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Prevalence of hospital PCR-confirmed COVID-19 cases in patients with chronic inflammatory and autoimmune rheumatic diseases
  1. Jose L Pablos1,2,
  2. Lydia Abasolo3,
  3. Jose M Alvaro-Gracia4,
  4. Francisco J Blanco5,6,
  5. Ricardo Blanco7,
  6. Isabel Castrejón4,
  7. David Fernandez-Fernandez8,
  8. Benjamín Fernandez-Gutierrez3,
  9. María Galindo-Izquierdo1,2,
  10. Miguel A Gonzalez-Gay7,
  11. Sara Manrique-Arija9,10,
  12. Natalia Mena Vázquez9,10,
  13. Antonio Mera Varela8,
  14. Miriam Retuerto1,
  15. Alvaro Seijas-Lopez8
  16. RIER investigators group
  1. 1 Servicio de Reumatología, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
  2. 2 Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Comunidad de Madrid, Spain
  3. 3 Servicio de Reumatologia, Hospital Clínico San Carlos, Instituto Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
  4. 4 Servicio de Reumatologia, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
  5. 5 Servicio de Reumatologia, INIBIC-Hospital Universitario A Coruña, A Coruña, Spain
  6. 6 Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidad de A Coruña, A Coruña, Spain
  7. 7 Servicio de Reumatologia, Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Cantabria, Spain
  8. 8 Servicio de Reumatologia, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
  9. 9 Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
  10. 10 UGC de Reumatología, Hospital Regional Universitario de Málaga, Malaga, Andalucía, Spain
  1. Correspondence to Dr Jose L Pablos, Servicio de Reumatología, Instituto de Investigación Hospital 12 de Octubre, Madrid 28041, Spain; jlpablos{at}


Background The susceptibility of patients with rheumatic diseases and the risks or benefits of immunosuppressive therapies for COVID-19 are unknown.

Methods We performed a retrospective study with patients under follow-up in rheumatology departments from seven hospitals in Spain. We matched updated databases of rheumatology patients with severe acute respiratory syndrome coronavirus 2-positive PCR tests performed in the hospital to the same reference populations. Rates of PCR+ confirmed COVID-19 were compared among groups.

Results Patients with chronic inflammatory diseases had 1.32-fold higher prevalence of hospital PCR+ COVID-19 than the reference population (0.76% vs 0.58%). Patients with systemic autoimmune or immune-mediated disease (AI/IMID) showed a significant increase, whereas patients with inflammatory arthritis (IA) or systemic lupus erythematosus did not. COVID-19 cases in some but not all diagnostic groups had older ages than cases in the reference population. Patients with IA on targeted-synthetic or biological disease-modifying antirheumatic drugs (DMARDs), but not those on conventional-synthetic DMARDs, had a greater prevalence despite a similar age distribution.

Conclusion Patients with AI/IMID show a variable risk of hospital-diagnosed COVID-19. Interplay of ageing, therapies and disease-specific factors seem to contribute. These data provide a basis to improve preventive recommendations to rheumatic patients and to analyse the specific factors involved in COVID-19 susceptibility.

  • arthritis
  • autoimmune diseases
  • epidemiology
  • biological therapy

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.

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  • Handling editor Josef S Smolen

  • Twitter @Fergutbe2001

  • Correction notice This article has been corrected since it published Online first. The author group '

    RIER investigators group' has been added.

  • Collaborators RIER investigators group: Rodrigo Aguirre, Guillermo Arribas, Francisco J De Toro-Santos (Servicio de Reumatología, INIBIC-Complejo Hospitalario Universitario A Coruña, Universidad de A Coruña, A Coruña, Spain); Patricia Carreira, Ana Lledó (Servicio de Reumatología, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain); Juan D Cañete, Jose A Gómez-Puerta, Julio Ramírez (Servicio de Reumatología, Hospital Clinic, IDIBAPS, Barcelona, Spain); María López-Lasanta, Sara Marsal (Servicio de Reumatología, Instituto de Investigación Hospital Vall Hebron, Universidad Vall Hebron (VHIR), Barcelona, Spain); Alejandro Escudero-Contreras, Chary López-Pedrera, Clementina Lopez-Medina (Hospital Universitario Reina Sofia, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Antonio Gonzalez (Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain); David Martinez-Lopez (Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain); Antonio Fernández-Nebro (Instituto de Investigación Biomédica de Málaga (IBIMA), UGC de Reumatología, Universidad de Málaga, Málaga, Spain); Amaya Puig-Kröger Amaya (Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain); Ana M Ortiz, Isidoro González-Álvaro (Servicio de Reumatología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain.); Leticia León-Mateos, Luis Rodríguez-Rodríguez (Servicio de Reumatología, Hospital Clínico San Carlos, Instituto Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain).

  • Contributors JLP and MG-I take responsibility for the integrity of the data, data analysis and statistical analyses. All authors participated in the acquisition of data, designing the analyses, interpreting the results and writing the manuscript. RIER investigators participated in the design and partially collaborated in the acquisition of data.

  • 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.

  • 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. All data relevant to the study are included in the article or uploaded as supplementary information. Additional data are available upon reasonable request from the corresponding author.