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The effect of COVID-19 infection on patients with rheumatic diseases in China

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Abstract

Objectives

At the end of 2022, the COVID-19 outbreak erupted in China, and BA.5.2 or BF.7 subtypes of Omicron novel variations were implicated in more than 90% of the cases. We created a real-world questionnaire survey to better understand how this new variant pandemic was affecting rheumatic patients in China.

Methods

During the COVID-19 outbreak in China, the subjects of this study were rheumatic patients and non-rheumatic individuals (control group), who were matched for sex and age. Professional physicians carefully questioned the participants before administering a questionnaire as part of the study. This study focused on the general baseline characteristics, clinical symptoms and treatment after COVID-19 infection, and the target populations’ awareness of COVID-19.

Results

The study included 1130 participants, of whom 572 were assigned to the rheumatic group and 558 to the control group. The percentage of vaccinated controls was significantly higher than that of rheumatic patients (90.1% vs. 62.8%, p < 0.001), while the rate of COVID-19 infection was not significantly different between the two groups (82.3% vs. 86.6%, p = 0.051). Patients with rheumatic disease experienced substantially more days of fever following infection (2.87 ± 3.42 vs. 2.18 ± 1.65, p = 0.002) compared to individuals in the control group. The rheumatic patients had a greater prevalence of cough (67.1% vs. 54.0%, p < 0.001), somnipathy (13.8% vs. 6.0%, p < 0.001), and conjunctivitis/ophthalmodynia (5.3% vs. 2.1%, p = 0.008), while dry throat/throat pain/weakness (49.9% vs. 59.4%, p = 0.003), myalgia/osteodynia (33.3% vs. 41.8%, p = 0.003), and dyspnea (14.0% vs. 25.3%, p < 0.001) were more likely to occur in non-rheumatic group after infection. Human immunoglobulin (2.1% vs. 0.2%, p = 0.006), glucocorticoids (19.5% vs. 1.6%, p < 0.001), oxygen support (6.8% vs. 2.1%, p < 0.001), and traditional Chinese medicine (21.9% vs. 16.6%, p = 0.037) were all more frequently used by rheumatic patients with COVID-19 infection. People in the control group were more confused about whether to use masks in following social activities after contracting COVID-19 (14.7% vs. 7.6%, p = 0.001). In the control group, more individuals than patients with rheumatic disease (25.1% vs. 13.4%, p < 0.001) expressed an interest to receive the vaccine again. After being exposed to COVID-19, the majority of rheumatic patients (66.9%) reported no discernible change, only 29.1% reported a worsening of their symptoms, and the remaining 4% indicated an improvement.

Conclusions

After the COVID-19 outbreak in China, the proportion of patients with rheumatic diseases infected with the virus was similar to that of normal individuals. But the clinical symptoms, follow-up treatment requirements, and awareness of the COVID-19 among rheumatic patients were distinct from those among non-rheumatic patients, necessitating the use of individualized diagnosis and treatment plans as well as health advice by medical professionals in clinical work.

Key Points

• Despite there were different comorbidities and vaccination rates, the rate of COVID-19 infection in patients with rheumatic disease was similar to that of normal individuals.

• After COVID-19 infection, rheumatic patients and normal controls had different clinical symptoms and drug usage.

• After being exposed to COVID-19, the majority of rheumatic patients felt no significant change in the primary disease, while the normal controls was more likely to accept a new vaccine injection and confused about whether to use masks in following social activities.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This study was supported by grants from the National Natural Science Foundation of China (32070883) and funding for Clinical Trial from the affiliated Drum Tower Hospital, Medical School of Nanjing University (2022-YXZX-MY-05, 2022-LCYJ-MS-38), and the Puai Medical Research Fund of Beijing Bethune Charitable Foundation (PAYJ-008).

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Author notes

  1. Peng Lai, Haifeng Chen and Yunxia Yan contributed equally to this work.

Authors and Affiliations

  1. Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China

    Peng Lai, Yunxia Yan, Mengru Du, Zhiling Zhao, Dandan Wang, Jun Liang, Lingyu Geng, Xue Xu & Lingyun Sun

  2. The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, 299 Qingyang Road, Wuxi, 214000, Jiangsu, China

    Haifeng Chen

Authors
  1. Peng Lai
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Contributions

LJ, GL, and XX designed and financially supported the study. LP, CH, YY, DM, ZZ, and WD collected the data. LP, CH, and YY performed the data analysis. LP, LJ, and XX interpreted the data and wrote the manuscript. LJ, XX, and SL critically provided several suggestions for the revision of the paper. The authors read and approved the final manuscript.

Corresponding authors

Correspondence to Jun Liang, Lingyu Geng or Xue Xu.

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Lai, P., Chen, H., Yan, Y. et al. The effect of COVID-19 infection on patients with rheumatic diseases in China. Clin Rheumatol 43, 1199–1206 (2024). https://doi.org/10.1007/s10067-023-06825-z

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  • DOI: https://doi.org/10.1007/s10067-023-06825-z

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