.2022.102868. Epub 2022 Jul 20.

Abstract

Objectives: To determine whether giant cell arteritis and polymyalgia rheumatica (GCA/PMR) represent independent risk factors for worse outcomes in COVID-19.

Methods: Observational, national, French, multicenter cohort (NCT04353609) comprising patients aged ≥18 years with confirmed diagnoses of either GCA, PMR or rheumatoid arthritis (RA) having presented COVID-19; those under rituximab were excluded. Primary endpoint was COVID-19 severity in GCA/PMR patients as compared to RA. We also aimed to describe the evolution of GCA/PMR patients following COVID-19. Multinomial logistic regression models were performed, with and without adjustment on pre-specified confounding factors (i.e., age, sex, body mass index, arterial hypertension, diabetes and cardiovascular disease). Unadjusted and adjusted multinomial odds-ratio (OR/aOR) and their 95% confidence intervals (CIs) were calculated as effect size using RA as reference group.

Results: Between April 15, 2020, and August 20, 2021, 674 patients [45 (6.6%) GCA, 47 (7.0%) PMR, 582 (86.4%) RA; 62.8 years, 73.2% female] were included. Compared to RA patients, those with GCA/PMR were older and more frequently presented hypertension, diabetes and cardiovascular disease. Severe COVID-19 and death occurred in 24 (26.1%) and 16 (17.8%) patients with GCA/PMR, respectively. Unadjusted analyses revealed higher odds of severe COVID-19 [OR = 3.32 (95% CI 1.89-5.83; p < 0.001)] and death [OR = 3.20 (95%CI 1.67-6.13; p < 0.001)] for GCA/PMR compared to RA. After model adjustment, these odds were attenuated.

Conclusion: Patients with GCA/PMR were more likely to have severe COVID-19 and higher mortality compared to those with RA. This worse prognosis is mostly due to well known risk factors for the general population rather than vasculitis per se.

Keywords: COVID-19; Giant cell arteritis; Polymyalgia rheumatica; Rheumatoid arthritis; SARS-CoV-2.

Publication types

  • Observational Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Arthritis, Rheumatoid* / epidemiology
  • COVID-19* / epidemiology
  • Cardiovascular Diseases* / epidemiology
  • Cohort Studies
  • Female
  • Giant Cell Arteritis* / diagnosis
  • Giant Cell Arteritis* / epidemiology
  • Humans
  • Hypertension*
  • Male
  • Polymyalgia Rheumatica* / diagnosis
  • Polymyalgia Rheumatica* / epidemiology