Factors Associated With Severe COVID-19 in Patients With Rheumatic Diseases


Patients with connective tissue diseases are at greater risk for severe coronavirus disease 2019 (COVID-19) than patients with chronic inflammatory arthritis.

New findings about how different groups of patients with rheumatic diseases were affected when infected with coronavirus disease 2019 (COVID-19) will have important implications on how to guide recommendations to specific groups of patients, according to a study in Annals of the Rheumatic Diseases.

Researchers in Spain compared rheumatic (n = 228) and nonrheumatic (n = 228) patients who received a diagnosis of COVID-19 to better understand the association between outcome and potential prognostic variables.

“Since severe COVID-19 is associated with a hyperinflammatory process, it is of particular interest to investigate how preexisting inflammatory diseases or the previous use of immunosuppressive agents influence COVID-19 expression,” the authors noted.

The majority (60%) of the rheumatic diseases were chronic inflammatory arthritis (IA), while the remainder (40%) were connective tissue diseases (CTDs). Factors studied in relation to outcome for the patients with rheumatic diseases were diagnostic group, disease duration, and treatments. COVID-19 treatment information was also collected—the most commonly used COVID-19 treatments were hydroxychloroquine, antivirals (lopinavir/ritonavir and remdesivir), glucocorticoids, and anticytokines.

Prior to the onset of COVID-19 symptoms, the patients with rheumatic diseases were on treatments that could have predisposed them to infections. The majority (57%) were on conventional synthetic disease-modifying antirheumatic drugs, with 40% on glucocorticoids, 23% on biologic agents, and 12% on immunosuppressants.

The risk of severe COVID-19 infection in the nonrheumatic cohort was 28.1% compared with 31.6% for the rheumatic cohort. In the nonrheumatic group, age ≥60 years, hypertension, and lung disease were associated with outcome, and in the rheumatic group, age ≥60 years and all comorbid variables (obesity, diabetes, hypertension, cardiovascular disease, and lung disease) were associated with outcome.

There was an independent association between CTD, age, and male sex, with higher risks for severe COVID-19 outcome.

“Our data illustrate how IA and CTD groups carry a different risk for severe COVID-19,” the authors wrote. “Whether specific diagnostics within the heterogeneous CTD group may have a different risk cannot be ruled out.”

The authors noted limitations including that the results are limited to hospitalized cases and exclude patients with rheumatic diseases with less severe COVID-19 infection.

Overall, the research showed that hospitalized patients with rheumatic diseases have poor outcomes if they have a CTD, and in general, the previously known risk factors of age and male sex apply to all patients with rheumatic diseases.

“This observation should help to tailor recommendations to specific diagnostic and therapeutic groups of patients with rheumatic diseases during this or future coronavirus pandemics,” the authors concluded.


Pablos JL, Galindo M, Carmona L, et al. Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study. Ann Rheum Dis. Published online August 12, 2020. doi:10.1136/annrheumdis-2020-218296

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