Abstract: medRxiv preprint doi: https://doi.org/10.1101/2020.10.26.20219154; this version posted October 27, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . Article Title: Clinical Course and Outcomes of coronavirus disease 2019 (COVID-19) in Rheumatic Disease Patients on Immunosuppression: A case Cohort Study at a Single Center with a Significantly Diverse Population Authors: Timothy Arleo, B.S.1; David Tong, M.D.2; Julie Shabto, B.A4; Ghazala O’Keefe, M.D.3 ; Arezou Khosroshahi, M.D.5 From Emory University School of Medicine, Atlanta, GA1,4; Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA2; Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA3; Division of Rheumatology, Emory University School of Medicine, Atlanta, GA5. Corresponding author: Arezou Khosroshahi, MD Associate Professor of Medicine Emory University School of Medicine Rheumatology Division 244 Whitehead Bldg., 615 Michael Street Atlanta, GA, 30322 akhosroshahi@emory.edu Phone: 404 778 6638 Conflicts of Interest: None declared Word count: 2786 Figure count: 6 1 NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: https://doi.org/10.1101/2020.10.26.20219154; this version posted October 27, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . ABSTRACT Objectives To determine clinical course and outcomes in rheumatic disease patients with coronavirus disease 2019 (COVID-19) and compare results to uninfected patients. Methods We conducted a case cohort study of autoimmune disease patients with COVID-19 (confirmed by severe acute respiratory syndrome coronavirus 2 PCR) from 02/01/2020 to 07/31/2020 and compared them in a 1:3 ratio with uninfected patients who were matched based on race, age, sex, and comorbidity index. Patient demographics, clinical course, and outcomes were compared among these patient groups. Results A total of 70 rheumatic disease patients with COVID-19 (mean age, 56.6 years; 64% African American) were identified. The 34 (49%) patients who were hospitalized used oral glucocorticoids more frequently (p<0.01). All 10 patients on anti-TNFα medications were treated as outpatients (p<0.01). Those hospitalized with COVID-19 more often required ICU admission (17 (50%) vs 27 (26%), OR=2.78 (95% CI: 1.24 to 6.20)) and intubation (10 (29%) vs 6 (6%), OR=6.67 (95% CI: 2.20 to 20.16)) than uninfected patients. They also had higher mortality rates (6 (18%) vs 3 (3%), OR=7.21 (95% CI: 1.70 to 30.69)). Of the six COVID-19 patients who died, one was of African ancestry (p=0.03). Conclusions 2 medRxiv preprint doi: https://doi.org/10.1101/2020.10.26.20219154; this version posted October 27, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . Rheumatic disease patients infected with COVID-19 were more likely to require ICU..