Abstracts Detail COVID-19 Breakthrough Infection, Long Haul Prevalence in Rheumatic Disease

Data outline prevalence of COVID-19 breakthrough and long haul infections among patients with rheumatic diseases.

Research presented at the American College of Rheumatology annual meeting highlighted data on COVID-19 among patients with rheumatic disease. While one study focused on post-vaccination COVID-19 infections among individuals with rheumatic diseases, a second sought to determine risk factors for “long haul” COVID-19 in rheumatology outpatients.

In the first analysis,1 researchers assessed data from the COVID-19 Global Rheumatology Alliance Provider Registry and identified those who developed COVID-19 between January and August 2021 after being partially or fully vaccinated against the disease.

“While COVID-19 vaccinations are a critical tool to prevent severe infections, poor immunogenicity in immunocompromised people threatens vaccine effectiveness,” researchers explained.

Patients’ demographic and clinical characteristics, COVID-19 outcomes and symptoms were evaluated. Among those who were fully vaccinated, investigators detailed baseline medication outcomes and clinical details of hospitalizations.

“Partially vaccinated was defined as being ≥14 days after the first dose in a 2-dose series or within 13 days of a single-dose vaccine,” authors said, and “fully vaccinated was defined as infection occurring ≥14 days after the second dose in a 2-dose series or 2 weeks after a single-dose vaccine.”

A total of 115 individuals with a mean age of 53 years were included in the study. The majority of patients were female (73%) and White (58%). Rheumatoid arthritis, systemic lupus erythematosus, as psoriatic arthritis were the most commonly reported rheumatic diseases and 20% of patients had moderate/high disease activity.

In addition, the most common comorbidities were hypertension (30%), lung disease (21%), and obesity (19%), while 59% of patients received mRNA vaccines, authors said. “The most common COVID-19 symptoms were cough (65%), fever (54%), and malaise (36%); 7% reported no symptoms,” they added.

Analyses revealed:

  • Among the fully vaccinated (n=39), infection occurred a mean (SD) of 86.5 (58.24) days after the second dose, and 29% were hospitalized
  • 11 (28%) were on methotrexate, 11 (28%) were on B cell-depleting therapies (BCDT), 11 (28%) were on other antimetabolites, and 5 (23%) were on other biologic disease-modifying antirheumatic drugs (DMARDs)
  • 67% were not taking systemic glucocorticoids
  • All but 2 cases continued their antirheumatic medications before or after their vaccine doses
  • Of those fully vaccinated and hospitalized (n = 11; age range 36-71 years), 6 had pre-existing lung disease and 2 had no reported comorbidities
  • 2 patients with comorbid lung disease subsequently died (one requiring non-invasive and the other requiring invasive mechanical ventilation)

Overall, most fully vaccinated patients with breakthrough infections in the study were taking anti-metabolites or BCDT. “Additional strategies, including additional vaccine doses, medication interruption, and monoclonal antibody pre- and post-exposure prophylaxis may be needed to protect this high-risk population,” researchers concluded.

An additional analysis2 presented at the meeting aimed to elucidate risk factors for “long haul” COVID-19 in rheumatology outpatients. Currently, “whether this is of particular concern for rheumatic disease patients, due to their underlying immune dysregulation and use of immunosuppressive medications, is poorly studied,” authors explained.

Researchers sent a web-based survey via email in March 2021 to 7505 patients aged 18 or older who were previously evaluated by a rheumatologist at a New York City center between 2018 and 2020.

As part of the study, patients completed a COVID-19 questionnaire and provided data on sociodemographic, medical comorbidities, medication use, and health-related quality of life. “We defined COVID ‘long haul’ as symptoms persistent for ≥3 months and used descriptive statistics to compare factors associated with this group compared to patients with COVID-19 symptoms < 1 month,” researchers said.

Of the 2572 individuals who completed the questionnaire, 254 indicated a history of suspected or confirmed COVID-19. Patients were either told by a health care provider of a COVID-19 diagnosis, or self-reported a positive nasopharyngeal PCR or antigen test, respectively.

Among those who reported a history of COVID-19, 142 (55.9%) indicated experiencing at least 3 months of symptoms, while 112 (44.09%) reported symptoms lasting less than one month. No demographic differences were seen between these 2 groups.

Data showed:

  • COVID-19 long-haulers were more likely to have ≥ 1 or more medical comorbidities and to be a current or former smoker
  • No difference in systemic rheumatic diseases (SRD) or non-SRD status was observed; only 2 patients with long haul symptoms had Fibromyalgia
  • Patients with long-haul COVID-19 were more likely to have used corticosteroids for ≥ 3 months at time of COVID-19 diagnosis (P = .002)
  • The long-haul group had significantly higher frequency of most COVID-19 symptoms at presentation, most commonly chills, cough, fatigue/malaise, headache/migraine, loss of smell or taste, muscle aches, memory/concentration problems, joint pain, and shortness of breath
  • Health-related quality of life assessment T-scores demonstrated significantly and clinically worse anxiety, depression, fatigue and pain in the long hauler group

In total, over half of rheumatology outpatients with COVID-19 at this center reported symptoms lasting at least 3 months. These individuals tended to have more comorbidities, a history of smoking, and were more likely to have used corticosteroids at the time of COVID-19 diagnosis. Long haulers also more frequently reported worse quality of life and COVID-19 symptoms at presentation.

“Future prospective analyses accounting for additional potential covariates are underway to identify risk factors in this vulnerable group,” authors concluded.


  1. Liew J, Gianfrancesco M, Harrison C, et al. SARS-CoV-2 infections among vaccinated individuals with rheumatic disease: results from the COVID-19 global rheumatology alliance provider registry. Presented at: American College of Rheumatology Convergence 2021; Online; November 3-9, 2021. Poster L04.
  2. Barbhaiya M, Jannat-Khan D, Levine J, et al. Risk factors for “long haul” COVID-19 in rheumatology outpatients in New York city. Presented at: American College of Rheumatology Convergence 2021; Online; November 3-9, 2021. Poster 0095.