Article Text

Download PDFPDF
Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study
  1. Jose L Pablos1,2,
  2. María Galindo1,
  3. Loreto Carmona3,
  4. Ana Lledó1,
  5. Miriam Retuerto1,
  6. Ricardo Blanco4,
  7. Miguel A Gonzalez-Gay4,
  8. David Martinez-Lopez4,
  9. Isabel Castrejón5,
  10. José M Alvaro-Gracia5,
  11. David Fernández Fernández6,
  12. Antonio Mera-Varela6,
  13. Sara Manrique-Arija7,
  14. Natalia Mena Vázquez7,
  15. Antonio Fernandez-Nebro7
  16. RIER Investigators Group
    1. 1 Servicio de Reumatología, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
    2. 2 Universidad Complutense de Madrid, Madrid, Spain
    3. 3 Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
    4. 4 Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla (IDIVAL), Santander, Spain
    5. 5 Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
    6. 6 Servicio de Reumatología, Hospital Clínico Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
    7. 7 UGC de Reumatología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
    1. Correspondence to Dr Jose L Pablos, Servicio de Reumatología, Instituto de Investigación Hospital 12 de Octubre, Madrid 28040, Spain; jlpablos{at}


    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.

    • rheumatoid
    • arthritis
    • psoriatic
    • autoimmune diseases
    • spondylitis
    • ankylosing
    • epidemiology

    This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

    Statistics from

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


    • Handling editor Josef S Smolen

    • Collaborators RIER investigators group: Rodrigo Aguirre, Álvaro Seijas-López, Francisco J Blanco, (Servicio de Reumatología, INIBIC-Complejo Hospitalario Universitario A Coruña, Universidad de A Coruña, A Coruña, Spain); Patricia Carreira, María Martín-López (Servicio de Reumatología, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain); Antonio Gonzalez (Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain); Amaya Puig-Kröger, Luis Salas (Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain).

    • Contributors JLP, MG and LC take responsibility for the integrity of the data, data analysis and statistical analyses. JLP and LC drafted the manuscript and all authors. All authors participated in acquisition of data, designing the analyses, interpreting the results and critical revision of the manuscript. RIER investigators participated in the design and partially collaborated in acquisition of data. All authors approved the final manuscript.

    • Funding The RIER network was supported by the Fondo de Investigación Sanitaria, Instituto de Salud Carlos III (RD16/0012 RETICS program) and cofinanced by the European Regional Development Fund (FEDER).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by Comité de Ética de la Investigación del Hospital Universitario 12 de Octubre, CEIm number: 20/160.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Individual de-identified patient data will made available to researchers who provide a reasonable and methodologically sound proposal. Proposals should be directed to the corresponding author.