Post by Nadica (She/Her) on Sept 30, 2024 21:47:07 GMT
RA Is a Risk Factor for Long COVID in older folks - Published Sept 30, 2024
By Martta Kelly
Older adults are more susceptible to COVID-19 complications, especially if they have preexisting conditions such as rheumatoid arthritis (RA).
Long COVID-19 syndrome occurs in 10% to 20% of patients who are infected with SARS-CoV-2, with new symptoms appearing within three months of the initial diagnosis, and it may last more than eight weeks, according to a study published in Annals of Epidemiology. A knowledge gap exists, however, about risk factors for long COVID, particularly for people with RA and other comorbidities.
The study authors, Marian L. Neuhouser, PhD, RD, a professor and the program head of the Cancer Prevention Program at Fred Hutchinson Cancer Center, in Seattle, and her colleagues analyzed data from the Women’s Health Initiative on postmenopausal women who completed surveys about COVID (Ann Epidemiol 2024;98:36-43).
They sought to leverage machine learning approaches to identify the set of risk factors most strongly associated with long COVID and their relative importance to risk for older women.
The researchers found that among 37,280 survey respondents, 1,237 reported a positive COVID-19 test, with 30% experiencing long COVID. Respondents with long COVID reported a range of symptoms: neurologic, musculoskeletal, cardiopulmonary, general fatigue and malaise.
A biological mechanism to explain how RA is a risk factor for long COVID is unknown, Dr. Neuhouser noted. “It is possible that either the condition itself or the use of medications [to treat it] may predispose patients with RA to long COVID,” she said. “This needs to be explored in future studies.”
For many people, COVID can be a life-threatening condition, said Joan Kapusnik-Uner, PharmD, FCSHP, FASHP, the senior vice president of informatics and clinical content at First Databank (FDB), in the San Francisco Bay Area. “Therefore, immediate contact with a primary care professional is warranted,” she said. “Additionally, nirmatrelvir [Paxlovid, Pfizer], an antiviral drug that eliminates virus replication in the body, is useful in preventing COVID from worsening and may help prevent long COVID.”
Dr. Kapusnik-Uner, who is also a professor of clinical pharmacy at the University of California, San Francisco, noted that “all medications that a patient is taking, including drugs to treat RA, require reevaluation when an acute COVID diagnosis is made. The benefits of each medication are weighed against the risks or when other interventions are recommended. Kidney and liver function should also be assessed to help determine appropriateness of medication dosages.”
Healthcare professionals should not initiate treatment with RA medications in patients with any active infection, including COVID, she said. “Continuation of RA medications during COVID depends on many factors and requires assessment by a healthcare provider at the time of diagnosis.”
Older patients with comorbid conditions and/or patients taking concomitant immunosuppressants may be at greater risk for serious infection, she said.
As for adverse effects, acute COVID infection symptoms can mimic common medication side effects, including gastrointestinal side effects such as nausea, vomiting and diarrhea, as well as headache, Dr. Kapusnik-Uner pointed out. “RA symptoms such as joint aches and fatigue can also mimic COVID symptoms. Therefore, having a good understanding of RA symptoms and keeping a symptom diary may be helpful for patients if COVID strikes.”
In older women, menopause may add additional clinical considerations due to decreased estrogen, according to Mallory Schmoll, PharmD, AAHIVP, the therapy lead, Clinical Pharmacy Strategy at Walgreens, in Louisville, Ky. “Research has indicated that drops in estrogen may be related to RA progression,” she said. “At this time, however, there is no clear consensus for any type of dosage adjustment in postmenopausal women. However, the American College of Rheumatology guidelines do recommend HRT [hormone replacement therapy] for most postmenopausal women with rheumatic conditions.”
Finally, there are steps that patients with RA can take to avoid getting COVID in the first place, Dr. Neuhouser said. “Patients with RA should remain extra vigilant and keep up with vaccines and other measures of prevention.”
The sources reported no relevant financial disclosures.
By Martta Kelly
Older adults are more susceptible to COVID-19 complications, especially if they have preexisting conditions such as rheumatoid arthritis (RA).
Long COVID-19 syndrome occurs in 10% to 20% of patients who are infected with SARS-CoV-2, with new symptoms appearing within three months of the initial diagnosis, and it may last more than eight weeks, according to a study published in Annals of Epidemiology. A knowledge gap exists, however, about risk factors for long COVID, particularly for people with RA and other comorbidities.
The study authors, Marian L. Neuhouser, PhD, RD, a professor and the program head of the Cancer Prevention Program at Fred Hutchinson Cancer Center, in Seattle, and her colleagues analyzed data from the Women’s Health Initiative on postmenopausal women who completed surveys about COVID (Ann Epidemiol 2024;98:36-43).
They sought to leverage machine learning approaches to identify the set of risk factors most strongly associated with long COVID and their relative importance to risk for older women.
The researchers found that among 37,280 survey respondents, 1,237 reported a positive COVID-19 test, with 30% experiencing long COVID. Respondents with long COVID reported a range of symptoms: neurologic, musculoskeletal, cardiopulmonary, general fatigue and malaise.
A biological mechanism to explain how RA is a risk factor for long COVID is unknown, Dr. Neuhouser noted. “It is possible that either the condition itself or the use of medications [to treat it] may predispose patients with RA to long COVID,” she said. “This needs to be explored in future studies.”
For many people, COVID can be a life-threatening condition, said Joan Kapusnik-Uner, PharmD, FCSHP, FASHP, the senior vice president of informatics and clinical content at First Databank (FDB), in the San Francisco Bay Area. “Therefore, immediate contact with a primary care professional is warranted,” she said. “Additionally, nirmatrelvir [Paxlovid, Pfizer], an antiviral drug that eliminates virus replication in the body, is useful in preventing COVID from worsening and may help prevent long COVID.”
Dr. Kapusnik-Uner, who is also a professor of clinical pharmacy at the University of California, San Francisco, noted that “all medications that a patient is taking, including drugs to treat RA, require reevaluation when an acute COVID diagnosis is made. The benefits of each medication are weighed against the risks or when other interventions are recommended. Kidney and liver function should also be assessed to help determine appropriateness of medication dosages.”
Healthcare professionals should not initiate treatment with RA medications in patients with any active infection, including COVID, she said. “Continuation of RA medications during COVID depends on many factors and requires assessment by a healthcare provider at the time of diagnosis.”
Older patients with comorbid conditions and/or patients taking concomitant immunosuppressants may be at greater risk for serious infection, she said.
As for adverse effects, acute COVID infection symptoms can mimic common medication side effects, including gastrointestinal side effects such as nausea, vomiting and diarrhea, as well as headache, Dr. Kapusnik-Uner pointed out. “RA symptoms such as joint aches and fatigue can also mimic COVID symptoms. Therefore, having a good understanding of RA symptoms and keeping a symptom diary may be helpful for patients if COVID strikes.”
In older women, menopause may add additional clinical considerations due to decreased estrogen, according to Mallory Schmoll, PharmD, AAHIVP, the therapy lead, Clinical Pharmacy Strategy at Walgreens, in Louisville, Ky. “Research has indicated that drops in estrogen may be related to RA progression,” she said. “At this time, however, there is no clear consensus for any type of dosage adjustment in postmenopausal women. However, the American College of Rheumatology guidelines do recommend HRT [hormone replacement therapy] for most postmenopausal women with rheumatic conditions.”
Finally, there are steps that patients with RA can take to avoid getting COVID in the first place, Dr. Neuhouser said. “Patients with RA should remain extra vigilant and keep up with vaccines and other measures of prevention.”
The sources reported no relevant financial disclosures.