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Clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and rheumatic disease: a comparative cohort study from a US ‘hot spot’
  1. Kristin M D’Silva1,2,
  2. Naomi Serling-Boyd1,
  3. Rachel Wallwork1,
  4. Tiffany Hsu3,
  5. Xiaoqing Fu1,2,
  6. Ellen M Gravallese3,
  7. Hyon K Choi2,
  8. Jeffrey A Sparks3,
  9. Zachary S Wallace1,2
  1. 1 Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2 Clinical Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3 Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Zachary S Wallace, Rheumatology Unit, Massachusetts General Hospital, Boston MA 02114, Massachusetts, USA; zswallace{at}


Objective To investigate differences in manifestations and outcomes of coronavirus disease 2019 (COVID-19) infection between those with and without rheumatic disease.

Methods We conducted a comparative cohort study of patients with rheumatic disease and COVID-19 (confirmed by severe acute respiratory syndrome coronavirus 2 PCR), compared in a 1:2 ratio with matched comparators on age, sex and date of COVID-19 diagnosis, between 1 March and 8 April 2020, at Partners HealthCare System in the greater Boston, Massachusetts area. We examined differences in demographics, clinical features and outcomes of COVID-19 infection. The main outcomes were hospitalisation, intensive care admission, mechanical ventilation and mortality.

Results We identified 52 rheumatic disease patients with COVID-19 (mean age, 63 years; 69% female) and matched these to 104 non-rheumatic disease comparators. The majority (39, 75%) of patients with rheumatic disease were on immunosuppressive medications. Patients with and without rheumatic disease had similar symptoms and laboratory findings. A similar proportion of patients with and without rheumatic disease were hospitalised (23 (44%) vs 42 (40%)), p=0.50) but those with rheumatic disease required intensive care admission and mechanical ventilation more often (11 (48%) vs 7 (18%), multivariable OR 3.11 (95% CI 1.07 to 9.05)). Mortality was similar between the two groups (3 (6%) vs 4 (4%), p=0.69).

Conclusions Patients with rheumatic disease and COVID-19 infection were more likely to require mechanical ventilation but had similar clinical features and hospitalisation rates as those without rheumatic disease. These findings have important implications for patients with rheumatic disease but require further validation.

  • autoimmune diseases
  • epidemiology
  • health services research
  • outcome and process assessment, health care

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  • KMD’S and NS-B are joint first authors.

  • JAS and ZSW are joint Last authors.

  • Handling editor Josef S Smolen

  • Twitter @jeffsparks

  • Contributors ZSW and JAS had the idea for the article. ZSW, JAS, KMD, NS-B, TH, HKC and EMG designed the study and interpreted results. KMD, NS-B, RW, TH, JAS and ZSW extracted data, planned analyses, interpreted results and wrote the first draft of the manuscript. XF assisted with planning analyses, performed the analyses and helped interpret the results. All authors critically reviewed the manuscript and agreed that it was ready for submission. ZSW accepts full responsibility for the finished article, had access to any data and controlled the decision to publish.

  • Funding KMD and NS-B are supported by the National Institutes of Health Ruth L. Kirschstein Institutional National Research Service Award (T32-AR-007258). HKC is funded by National Institutes of Health (P50-AR-060772). JAS is funded by NIH/NIAMS (grant numbers K23 AR069688, R03 AR075886, L30 AR066953, P30 AR070253 and P30 AR072577), the Rheumatology Research Foundation K Supplement Award, the Brigham Research Institute and the R. Bruce and Joan M. Mickey Research Scholar Fund. ZSW is funded by NIH/NIAMS (K23AR073334 and L30 AR070520).

  • Competing interests EMG reports editor position at New England Journal of Medicine and royalties from the textbook Rheumatology. HKC reports research support from AstraZeneca and consultancy fees from Takeda, Selecta, GlaxoSmithKline and Horizon. JAS reports research support from Amgen and Bristol-Myers Squibb and consultancy fees from Bristol-Myers Squibb, Gilead, Inova, Janssen and Optum.

  • 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 This study was considered to be exempt by the Partners HealthCare System Institutional Review Board.

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

  • Data availability statement No data are available.