Bernard Combe, MD, PhD, France

Unsurprisingly, COVID-19 held centre stage at this year’s ACR Convergence 2020, just as it has across many facets of our lives and clinical practices. While it did, we as a community of rheumatologists still found ways to collaborate and support our patients. Rheumatologists from across the globe were able to share information through registries specific to COVID-19 and rheumatic and musculoskeletal disease (RMD), such as the one developed by EULAR.1 And early data from those registries came as a relief for many, including myself, with initial data showing that patients living with RMDs were not at an increased risk for COVID-19.

Instead, research showed that the COVID-19 risk factor with the biggest impact on patients living with RMDs was not their compromised immune systems, but rather, their increased rates of comorbidities.2 New data from registries presented at the ACR Convergence 2020 continued to show an increased risk for hospitalisation due to COVID-19 in patients living with both RMDs and certain comorbid conditions such as:3-6

  • Hypertension
  • Diabetes
  • Chronic kidney disease

These same comorbidities are common among patients with RA, and as rheumatologists, we know that when treating patients living with RA, we must consider the impacts of these comorbidities. At the ACR Convergence 2020, we saw abstracts discussing the complexity of treating RA in patients living with not just one comorbidity, but multiple comorbidities, or multimorbidities.7,8 This is reflective of what I see in my practice, where most of my patients present with an average of 2 comorbidities. Reports across the meeting showed that these patients have a decreased likelihood of achieving remission or low disease activity and have a reduced quality of life.9

As patients with RA and comorbidities are more susceptible to COVID-19 infection, I have started to consider my patients’ comorbidities more regularly and recommend ways to modify their health and minimise risk factors.3,10-12 As rheumatologists we play an important role in educating our patients on the risks they face when living with RA and how to take an active role in managing their disease. It is also why the EULAR guidelines and ACR guidelines both stress the importance of considering patients’ comorbidities when making treatment decisions.13,14

I share more information about the updates to the ACR guidelines and practical guidance in another blog posted to this site.

Bernard Combe, MD, PhD
Professor of Rheumatology at Montpellier University, France
Head of the Bone and Joint Department at Montpellier University Hospital

ACR, American College of Rheumatology; EULAR, European League Against Rheumatism; RA, rheumatoid arthritis; RMD, rheumatic disease.

References: 1. EULAR COVID-19 Database. https://www.eular.org/eular_covid19_database.cfm. Accessed November 11, 2020. 2. Landewé RBM, et al. Ann Rheum Dis 2020;79:851–858. 3. D’Silva KM, et al. ACR Convergence 2020. Presentation [abstract 0430]. 4. Grainger R, et al. ACR Convergence 2020. Presentation [session 2F042]. 5. Flood R, et al. ACR Convergence 2020. Presentation [abstract 0454]. 6. Loarce-Martos J, et al. ACR Convergence 2020. Poster [abstract 0629]. 7. England BR, et al. ACR Convergence 2020. Poster [abstract 0179]. 8. England BR, et al. ACR Convergence 2020. Presentation [abstract 1466]. 9. England BR, et al. ACR Convergence 2020. Poster [abstract 0178]. 10. Haberman RH, et al. ACR Convergence 2020. Poster [abstract 1339]. 11. Kambhatla S, et al. ACR Convergence 2020. Poster [abstract 1004]. 12. Overbury R, et al. ACR Convergence 2020. Presentation [abstract 0465]. 13. Smolen JS, et al. Ann Rheum Dis. 2020;0:1-15. 14. Singh JA, et al. Arthritis Rheumatol. 2016;68(1):1-26.