Similar Rates of COVID-19 Incidence, Severity in Patients With and Without Rheumatic Disease

Researchers compared the incidence and severity of COVID-19 in patients with rheumatic disease receiving DMARDs and the general population.

The incidence and severity of coronavirus disease 2019 (COVID-19) in patients with rheumatic disease receiving disease-modifying antirheumatic drugs (DMARDs) vs the general population is not significantly different, according to study results published in Arthritis and Rheumatology.

Patients at 2 rheumatology centers in Lombardy, Italy were invited to participate in a survey for the study between February 25t and April 10, 2020. All patients with rheumatic disease were being treated with targeted synthetic or biologic DMARDs (ts/bDMARDs). The survey included data on contact with individuals infected with COVID-19, viral symptoms, and changes in behavior, or disease management; COVID-19 was confirmed by a nasopharyngeal swab.

A total of 955 patients (67.4% women; mean age, 53.7±14 years) with rheumatic diseases, such as rheumatoid arthritis, psoriatic arthritis, spondyloarthritis, and other autoinflammatory diseases, were included in the study, with a survey responder rate of 98.05%. A majority of patients were receiving anti-tumor necrosis factor (TNF) therapy (55.8%), with nearly half the patient cohort (47.3%) receiving a bDMARD as monotherapy. A total of 47.3% of patients had ≥1 comorbidity, mostly high blood pressure.

The survey indicated that 90.6% of patients took precautionary measures to prevent infection with COVID-19; 93.2% of patients maintained their ts/bDMARD treatment regimen, and rheumatic disease activity remained stable in 89.5%. In total, 6 patients with rheumatic diseases tested positive for COVID-19, 5 of whom were treated with anti-TNF agents; 2 patients were receiving bDMARDs as monotherapy.

Researchers observed that the COVID-19 infection rate of patients with rheumatic disease did not differ from the general population (0.62% vs 0.66%; P =.92). While half the number of infected patients (n=3) were admitted to the hospital for oxygen supplementation, none were admitted to the intensive care unit. All patients who tested positive for COVID-19 temporarily discontinued receiving ts/bDMARD therapy during viral infection. An additional 144 patients developed respiratory symptoms; however, they had no access to nasopharyngeal swabs. Of these patients who suspected to have COVID-19, 33 temporarily suspended receiving biologic therapy for an average of 16.9 days, with 9 patients reporting a disease relapse.

A limitation of this study was the cross-sectional survey design. Patients were interviewed by telephone, and it was possible that some symptoms were missed or that nonresponsive patients (n=24) were infected. Furthermore, tests for COVID-19 were unavailable for many patients who were experiencing respiratory symptoms.

Researchers concluded “[The] results highlight the attitude [of patients with] rheumatic [disease] to prevent the contagion while maintaining their chronic treatments. The incidence and severity of COVID-19 in patients treated with ts/bDMARDs was not significantly different from that of the general population in the same region.”


Favalli EG, Monti S, Ingegnoli F, Balduzzi S, Caporali R, Montecucco C. Incidence of COVID-19 in patients with rheumatic diseases treated with targeted immunosuppressive drugs: what can we learn from observational data? [published online June 7, 2020] Arthritis Rheum. doi:10.1002/ART.41388