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Comparative Study
. 2020 Sep;79(9):1156-1162.
doi: 10.1136/annrheumdis-2020-217888. Epub 2020 May 26.

Clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and rheumatic disease: a comparative cohort study from a US 'hot spot'

Kristin M D'Silva  1   2 , Naomi Serling-Boyd  1 , Rachel Wallwork  1 , Tiffany Hsu  3 , Xiaoqing Fu  1   2 , Ellen M Gravallese  3 , Hyon K Choi  2 , Jeffrey A Sparks  3 , Zachary S Wallace  4   2
Affiliations
Comparative Study

Clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and rheumatic disease: a comparative cohort study from a US 'hot spot'

Kristin M D'Silva et al. Ann Rheum Dis. 2020 Sep.

Abstract

Objective: To investigate differences in manifestations and outcomes of coronavirus disease 2019 (COVID-19) infection between those with and without rheumatic disease.

Methods: We conducted a comparative cohort study of patients with rheumatic disease and COVID-19 (confirmed by severe acute respiratory syndrome coronavirus 2 PCR), compared in a 1:2 ratio with matched comparators on age, sex and date of COVID-19 diagnosis, between 1 March and 8 April 2020, at Partners HealthCare System in the greater Boston, Massachusetts area. We examined differences in demographics, clinical features and outcomes of COVID-19 infection. The main outcomes were hospitalisation, intensive care admission, mechanical ventilation and mortality.

Results: We identified 52 rheumatic disease patients with COVID-19 (mean age, 63 years; 69% female) and matched these to 104 non-rheumatic disease comparators. The majority (39, 75%) of patients with rheumatic disease were on immunosuppressive medications. Patients with and without rheumatic disease had similar symptoms and laboratory findings. A similar proportion of patients with and without rheumatic disease were hospitalised (23 (44%) vs 42 (40%)), p=0.50) but those with rheumatic disease required intensive care admission and mechanical ventilation more often (11 (48%) vs 7 (18%), multivariable OR 3.11 (95% CI 1.07 to 9.05)). Mortality was similar between the two groups (3 (6%) vs 4 (4%), p=0.69).

Conclusions: Patients with rheumatic disease and COVID-19 infection were more likely to require mechanical ventilation but had similar clinical features and hospitalisation rates as those without rheumatic disease. These findings have important implications for patients with rheumatic disease but require further validation.

Keywords: autoimmune diseases; epidemiology; health services research; outcome and process assessment, health care.

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Conflict of interest statement

Competing interests: EMG reports editor position at New England Journal of Medicine and royalties from the textbook Rheumatology. HKC reports research support from AstraZeneca and consultancy fees from Takeda, Selecta, GlaxoSmithKline and Horizon. JAS reports research support from Amgen and Bristol-Myers Squibb and consultancy fees from Bristol-Myers Squibb, Gilead, Inova, Janssen and Optum.

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