Epidemiology
Table 3 Symptoms and clinical course for study participants with rheumatic disease and COVID-19, stratified by vaccination status at the time of infection All rheumatic disease patients (N=280) Breakthrough COVID-19 infection (N=116) Non-breakthrough COVID-19 infection (N=164) P value Date of COVID-19 diagnosis, n (%) <0.0001 March 1–June 30, 2020 45 (16) 0 (0) 45 (27) July 1, 2020–January 31, 2021 97 (35) 0 (0) 97 (59) February 1–June 30, 2021 21 (8) 3 (3) 18 (11) July 1–December 16, 2021 30 (11) 29 (25) 1 (1) D ecember 17, 2021–July 8, 2022 87 (31) 84 (72) 3 (2) COVID-19 symptoms, n (%) Fatigue/malaise 220 (79) 93 (80) 127 (77) 0.66 Fever 165 (59) 66 (57) 99 (60) 0.62 Headache 175 (63) 71 (61) 104 (63) 0.71 Myalgias 162 (58) 63 (54) 99 (60) 0.33 Nasal congestion or rhinorrhoea 160 (57) 85 (73) 75 (46) <0.0001 Cough 146 (52) 73 (63) 73 (45) <0.01 Anosmia 101 (36) 25 (22) 76 (46) <0.0001 Dysgeusia 106 (38) 32 (28) 74 (45) <0.01 Sore throat 124 (44) 63 (54) 61 (37) <0.01 Dyspnoea 83 (30) 28 (24) 55 (34) 0.11 Chest pain 59 (21) 25 (22) 34 (21) 0.88 Nausea or vomiting 44 (16) 16 (14) 28 (17) 0.51 Joint pain 23 (8) 5 (4) 18 (11) 0.049 New rash, hives or blisters 17 (6) 4 (3) 13 (8) 0.14 None 64 (23) 39 (34) 25 (15) <0.01 Acute COVID-19 treatment, n (%) Dexamethasone 17 (6) 3 (3) 14 (9) 0.04 Remdesivir 12 (4) 3 (3) 9 (5) 0.37 Monoclonal antibody 52 (19) 39 (34) 13 (8) <0.0001 Nirmatrelvir/ritonavir 15 (5) 14 (12) 1 (1) <0.0001 COVID-19 severity, n (%) <0.01 Not hospitalised 244 (87) 110 (95) 134 (81) H ospitalised with or without supplemental oxygen 32 (11) 5 (4) 27 (16)
There are limited data regarding the potential impact of SARS-CoV-2 vaccination on the risk of PASC in the general population and, to our knowledge, no studies in patients with SARDs. A previous community-based study of the general popu- lation in the United Kingdom found a nearly 50% reduced risk of PASC (≥ 28 days) in those with a breakthrough infection (OR 0.51, 95% CI 0.32 to 0.82). 18 Similar findings were observed in a cohort study of the Israeli general population after COVID- 19. 35 Further, a large study conducted among Veterans Affairs beneficiaries found that the risk of cardiovascular, pulmonary, metabolic and coagulopathic sequelae was lower in those with breakthrough COVID-19. 19 Our findings expand on these prior studies, providing important new evidence in patients with SARD suggesting that despite concerns regarding the impact of SARD diagnoses and their treatments on vaccine immunoge- nicity, vaccination provides important long-term benefits after acute COVID-19. Due to the timing of introduction of SARS-CoV-2 vaccines, calendar time varied between those with and without break- through infection. Those with breakthrough infection were more often infected later in the pandemic when the Delta and Omicron variants were predominant. It is therefore possible that our findings may be the result of differences in the SARS-CoV-2 variants rather than the effects of vaccination. Some prior studies
Patient-reported outcome measures comparing PASC following breakthrough COVID-19 infection (n=48) vs PASC following non-breakthrough COVID-19 infection (n=89) were similar in terms of pain, fatigue, functional status and overall health status (online supplemental table 5). The frequency and timing relative to infection of self-reported flares of the under- lying SARD were also similar following COVID-19 infection in those with breakthrough versus non-breakthrough infection (40% vs 42%, p=0.71) (online supplemental table 6). DISCUSSION In this prospective study of patients with SARDs and COVID- 19, those with breakthrough infection had significantly shorter symptom duration and lower rates of PASC than those unvac- cinated or partially vaccinated prior to infection. This corre- sponded with less pain and fatigue, two common manifestations of PASC, in those with breakthrough infection compared with those with non-breakthrough infection following the acute course. Collectively, our findings suggest that SARS-CoV-2 vaccination reduces the risk of PASC in patients with SARD, in addition to the known reduction in the risk of severe acute COVID-19 outcomes. These results provide further rationale for vaccination among patients with SARD.
Patel NJ, et al . Ann Rheum Dis 2023; 82 :565–573. doi:10.1136/ard-2022-223439
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