Background/Purpose: The impact of COVID-19 infection in patients with autoimmune/auto-inflammatory rheumatic diseases (AARD) under immunomodulatory treatment is not entirely clear and deeper knowledge is of paramount importance during the SARS-CoV-2 pandemic. Whether risk factors as in the general population or the immune dysregulation in the context of the underlying AARD per se and/or the immunomodulatory therapy used predispose to a more severe disease course and hospitalization, has to be elucidated.

Methods: In this observational study, demographic data, AARD related features and comorbidities, COVID-19 manifestations and outcome, as well as antibody responses to SARS-CoV-2 were recorded among 77 AARD patients infected by SARS-CoV-2. We next wished to identify risk factors for COVID-19 severity and subsequent hospitalization Analysis of data was performed using univariate and multivariate models.

Results: The majority of patients (68.8%) experienced a mild COVID-19 course. The predominant symptoms were upper respiratory tract symptoms (68.8%), fatigue (58.4%) and low grade fever (45.4%). One out of four patients required hospitalization (23.3%) and the mortality rate was 1.3%. Regarding COVID-19 severity, prior treatment with corticosteroids, mycophenolate mofetil or rituximab was more common in patients who developed a more serious disease course (60.0 vs 29.9%, p=0.003, 40.0 vs 7.5%, p=0.003, 10.0 vs 0.0%, p=0.009, respectively). Among COVID-19 related features, patients with shortness of breath and high-grade fever were more likely to get hospitalized (OR [95%]: 7.06 [1.36–36.57], 12.04 [2.96–48.86]), while anosmia was independently associated with lower hospitalization risk (OR [95%]: 0.09 [0.01–0.99]). When disease related features and comorbidities were considered in multivariate models, older age and lung disease in the context of the AARD were found to be independent predictive factors for hospitalization (OR [95%]: 1.09 [1.03–1.15] and 6.43 [1.11–37.19]).

Conclusion: Though the majority of AARD patients displayed a mild COVID-19 course, certain AARD related features and COVID-19 related manifestations should prompt alertness for the physician to identify patients with AARD at high risk for severe COVID-19 and need for hospitalization.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/covid-19-infection-among-autoimmune-auto-inflammatory-rheumatic-disease-patients-data-from-an-observational-study/