Am I at increased risk for COVID-19? UPDATED 3-29-21
Updated: May 21, 2021
YES. Sjogren’s patients are at higher risk of infection and serious complications of infection, especially respiratory infections.
My opinion about how this pertains to COVID-19 is shared by many, but not all, rheumatologists. As of this 3-29-21 update, there is suggestive, but not firm, evidence Sjogren's patients have higher rates of serious complications from COVID-19 infection. People with lung disease, kidney disease, or who take immune suppressing drugs are known to have increased risk for poor outcomes. Many Sjogren's patients fit one or more of these risk categories. Most people with Sjogren's have lung disease, sometimes without obvious symptoms. A smaller number have Sjogren's-related kidney disease. The recently published Pulmonary (lung) Clinical Practice Guidelines should be shared with your rheumatologist because many remain unaware of the high prevalence of Sjogren's lung disease. Regardless of what we eventually learn about Sjogren's and COVID-19, it is clear that Sjogren’s patients should take extra precautions to avoid COVID-19. This includes getting a vaccine as soon it is available to you. If you have questions about the vaccine, please see this blog post for links to reliable information and discuss your concerns with your rheumatologist.
Why Sjogren’s patients are likely to be at increased risk for serious complications with COVID-19:
1. Dryness decreases surface immunity, the first line of defense.
The mucus layer is a critical first step to avoiding infection. This moist layer creates both a physical barrier and an immune system barrier from the outside world to the lungs. Dryness decreases this important surface immunity, making the airways and lung tissue more vulnerable to infection.
2. Lung disease, a common problem, increases the risk for complications if infection does occur.
About 10% of patients have interstitial lung disease (ILD) with symptoms. Many more (up to 50% plus) have signs of ILD on high-resolution CT. Moreover, there are many other types of lung disease that Sjogren’s patients have, often undiagnosed. Lung disease is a known risk factor for COVID-19 complications.
3. Dysfunctional immune system
Sjogren’s patients do not have normal immune systems. An overactive immune system does not mean better protection against infection; the overactivity is misdirected.
4. Immune suppressing drugs
Many drugs such as methotrexate, prednisone, Cellcept, Rituxan, and others suppress the immune system. These increase the risk of serious infection.
Note: Hydroxychloroquine (HCQ, aka Plaquenil) is not an immune suppressant, but an immune system modulator. Do not assume that taking HCQ will protect you from infection. This has been disproven.
5. Sjogren’s patients are at increased risk for severe infections.
Severe infections are known to contribute to a higher rate of hospitalization and death in Sjogren’s patients (61). This is another reason for Sjogren’s patients to protect themselves in the time of COVID-19. Everyone, but especially those with chronic illness, needs to take masking and physical/ social distancing seriously. We need to stay physically apart to protect ourselves from getting the infection, but don’t stop calling and connecting virtually with people. This is a huge, but necessary step.
Trust the Experts!
Medical experts such as infectious disease doctors and epidemiologists are the best source of information about COVID-19. Your rheumatologist should be able to answer questions about your individual circumstances such as how to manage medications during and after vaccination or COVID-19 illness.