Coronavirus disease 2019 (COVID-19) infection in patients with rheumatic diseases: Clinical characteristics and relation to anti-rheumatic therapy

Background

Rheumatic disease (RD) patients are risky to severe coronavirus disease-2019 (COVID-19) infection, however, antirheumatic drugs may treat the infection and improve the outcome.

Aim of the work

To describe the clinical manifestations of COVID-19 infection in patients with rheumatic diseases and to investigate the relationship with antirheumatic therapy.

Patients and methods

The study included 215 RD patients. Patients' clinical characteristics and medications received were recorded as well as history of COVID-19 infection.

Results

The RD patients had systemic lupus erythematosus (SLE) (40.5%), rheumatoid arthritis (35.8%), psoriatic arthritis (PsA) (7.4%), ankylosing spondylitis (AS) (5.1%), gout (4.2%), systemic sclerosis (SSc) (3.3%), dermatomyositis (1.9%), Behςets disease (1.4%) and adult-onset Stills disease (0.5%). COVID-19 infection was reported in 124 (57.7%) RD patients. Body-ache was the commonest manifestation (n = 116;93.5%) followed by headache (n = 97;78%), fever (n = 90;72.5%). Infected patients were significantly older, with higher frequency of diabetes and hypertension without significant difference regarding type of RD or treatment except for lower frequency of biologics (n = 7;5.7%) compared to noninfected (n = 22;24.2%)(p < 0.001) patients. 95(76.6%) received home treatment, 27(21.7%) were hospitalized and 2(1.6%) needed intensive care. Hospitalized patients were significantly older (p < 0.001), had longer disease duration (p = 0.017), higher frequency of diabetes/hypertension (p < 0.001) and lower frequency of azathioprine intake (p < 0.034). Recovery period significantly correlated with disease duration (r = 0.197,p = 0.028) and age (r = 0.392,p < 0.001).

Conclusion

Body-aches, headache and fever were the commonest symptoms of COVID-19 infection in RD patients. Most infections were mild. Severe infection was related to older age, longer disease duration, diabetes and hypertension. The RDs and therapy were not associated with COVID-19 infection outcome.