Identifying Characteristics and Outcomes of COVID-19 in Patients With Systemic Lupus Erythematosus

doctors with mask caring for patient with mask in hospital, COVID19
Researchers characterized COVID-19 in patients with systemic lupus erythematosus and analyzed the association between comorbidities and medications and infection outcomes.

Patients with systemic lupus erythematosus (SLE) may be at similar risk for coronavirus disease 2019 (COVID-19) as the general population, according to study results published in Arthritis & Rheumatology.

Using data from patients in the New York University hospital system and Bellevue Hospital Center, New York, investigators aimed to characterize the presentation and progression of COVID-19 in patients with SLE.

A total of 226 patients with SLE (92.9% women) were identified, including 41 patients with confirmed COVID-19, 19 patients with a negative reverse transcription polymerase chain reaction (RT-PCR) test despite COVID-19-like symptoms or known exposure, 42 patients with COVID-19-like symptoms with no test, and 124 patients without any symptoms who were not tested for COVID-19.

Patients with confirmed COVID-19 were predominantly women (92.7%) and Black (41.5%) or Hispanic (36.6%). The most commonly observed symptoms of COVID-19 were cough (78.4%), fever (64.9%), and shortness of breath (64.9%). The majority of patients were receiving hydroxychloroquine (78%); 43.9% were receiving systemic steroids and 58.5% were receiving ≥1 immunosuppressants. The most common immunosuppressant was mycophenolate mofetil (24.4%), followed by tacrolimus (12.2%).

Hospitalization was required for 24 (58.5%) patients with confirmed COVID-19, of whom 52.7% required supplemental oxygen, 16.7% required admission to the intensive care unit, and 13% required intubation and mechanical ventilation. Four patients died of respiratory failure, a majority of whom (75%) were non-White, women, and experiencing ≥1 comorbidity. All patients who died were receiving hydroxychloroquine. Compared with patients with COVID-19 who did not require hospitalization, those who were treated in the hospital setting were older, less likely to be White, and more likely to have a history of ≥1 comorbid condition. In multivariable analyses, the non-White race (odds ratio [OR], 7.78; 95% CI, 1.13-53.58; P =.037), the presence of ≥1 comorbidities (OR, 4.66; 95% CI, 1.02-21.20; P =.047), and body mass index (OR, 1.08 per kg/m2 increase; 95% CI, 0.99-1.18; P =.096) were independent predictors of hospitalization.

Among patients with COVID-19-like symptoms with no test, cough (52.4%), fever (45.2%), and sore throat (38.1%) were the most common symptoms. Sex and racial/ethnic demographics were similar to those of patients with confirmed COVID-19; however, patients with COVID-19-like symptoms vs confirmed COVID-19 were slightly younger (41 vs 47 years, respectively) and lesser frequent lupus nephritis (7.1% vs 34.1%, respectively). Other comorbidities were also less common. Use of hydroxychloroquine and immunosuppressants were similar between groups, but the use of systemic steroids was lower in the group with suspected COVID-19 (11.9% vs 43.9%, respectively).

Cough (36.8%), fever (36.8%), shortness of breath (31.6%), and sore throat (31.6%) were also the most common symptoms in patients who tested negative for COVID-19. Because of a high index of suspicion, 6 patients were tested multiple times, among whom 2 were hospitalized (1 for severe thrombocytopenia [with an incidental finding of lung infiltrates] and 1 for end-stage kidney disease).

Investigators noted that the availability and accuracy of testing represented limitations of the study.

“[O]ur data suggest that patients with SLE and COVID-19 have a high rate of hospitalization but a similar mortality rate to the general population in [New York City],” they concluded. “There is insufficient evidence to conclude with our data that SLE-specific factors additionally contribute to the risk of hospitalization.”

Disclosures: Several authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.


Fernandez-Ruiz R, Masson M, Kim MY, et al. Leveraging the United States epicenter to provide insights on COVID-19 in patients with systemic lupus erythematosus. Arthritis Rheumatol. Published online July 26, 2020. doi:10.1002/art.41450