Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul;40(7):2633-2642.
doi: 10.1007/s10067-021-05578-x. Epub 2021 Jan 9.

Clinical course and outcomes of COVID-19 in rheumatic disease patients: a case cohort study with a diverse population

Timothy Arleo  1 , David Tong  2 , Julie Shabto  1 , Ghazala O'Keefe  3 , Arezou Khosroshahi  4
Affiliations

Clinical course and outcomes of COVID-19 in rheumatic disease patients: a case cohort study with a diverse population

Timothy Arleo et al. Clin Rheumatol. 2021 Jul.

Abstract

Objective: To determine clinical course and outcomes in rheumatic disease patients with coronavirus disease 2019 (COVID-19) and compare results to uninfected patients.

Methods: We conducted a case cohort study of autoimmune disease patients with COVID-19 (confirmed by severe acute respiratory syndrome coronavirus 2 PCR) from February 1, 2020, to July 31, 2020, and compared them in a 1:3 ratio with uninfected patients who were matched based on race, age, sex, and comorbidity index. Patient demographics, clinical course, and outcomes were compared among these patient groups.

Results: A total of 70 rheumatic disease patients with COVID-19 (mean age, 56.6 years; 64% African American) were identified. The 34 (49%) patients who were hospitalized used oral glucocorticoids more frequently than those treated as outpatients (p < 0.01). All 10 patients using anti-TNFα medications were treated as outpatients (p < 0.01). Those hospitalized with COVID-19 more often required ICU admission (17 (50%) vs 27 (26%), p = 0.01) and intubation (10 (29%) vs 6 (6%), p < 0.01) than uninfected patients and had higher mortality rates (6 (18%) vs 3 (3%), p < 0.01). Of the six COVID-19 patients who died, only one was of African ancestry (p = 0.03).

Conclusion: Rheumatic disease patients infected with COVID-19 were more likely to require ICU admission, ventilation, and died more frequently versus uninfected patients with autoimmune disease. Patients on anti-TNFα medications were hospitalized less frequently, while those on chronic glucocorticoids were hospitalized more frequently. These findings have important implications for medication choice in rheumatic disease patients during the ongoing spread of COVID-19. Key Points • We show that hospitalized rheumatic disease patients with COVID-19 have poorer outcomes including ICU admission, ventilation, and death compared to hospitalized rheumatic disease patients not infected with COVID-19. • This study adds further support regarding protective effects of anti-TNFα medications in COVID-19 disease course, with 0 of 10 of these patients required hospitalization.

Keywords: Immunosuppressive agents; Rheumatic diseases; SARS-CoV-2; Tumor necrosis factor inhibitors.

PubMed Disclaimer

Conflict of interest statement

Dr. Khosroshahi reports grant from Pfizer and personal fees from Viela Bio, outside of the submitted work.

References

    1. Brito CA, Paiva JG, Pimentel FN, Guimarães RS, Moreira MR (2020) COVID-19 in patients with rheumatological diseases treated with anti-TNF. Ann Rheum Dis. 10.1136/annrheumdis-2020-218171 - PubMed
    1. Monti S, Balduzzi S, Delvino P, Bellis E, Quadrelli VS, Montecucco C. Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies. Ann Rheum Dis. 2020;79(5):667–668. doi: 10.1136/annrheumdis-2020-217424. - DOI - PMC - PubMed
    1. Gianfrancesco M, Hyrich KL, Al-Adely S, Carmona L, Danila M, Gossec L, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 global rheumatology Alliance physician-reported registry. Ann Rheum Dis. 2020;79(7):859–866. doi: 10.1136/annrheumdis-2020-217871. - DOI - PMC - PubMed
    1. D’Silva KM, Serling-Boyd N, Wallwork R, Hsu T, Fu X, Gravallese EM, Choi HK, Sparks JA, Wallace ZS. Clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and rheumatic disease: a comparative cohort study from a US ‘hot spot.’. Ann Rheum Dis. 2020;79(9):1156–1162. doi: 10.1136/annrheumdis-2020-217888. - DOI - PMC - PubMed
    1. Zhao J, Pang R, Wu J, Guo Y, Yang Y, Zhang L, Xia X (2020) Clinical characteristics and outcomes of patients with COVID-19 and rheumatic disease in China ‘hot spot’ versus in US ‘hot spot’: similarities and differences. Ann Rheum Dis:annrheumdis-2020-218183. 10.1136/annrheumdis-2020-218183 - PubMed