Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study
Pablos et al.
, Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic..
, Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-218296
Retrospective 228 rheumatic disease and 228 non-rheumatic disease hospitalized COVID-19 patients in Spain, showing higher risk of severe COVID-19 with HCQ treatment.
risk of severe case, 126.0% higher, OR 2.26, p = 0.002, treatment 172, control 56, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Pablos et al., 12 Aug 2020, retrospective, Spain, peer-reviewed, mean age 63.0, 15 authors.
Abstract: EPIDEMIOLOGICAL SCIENCE
Clinical outcomes of hospitalised patients with
COVID-19 and chronic inflammatory and autoimmune
rheumatic diseases: a multicentric matched
Jose L Pablos ,1,2 María Galindo,1 Loreto Carmona,3 Ana Lledó,1
Miriam Retuerto ,1 Ricardo Blanco ,4 Miguel A Gonzalez-Gay ,4
David Martinez-Lopez,4 Isabel Castrejón,5 José M Alvaro-Gracia ,5
David Fernández Fernández ,6 Antonio Mera-Varela ,6 Sara Manrique-Arija ,7
Natalia Mena Vázquez ,7 Antonio Fernandez-Nebro ,7 RIER Investigators Group
Handling editor Josef S
For numbered affiliations see
end of article.
Dr Jose L Pablos, Servicio de
Reumatología, Instituto de
Investigación Hospital 12 de
Octubre, Madrid 28040, Spain;
Received 12 June 2020
Revised 31 July 2020
Accepted 31 July 2020
Published Online First
12 August 2020
© Author(s) (or their
employer(s)) 2020. No
commercial re-use. See rights
and permissions. Published
To cite: Pablos JL,
Galindo M, Carmona L,
et al. Ann Rheum Dis
Objectives The impact of inflammatory rheumatic
diseases on COVID-19 severity is poorly known. Here,
we compare the outcomes of a cohort of patients with
rheumatic diseases with a matched control cohort to
identify potential risk factors for severe illness.
Methods In this comparative cohort study, we
identified hospital PCR+COVID-19 rheumatic patients
with chronic inflammatory arthritis (IA) or connective
tissue diseases (CTDs). Non-rheumatic controls were
randomly sampled 1:1 and matched by age, sex and
PCR date. The main outcome was severe COVID-19,
defined as death, invasive ventilation, intensive care
unit admission or serious complications. We assessed
the association between the outcome and the potential
prognostic variables, adjusted by COVID-19 treatment,
using logistic regression.
Results The cohorts were composed of 456 rheumatic
and non-rheumatic patients, in equal numbers. Mean age
was 63 (IQR 53–78) years and male sex 41% in both
cohorts. Rheumatic diseases were IA (60%) and CTD
(40%). Most patients (74%) had been hospitalised, and
the risk of severe COVID-19 was 31.6% in the rheumatic
and 28.1% in the non-rheumatic cohort. Ageing,
male sex and previous comorbidity (obesity, diabetes,
hypertension, cardiovascular or lung disease) increased
the risk in the rheumatic cohort by bivariate analysis.
In logistic regression analysis, independent factors
associated with severe COVID-19 were increased age
(OR 4.83; 95% CI 2.78 to 8.36), male sex (1.93; CI 1.21
to 3.07) and having a CTD (OR 1.82; CI 1.00 to 3.30).
Conclusion In hospitalised patients with chronic
inflammatory rheumatic diseases, having a CTD but
not IA nor previous immunosuppressive therapies was
associated with severe COVID-19.
What is already known about this subject?
►► There is limited evidence on the outcomes of
COVID-19 in patients with rheumatic diseases
and the impact of age, comorbidity, therapy or
other factors associated to severity specifically
in these patients.
What does this study add?
►► We found that severe COVID-19 occurred in
31.6% of the rheumatic and 28.1% of non-
►► Having a connective tissue disease but not its
therapy was significantly associated with severe
►► Other known risk factors as ageing or male sex
also apply to patients with rheumatic diseases.
How might this impact on clinical practice or
is less effective
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