Increased Prevalence of Hospital-Diagnosed COVID-19 in Autoimmune/Immune-Mediated Inflammatory Diseases

Hospital, intensive care
Hospital, intensive care
Researchers evaluated the prevalence of hospital-diagnosed COVID-19 in chronic inflammatory and autoimmune rheumatic diseases.

There is an increased rate of hospital-diagnosed coronavirus disease 2019 (COVID-19) cases associated with chronic inflammatory or autoimmune conditions, including systemic autoimmune or immune-mediated inflammatory diseases (AI/IMIDs), according to study results published in the Annals of the Rheumatic Diseases.

To guide prevention and therapy of severe COVID-19, researchers performed an exploratory analysis of the relative prevalence of hospital COVID-19 in 7 multicentric cohorts of patients with rheumatic diseases receiving follow-up, diagnosed with chronic inflammatory arthritis or AI/IMIDs, including rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), polymyalgia rheumatica or giant cell arteritis, and other diseases. Databases of rheumatology patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive polymerase chain reaction (PCR) tests performed in the hospital were matched with those of the same reference populations between April 7 and 17, 2020. Rates of PCR-positive-confirmed COVID-19 were compared between the 2 groups.

In total, 26,131 patients receiving follow-up in rheumatology departments were screened for hospital-positive SARS-CoV-2 PCR results. Compared with the reference population, patients with chronic inflammatory diseases had a 1.32-fold higher prevalence of hospital PCR-positive COVID-19 (0.76%; OR 1.3; CI, 1.15%-1.52%). In addition, all aggregated groups of patients (AI/IMID) demonstrated higher rates of COVID-19; patients with inflammatory arthritis (RA, PsA, and SpA) or SLE showed a similar prevalence to that in the reference population, except the SpA subset.

In terms of age distribution of COVID-19 cases, some but not all diagnostic groups had older ages than those in the reference population. However, the prevalence in older (>65 years) vs younger individuals was comparable in patients with rheumatic disease (OR, 1.77; CI 1.20-2.60; n=8270) and the reference population (OR, 1.86; CI 1.73-1.99; n=372,000). Despite similar age distribution, patients with IA who received targeted synthetic or biologic disease-modifying antirheumatic drugs (DMARDs), but not conventional synthetic DMARDs, had a greater prevalence.

Study limitations included identifying only patients who required hospitalization, other confounding factors, and the possibility of bias toward different PCR testing.

Researchers concluded, “These data provide a basis to improve preventive recommendations to patients [with rheumatic disease] and to analyze the specific factors involved in COVID-19 susceptibility.”


Pablos JL, Abasolo L, Alvaro-Garcia JM, , et al. Prevalence of hospital PCR-confirmed COVID-19 cases in patients with chronic inflammatory and autoimmune rheumatic diseases [published June 12, 2020]. Ann Rheum Dis. doi:10.1136/annrheumdis-2020-217763