Skill Checkup: A 68-Year-Old Woman With Low-Grade Fever, Headache, Body Aches, Fatigue, Nasal Congestion, and Sore Throat

Enrico Brunetti, MD


November 07, 2022

In addition to being unvaccinated against SARS-CoV-2, over 65 years of age, and having elevated blood pressure that could indicate undiagnosed hypertension, the patient has an underlying condition that could amplify the risk of progressing to severe disease. In a Danish nationwide matched cohort study, the incidence of COVID-19 hospitalization was increased for both unvaccinated and vaccinated patients with RA compared with controls. This patient is considered at high risk for COVID-19 hospitalization.

Further, the likelihood of developing severe COVID-19 increases with the use of some immunomodulatory or immunosuppressive treatments, particularly rituximab, mycophenolate mofetil (MMF), glucocorticoids, and possibly Janus kinase inhibitors (JAKi). Therefore, patients with RA and other musculoskeletal diseases should be encouraged to stay up to date with vaccination for SARS-CoV-2.

More generally, patients with the following underlying conditions are considered at high risk for COVID-19 hospitalization: cancer, cerebrovascular disease, chronic kidney disease, chronic obstructive pulmonary disease, diabetes type 1 and type 2, heart conditions, an immunocompromising state from a solid organ transplant, and obesity. Pregnant patients and current or former smokers are also at increased risk.


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