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Clinical characteristics and outcomes of patients with COVID-19 and rheumatic disease in China ‘hot spot’ versus in US ‘hot spot’: similarities and differences
  1. Jun Zhao1,
  2. Rongrong Pang1,2,
  3. Jian Wu1,
  4. Yanju Guo1,
  5. Yang Yang1,
  6. Libo Zhang1,2,
  7. Xinyi Xia1,3,4
  1. 1 COVID-19 Research Center, Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, China
  2. 2 Department of Laboratory Medicine, Nanjing Red Cross Blood Center, Nanjing, Jiangsu 210003, China
  3. 3 Department of Laboratory Medicine & Blood Transfusion, Wuhan Huoshenshan Hospital, Wuhan, Hubei 430100, China
  4. 4 Joint Expert Group for COVID-19, Wuhan Huoshenshan Hospital, Wuhan, Hubei 430100, China
  1. Correspondence to Professor Xinyi Xia, Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, China; xiaxynju{at}

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We read with great interest the article by D’Silva et al concerning clinical characteristics and outcomes of patients with COVID-19 and rheumatic disease.1 In this study, the authors mentioned that patients with and without rheumatic disease had similar symptoms and laboratory findings, but those with rheumatic disease were more likely to require mechanical ventilation.

We analysed our data of 3059 patients with confirmed COVID-19, including 29 cases in combination with rheumatic diseases from Huoshenshan Hospital in Wuhan, which was a ‘hot spot’ of COVID-19 in China, from 4 February 2020 to 9 April 2020. There were 15 rheumatoid arthritis, 5 systematic lupus erythematosus, 1 Rhupus, 2 myasthenia gravis, 1 Sjögren’s syndrome, 1 ankylosing spondylitis, 1 dermatomyositis, 1 autoimmune liver disease and 2 undifferentiated connective tissue disease cases (figure 1). The study population encompassed 4 men and 25 women, with median age of 61 years. Twenty-one patients presented with cough, 21 patients had fatigue, 3 had diarrhoea, 14 had varying degrees of difficulty in breathing and fever was observed in all cases.

Figure 1

Basic situation and medication of patients with rheumatic disease with COVID-19 during the course of the disease. Heatmap in the panel records the patient’s disease classification, severity grade of COVID-19, number of underlying diseases, duration of disease, special treatment, inpatient and long-term medication, oxygen therapy, intensive care and clinical outcomes. Rheumatic immune diseases including systemic lupus erythematosus (SLE); rheumatoid arthritis (RA); myasthenia gravis (MG); Sjogren’s syndrome (SS); dermatomyositis (DM); ankylosing spondylitis (AS); autoimmune hepatitis (AIH); undifferentiated connective tissue disease (UCTD). Basic diseases include hypertension, diabetes, coronary heart disease, lung disease, kidney disease, anaemia, thyroid disease and so on. Diabetes is the most combined basic disease, a total of six people. CPT, convalescent plasma therapy; ICU, intensive care unit.

Along with the results reported by D’Silva et al, the main manifestations and laboratory findings (figure 2) in patients with rheumatic disease were similar to patients with COVID-19 in the general population. Nevertheless, the need for mechanical ventilation was much lower in our study (2/29 vs 7/52). We hypothesised that part of the differences cross studies could be explained by medication and therapeutic strategy of the rheumatic population.

Figure 2

Laboratory index of COVID-19 in patients with rheumatism. Test items include white blood cells (WBC); lymphocytes (LYM); neutrophils (NEUT); platelets (PLT); haemoglobin (HGB); alanine aminotransferase (ALT); aspartate aminotransferase (AST); D-dimer; prothrombin time (PT); high sensitivity C-reactive protein (hsCRP); cystatin c (CysC). Colours indicate the rise and fall of the indicator; there are four missing values. # defined as absolute count.

First, we note that the proportion of rheumatic diseases (0.95%) in our hospital was relative lower than reported by D’Silva (2.2%). And the most common comorbidity in patients with rheumatic disease was diabetes (6/29) in our study, whereas hypertension (34/52) was the most common in D’Silva’s report. It is indeed that different ethnicity, different regional prevalence of rheumatic diseases, different varieties and proportion of these diseases, and also different burden of comorbidities may contribute to the different outcome.

Second, medication is another important issue. In our study, five patients were treated with hydroxychloroquine (HCQ) for long term, and seven took corticosteroids as a regular prescription before the diagnosis of COVID-19, whereas eight received corticosteroids during hospitalisation. HCQ and chloroquine have been successfully used to treat variety of rheumatic diseases, and the sudden outbreak raises many questions concerning the potential benefit on protecting or antiviral potency of severe acute respiratory syndrome coronavirus 2 infection.2–4 None of the five cases with long-term HCQ treatment progressed to critical severe cases. Notably, the traditional Chinese medicines such as Lianhuaqingwen capsule were also confirmed to have the potency of ameliorating clinical symptoms of COVID-19.5

Lastly, we also use convalescent plasma therapy in three patients, and tocilizumab in one patient due to their immunocompromised status. All patients recovered within 1 week after administration of immunotherapy.

In conclusion, we observed similar clinical manifestations of patients with COVID-19 and rheumatic disease in line with D’Silva’s report. However, the need for mechanical ventilation was much lower in our study, and this remains inconclusive due to different ethnicity, different regional prevalence of rheumatic diseases and also concomitant treatments. Immunotherapy as an alternative therapy might play a role in maintaining the immune function, delaying or preventing the worsening of the disease and further minimising the need for mechanical ventilation.



  • JZ, RP and JW contributed equally.

  • Correction notice This article has been corrected since it published Online First. The title has has been corrected.

  • Contributors JZ and RP conducted data analysis and wrote the manuscript. LZ contributed with comments during the writing. JW, YG and YY conducted data analysis. XX and LZ conceived the study.

  • Funding Key Foundation of Wuhan Huoshenshan Hospital (2020[18]), Key Research & Development Program of Jiangsu Province (BE2018713), Medical Innovation Project of Logistics Service (18JS005).

  • 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.

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

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