By Pat Anson, PNN Editor

Patients with lupus and other forms of arthritis are not at increased risk of being hospitalized with COVID-19 due to medications that weaken their immune systems, according to researchers at NYU’s Grossman School of Medicine.

Lupus, spondyloarthritis, psoriatic and rheumatoid arthritis are autoimmune conditions in which the body’s immune system attacks joints, skin, kidneys and other tissues, causing pain and inflammation. The arthritic conditions are often treated with steroids, biologics and other immune suppressing medications, which has raised concern that the drugs could also make patients more susceptible to risks from coronavirus infection.

But in two studies recently published in the journal Arthritis and Rheumatology, researchers found that most patients with arthritis had the same risk of hospitalization as the general population.

“People with lupus or inflammatory arthritis have the same risk factors for getting seriously ill from COVID-19 as people without these disorders,” said co-author Ruth Fernandez-Ruiz, MD, a postdoctoral fellow in rheumatology in the Department of Medicine at NYU Langone.

The first study involved 226 adult patients in New York City who were being treated for mild to severe forms of lupus between April 13 and June 1, when the coronavirus pandemic peaked in the New York City region. Forty-one of the lupus patients were also diagnosed with COVID-19. Of those, 24 were hospitalized and four died. Another 42 patients had COVID-19-like symptoms but were not formally tested.

The second study involved 103 women being treated for inflammatory arthritis between March 3 and May 4 in New York City. All tested positive for COVID-19 or had symptoms highly suggesting they were infected. Twenty-seven of them were hospitalized and four died.

Researchers say the lupus patients taking immune-suppressing medications such as mycophenolate mofetil (Cellcept) and azathioprine (Imuran), had no greater risk of hospitalization than patients not using the drugs. Similarly, hospitalization rates for people with inflammatory arthritis and COVID-19 were no greater than for all New Yorkers.

“Patients receiving therapy for lupus and inflammatory arthritis should not automatically stop taking their medications for fear that they would be worse off if they also caught the coronavirus,” said co-author Rebecca Haberman, MD, a clinical instructor in rheumatology in the Department of Medicine at NYU Langone.

Haberman and her colleagues say arthritis patients taking biologic drugs such as adalimumab (Humira) and etanercept (Enbrel), or the antiviral drug hydroxychloroquine, were also at no greater or lesser risk of hospitalization than those not taking the drugs.

However, arthritis patients taking glucocorticoids, a type of steroid, even in mild doses, were up to 10 times more likely to be hospitalized than patients not using steroids. The researchers caution that although statistically significant, the study’s small size may overestimate the actual risk from steroids.

“Our findings represent the largest of its kind for American patients with lupus or arthritis and COVID-19, and should reassure most patients, especially those on immunosuppressant therapy, that they are at no greater risk of having to be admitted to hospital from COVID-19 than other lupus or arthritis patients,” said Fernandez-Ruiz.

Risk factors that can double the risk of hospitalization from COVID-19 are having multiple health conditions, such as obesity, hypertension and diabetes.