Objective The clinical features of rheumatic patients with coronavirus disease 2019 (COVID-19) have not been reported. This study aimed to describe the clinical features of COVID-19 in rheumatic patients and provide information for handling this situation in clinical practice.
Methods This is a retrospective case series study. Deidentified data, including gender, age, laboratory and radiological results, symptoms, signs, and medication history, were collected from 2326 patients diagnosed with COVID-19, including 21 cases in combination with rheumatic disease, in Tongji Hospital between 13 January and 15 March 2020.
Results Length of hospital stay and mortality rate were similar between rheumatic and non-rheumatic groups, while the presence of respiratory failure was more common in rheumatic cases (38% vs 10%, p<0.001). Symptoms of fever, fatigue and diarrhoea were seen in 76%, 43% and 23% of patients, respectively. There were four rheumatic patients who experienced a flare of rheumatic disease during hospital stay, with symptoms of muscle aches, back pain, joint pain or rash. While lymphocytopaenia was seen in 57% of rheumatic patients, only one patient (5%) presented with leucopenia in rheumatic cases. Rheumatic patients presented with similar radiological features of ground-glass opacity and consolidation. Patients with pre-existing interstitial lung disease showed massive fibrous stripes and crazy-paving signs at an early stage. Five rheumatic cases used hydroxychloroquine before the diagnosis of COVID-19 and none progressed to critically ill stage.
Conclusions Respiratory failure was more common in rheumatic patients infected with COVID-19. Differential diagnosis between COVID-19 and a flare of rheumatic disease should be considered.
Trial registration number ChiCTR2000030795.
- autoimmune diseases
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Handling editor Josef S Smolen
CY and SC contributed equally.
Correction notice This article has been corrected since it published Onilne First. The section heading has been changed to 'Epidemiology'.
Contributors Study design: LD, JZ, CY. Data collection: CY, SC, GS, HG, LZ, YH, WT, YuC, YY, XW, YuxC. Data analysis: CY, SC, JZ. Interpretation of findings: CY, JZ, LD. Preparation of manuscript: CY, SC, JZ. All authors read and approved the final manuscript.
Funding This work was supported by grants from the National Natural Science Foundation of China (81974254, 81670431 and 81771754), Tongji Hospital Clinical Research Flagship Program (no 2019CR206), and Hubei Chen Xiaoping Science and Technology Development Foundation Clinical Research Special Fund (CXPJJH11800005-07).
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 the Institutional Review Board and Medical Ethics Committee of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.