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Systemic sclerosis and the COVID-19 pandemic: World Scleroderma Foundation preliminary advice for patient management
  1. Marco Matucci-Cerinic1,
  2. Cosimo Bruni1,
  3. Yannick Allanore2,
  4. Massimo Clementi3,4,
  5. Lorenzo Dagna5,6,
  6. Nemanja S Damjanov7,
  7. Amato de Paulis8,
  8. Christopher P Denton9,
  9. Oliver Distler10,
  10. David Fox11,
  11. Daniel E Furst1,12,13,
  12. Dinesh Khanna11,
  13. Thomas Krieg14,
  14. Masataka Kuwana15,
  15. Eun Bong Lee16,
  16. Mengtao Li17,
  17. Shiv Pillai18,
  18. Yukai Wang19,
  19. Xiaofeng Zeng20,
  20. Gloria Taliani21
  1. 1 Department of Experimental and Clinical Medicine, Division of Rheumatology, Università degli Studi di Firenze, Firenze, Toscana, Italy
  2. 2 Rheumatology Department, Cochin Hospital, APHP, Paris Descartes University, Paris, France
  3. 3 Unit of Microbiology and Virology, San Raffaele Hospital, Milano, Lombardia, Italy
  4. 4 Unit of Microbiology and Virology, Università Vita Salute San Raffaele, Milano, Lombardia, Italy
  5. 5 Vita-Salute San Raffaele University, Milan, Italy
  6. 6 Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
  7. 7 Rheumatology department, University of Belgrade School of Medicine, Belgrade, Serbia
  8. 8 Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
  9. 9 Department of Rheumatology, Royal Free Hospital, University College London, London, UK
  10. 10 Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
  11. 11 Rheumatology department, University of Michigan, Ann Arbor, Michigan, USA
  12. 12 Department of Medicine, Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA
  13. 13 University of Washington, Seattle, Washington DC, USA
  14. 14 Translational Matrix Biology, Medical Faculty, Cologne, Germany
  15. 15 Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
  16. 16 Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
  17. 17 Rheumatology & Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  18. 18 Ragon Institute, Massachusetts General Hospital, Cambridge, Massachusetts, USA
  19. 19 Rheumatology department, Shantou Central Hospital, Shantou, Guangdong, China
  20. 20 Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
  21. 21 Infectious Diseases Unit, Department of Translational and Precision Medicine, Sapienza University of Rome, Roma, Lazio, Italy
  1. Correspondence to Marco Matucci-Cerinic, Experimental and Clinical Medicine, Division of Rheumatology, Università degli Studi di Firenze, Firenze 50139, Italy; marco.matuccicerinic{at}


Due to the frequent presence of interstitial lung disease and widespread use of immunosuppressive treatment, systemic sclerosis (SSc) patients may be considered at risk for a more severe disease course and higher mortality when they develop Severe Acute Respiratory Syndrome - Coronavirus - 2 (SARS-CoV-2) virus infection. Therefore, with World Scleroderma Foundation endorsement, experts from different specialties including rheumatology, virology and clinical immunology gathered virtually to answer to the main practical clinical questions regarding SARS-CoV-2 infection coming from both patients and physicians. This preliminary advice is aligned with other national and international recommendations, adapted for SSc patients.

  • scleroderma
  • systemic
  • autoimmune diseases
  • hydroxychloroquine

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  • MM-C and CB are joint first authors.

  • Handling editor Josef S Smolen

  • MM-C and CB contributed equally.

  • Correction notice This article has been corrected since it published Online First. The author affiliations have been corrected.

  • Contributors All authors contributed to manuscript preparation and approved the submitted version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MMC reports grant and personal fees from Actelion, Biogen, Bayer, Boehringer Ingelheim, CSL Behring, Eli-Lilly, outside the submitted work. CB reports consultancy fee from Actelion, Eli Lilly. YA reports personal fees from Actelion, Bayer, BMS, Boehringer and Curzion, and grants and personal fees from Inventiva, Roche and Sanofi. MC; NSD: none. LD received consultation honoraria from Abbvie, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI. CPD has received consultancy fees and/or research grant funding from Actelion, GlaxoSmithKline, Bayer, Sanofi-Aventis, Inventiva, Boehringer Ingelheim, Roche, CSL Behring, UCB Pharma, Leadiant Biosciences, Corbus, Acceleron. OD had consultancy relationship and/or has received research funding from Abbvie, Actelion, Acceleron Pharma, Amgen, AnaMar, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, Catenion, Competitive Drug Development International Ltd, CSL Behring, Curzion Pharmaceuticals, Ergonex, Galapagos NV, Glenmark Pharmaceuticals GSK, Inventiva, Italfarmaco, iQvia, Lilly, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Target Bio Science and UCB in the area of potential treatments of scleroderma and its complications. In addition, OD has a patent mir-29 for the treatment of systemic sclerosis issued (US8247389, EP2331143). Grants (2 Jahre) from Actelion, Bayer, Boehringer Ingelheim, Mitsubishi Tanabe Pharma Patent issued: mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143). Comment: To investigate potential treatments of scleroderma and its complications. DF has received consulting fees, speaking fees and/or honoraria from Pfizer and research support from Regeneron, Gilead and Seattle Genetics. DEF: Grant/Research Support Corbus, Galapagos GSK, Pfizer, Talaris, CSL Behring, Mitsubishi; Consultant Actelion, Amgen, Corbus, Galapagos, Novartis, Pfizer, Roche/Genentech, Talaris, CSL Behring, Boehringer Ingelheim; DK reports personal fees from Actelion, Abbvie, Bayer, Boehringer-Ingelheim, Chemomab, Corbus, CSL Behring, Genentech/Roche, Gilead, GSK, Mitsubishi Tanabi, Sanofi-Aventis, UCB Pharma. He reports grants from Bayer, Boehringer-Ingelheim, Genentech/Roche, Pfizer, Sanofi-Aventis and has stock options in Eicos Sciences. MK has received consultancy fees and/or research grant funding from Abbvie, Actelion Pharmaceuticals, Astellas, Bayer, Boehringer Ingelheim, Chugai, Corbus, CSL Behring, Eisai, Mochida, Nippon Shinyaku, Novartis, Ono, Pfizer, Reata and Tanabe-Mitsubishi. SP reports SAB from Abpro. TK recieved consultancy fee and grant funding from Actelion.

  • 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.

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