Abstract: Clinical Rheumatology (2020) 39:3195–3204 https://doi.org/10.1007/s10067-020-05334-7 ORIGINAL ARTICLE COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series Clodoveo Ferri 1,2 & Dilia Giuggioli 1 & Vincenzo Raimondo 2 & Massimo L’Andolina 3 & Antonio Tavoni 4 & Riccardo Cecchetti 5 & Serena Guiducci 6 & Francesco Ursini 7 & Maurizio Caminiti 8 & Giuseppe Varcasia 9 & Pietro Gigliotti 10 & Roberta Pellegrini 11 & Domenico Olivo 12 & Michele Colaci 13 & Giuseppe Murdaca 14 & Raffaele Brittelli 2 & Giuseppa Pagano Mariano 8 & Amelia Spinella 1 & Silvia Bellando-Randone 6 & Vincenzo Aiello 2 & Silvia Bilia 4 & Daiana Giannini 4 & Tommaso Ferrari 9 & Rodolfo Caminiti 2 & Veronica Brusi 7 & Riccardo Meliconi 7 & Poupak Fallahi 15 & Alessandro Antonelli 16 & for the COVID-19 & ASD Italian Study Group Received: 26 May 2020 / Revised: 13 July 2020 / Accepted: 17 July 2020 / Published online: 27 August 2020 # The Author(s) 2020 Abstract Introduction Covid-19 infection poses a serious challenge for immune-compromised patients with inflammatory autoimmune systemic diseases. We investigated the clinical-epidemiological findings of 1641 autoimmune systemic disease Italian patients during the Covid-19 pandemic. Method This observational multicenter study included 1641 unselected patients with autoimmune systemic diseases from three Italian geographical areas with different prevalence of Covid-19 [high in north (Emilia Romagna), medium in central (Tuscany), and low in south (Calabria)] by means of telephone 6-week survey. Covid-19 was classified as (1) definite diagnosis of Covid-19 disease: presence of symptomatic Covid-19 infection, confirmed by positive oral/nasopharyngeal swabs; (2) highly suspected Covid-19 disease: presence of highly suggestive symptoms, in absence of a swab test. Results A significantly higher prevalence of patients with definite diagnosis of Covid-19 disease, or with highly suspected Covid19 disease, or both the conditions together, was observed in the whole autoimmune systemic disease series, compared to “Italian general population” (p = .030, p = .001, p = .000, respectively); and for definite + highly suspected diagnosis of Covid-19 disease, in patients with autoimmune systemic diseases of the three regions (p = .000, for all comparisons with the respective regional general population). Moreover, significantly higher prevalence of definite + highly suspected diagnosis of Covid-19 disease was found either in patients with various “connective tissue diseases” compared to “inflammatory arthritis group” (p < .000), or in * Alessandro Antonelli alessandro.antonelli@med.unipi.it 8 UOD Reumatologia, Grande Ospedale Metropolitano, Reggio Calabria, Italy 9 U.O.S. Reumatologia, Ospedale Castrovillari, Cosenza, Italy 10 U.O.T. Specialistica Ambulatoriale ASP 201, Cosenza, Italy 11 Rheumatology Unit, School of Medicine, University of Modena & RE, Modena, Italy U.O.C. Medicina Interna “M.Valentini” P.O. Annunziata, Cosenza, Italy 12 Rheumatology Clinic ‘Madonna dello Scoglio’ Cotronei, Crotone, Italy Rheumatology Outpatient Clinic, San Giovanni di Dio Hospital, Crotone, Italy 13 Rheumatology Unit, University of Catania, Catania, Italy 14 Department of Internal Medicine, San Martino Policlinic Hospital, University of Genoa, Genoa, Italy 15 Department of Translational Research and New Technologies in Medicine and Surgery, School of Medicine, University of Pisa, Pisa,..