Patients With Rheumatic Diseases at No Greater Risk of Contracting COVID-19

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Despite concerns about treatment with immunosuppressive agents, coronavirus disease 2019 (COVID-19) infection remains low in patients with rheumatic diseases, according to 2 abstracts presented at the annual meeting of the American College of Rheumatology.

Infection with coronavirus disease 2019 (COVID-19) remains low in patients with rheumatic diseases, and among those who did contract COVID-19, the course of illness was mild, according to 2 abstracts to be presented at ACR Convergence, the annual meeting of the American College of Rheumatology (ACR).

At the beginning of the pandemic, it was unclear how much more susceptible patients treated with immunosuppressant therapies would be to a COVID-19 infection. In the first abstract, researchers from the University of Texas Medical Branch conducted a systematic review of studies reporting outcomes of COVID-19 infection in patients taking biologic or targeted therapies for their rheumatic diseases.1

“When the pandemic started, there was concern on whether to continue or hold immune therapies among patients with rheumatic diseases because they are at increased risk for infection,” study coauthor Akhil Sood, MD, said in a statement. “We were interested to see if these patients are at an increased risk for COVID-19 infection. If they were to become infected, we wanted to know the severity of their clinical course. This can help us to determine whether it is safe to continue or hold immune therapies in setting of COVID-19 infection.”

Sood and his colleagues identified studies published between January 1 and June 1, 2020, on PubMed/Medline and Scopus. The review included 8 observational cohort studies comprising 6095 patients total. The most common rheumatic disease represented among the studies was rheumatoid arthritis (28%) followed by psoriatic arthritis (7%). The majority of patients (68%) across all studies were on biologics, with tumor necrosis factor inhibitors being the most common biologic agent (31%).


Only 123 patients (2%) were positive or highly suspicious for COVID-19. Among those who had an infection, 91 patients (73%) were not hospitalized, and only 13 patients (11%) with an infection were admitted to the intensive care unit and 4 patients (3.2%) died.

While the study found the majority of patients had mild clinical course and the case fatality was low, the authors explained further studies are needed to compare outcomes between biologic and nonbiologic users.

“We are waiting for additional extensive studies that include more patients with rheumatic disease on biologic and targeted therapies. Another area of interest for us is examining risk factors for severe COVID-19 infection in patients with rheumatic disease. We hope this can help us identify which patients to closely monitor and possibly develop precautions to mitigate their risk.”

In the second abstract, the researchers specifically looked at COVID-19 infection in children with rheumatic diseases.2 The researchers analyzed data from the COVID-19 Global Rheumatology Alliance Patient Experience Survey, an international patient registry. Parents of children with rheumatic diseases responded to surveys seeking information on the child’s rheumatic disease, medications, COVID-19 infection, and outcomes for those who were infected. The surveys were distributed online through patient support organizations and social media.

The analysis included 427 children, the majority of which lived in the Americas (64.9%), were white (73.3%), were female (63.0%), and were between the ages of 5 and 14 years (64.9%). More than half (54.6%) were taking conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and 51.8% were taking biologic DMARDs.

Only 5 children (1.2%) were diagnosed with COVID-19 and none of them were hospitalized. The children who contracted COVID-19 were diagnosed with juvenile idiopathic arthritis (n = 2), autoinflammatory disease (n = 2), or systemic juvenile idiopathic arthritis (n = 1). Two of the children were sick for 5 days or less, another 2 for more than 20 days, and 1 had illness that had not been resolved at the time of the survey. Three of the children were being treated with nonsteroidal anti-inflammatory drugs at the time of their diagnosis, 1 was being treated with methotrexate, and 1 was receiving no treatment for their rheumatic disease.

The authors concluded that children with rheumatic diseases were not at any greater of a risk of developing COVID-19 or complications related to the infection than otherwise healthy children.

“These findings are important as policymakers and educators contemplate reopening schools with the pandemic still ongoing, and with parents and physicians struggling to make decisions of whether to send their children back to school,” study coauthor Jonathan S. Hausmann, MD, Instructor in Medicine at Harvard Medical School and a pediatric rheumatologist at Boston Children’s Hospital, said in a statement. “Our study suggests that children with rheumatic disease should continue their immunosuppressive drugs during the pandemic, as it does not appear to place them at increased risk of COVID-19 related complications. Our findings support the recent ACR guidelines for managing immunosuppression during the pandemic.”


1. Sood A, Galestanian A, Murthy V, Gonzalez E, Raji M. COVID-19 infection among patients with rheumatic disease on biologic & targeted therapies: a systematic review. Presented at: ACR Convergence 2020; November 5-9, 2020; Abstract 0008.

2. Hausmann J, Kennedy K, Surangiwala S, et al. Impact of the COVID-19 pandemic among children with rheumatic diseases from around the globe. Presented at: ACR Convergence 2020; November 5-9, 2020; Abstract 1685.