Is psoriatic arthritis a risk factor for severe COVID -19 infection? Data from the Argentinian registry SARS-COVID

Abstract

Comorbidities, particularly cardio-metabolic disorders, are highly prevalent in patients with psoriatic arthritis (PsA) and they were associated with an increased risk of atherosclerotic cardiovascular disease, which have been associated with higher morbidity and mortality. Whether PsA enhances the risk of SARS-CoV-2 infection or affects the disease outcome remains to be ascertained. The purpose of the present work was to describe the sociodemographic, clinical and treatment characteristics of patients with PsA with confirmed SARS-CoV-2 infection from the SAR-COVID registry and to identify the variables associated with poor COVID-19 outcomes, comparing them with those with rheumatoid arthritis (RA) 

Cross-sectional observational study including patients ≥18 years old, with diagnosis of PsA (CASPAR criteria) and RA (ACR / EULAR 2010 criteria), who had confirmed SARS-CoV-2 infection (RT-PCR or serology) from the SAR-COVID registry. Recruitment period was between August 13, 2020 and July 31, 2021. Sociodemographic variables, comorbidities, and treatments were analyzed. To assess the severity of the infection, the ordinal scale of the National Institute of Allergy and Infectious Diseases (NIAID) was used, and it was considered that a patient met the primary outcome, if they presented criteria of categories 5 or higher on the severity scale. For this analysis, Chi2 test, Fisher's test, Student's test or Wilcoxon test, and binomial logistic regression using NIAID>=5 as dependent variable were performed.

A total of 129 PsA patients and 808 with RA were included, with similar age (51.7±12.7 vs 53.1±12.9; p=0.239), greater female sex in RA (84.7% vs 55.8 %; p<0.001).  Patients with PsA had 2 or more comorbidities (42.6% vs 27.1%; p<0.001), cardiovascular or cerebrovascular disease (11.4% vs 3.9%; p=0.033), less use of conventional DMARD and more biologics (36.4% vs 54.8%; p<0.001, 46.5% vs 23.9%; p<0.001), less methotrexate (48.1% vs 63.4%; p=0.001) and glucocorticoids (11.7% vs 42.7%; p<0.001), JAK inhibitors (3.1% vs 8.9%; p=0.038), and receiving more anti-TNF (27.1% vs 16.8 %; p=0.007). Disease activity was higher in RA (p=0.027). Smoking was low and similar (3.6% vs 8.4%; p=0.079). The frequency of NIAID≥5 was comparable between group (NIAID≥5: 19.5% vs 20.1%; p=0.976), with recovery without sequelae in more than 80%. PsA patients with NIAID≥5 in comparison with NIAID<5 were older (58.6±11.4 vs 50±12.5; p=0.002), had more frequently hypertension (52.2% vs 23%; p=0.011) and dyslipidemia (39.1% vs 15%; p=0.017). In the multivariate analysis, age (OR 1.06; 95% CI 1.02–1.11) was associated with a worse outcome of the COVID-19 (NIAID≥5) in patients with PsA, while those who received methotrexate (OR 0.34 ; 95% CI 0.11–0.92) and biological DMARDs (OR 0.28; 95% CI 0.09–0.78) had a better outcome. Mortality was higher in RA, without statistical significance (4.31% vs 0.8%, p=0.074). Regarding PsA treatment, 12.4% of PsA were receiving IL-17 inhibitors, 5.4% IL12-23 inhibitors, one patient apremilast and one abatacept. 

Although PsA patients have a higher frequency of cardiovascular and metabolic comorbidities than those with RA, the COVID-19 severity was similar.  Most of the patients had mild SARS-CoV-2 infection and a low death rate.