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Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance
  1. Manuel Francisco Ugarte-Gil1,2,
  2. Graciela S Alarcón3,4,
  3. Zara Izadi5,6,
  4. Ali Duarte-García7,8,
  5. Cristina Reátegui-Sokolova2,9,
  6. Ann Elaine Clarke10,
  7. Leanna Wise11,
  8. Guillermo J Pons-Estel12,13,
  9. Maria Jose Santos14,15,
  10. Sasha Bernatsky16,
  11. Sandra Lúcia Euzébio Ribeiro17,
  12. Samar Al Emadi18,
  13. Jeffrey A Sparks19,
  14. Tiffany Y -T Hsu19,
  15. Naomi J Patel20,
  16. Emily L Gilbert21,
  17. Maria O Valenzuela-Almada7,
  18. Andreas Jönsen22,
  19. Gianpiero Landolfi23,
  20. Micaela Fredi24,25,
  21. Tiphaine Goulenok26,27,
  22. Mathilde Devaux28,
  23. Xavier Mariette29,
  24. Viviane Queyrel30,
  25. Vasco C Romão31,32,
  26. Graca Sequeira33,
  27. Rebecca Hasseli34,
  28. Bimba Hoyer35,
  29. Reinhard E Voll36,
  30. Christof Specker37,
  31. Roberto Baez38,
  32. Vanessa Castro-Coello39,
  33. Hernan Maldonado Ficco40,
  34. Edgard Torres Reis Neto41,
  35. Gilda Aparecida Aparecida Ferreira42,43,
  36. Odirlei Andre André Monticielo44,45,
  37. Emily Sirotich46,47,
  38. Jean Liew48,
  39. Jonathan Hausmann49,50,
  40. Paul Sufka51,
  41. Rebecca Grainger52,
  42. Suleman Bhana53,
  43. Wendy Costello54,
  44. Zachary S Wallace20,
  45. Lindsay Jacobsohn6,
  46. Tiffany Taylor6,
  47. Clairissa Ja6,
  48. Anja Strangfeld55,
  49. Elsa F Mateus56,57,
  50. Kimme L Hyrich58,59,
  51. Loreto Carmona60,
  52. Saskia Lawson-Tovey59,61,
  53. Lianne Kearsley-Fleet62,
  54. Martin Schäfer63,
  55. Pedro M Machado64,65,66,67,
  56. Philip C Robinson68,69,
  57. Milena Gianfrancesco6,
  58. Jinoos Yazdany6
  1. 1 Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Cientifica del Sur, Lima, Peru
  2. 2 Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
  3. 3 Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
  4. 4 School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
  5. 5 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
  6. 6 Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
  7. 7 Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
  8. 8 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
  9. 9 Unidad de Investigación Para La Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima Peru
  10. 10 Division of Rheumatology Department of Medicine. Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  11. 11 Department of Internal Medicine, Division of Rheumatology, University of Southern California, Los Angeles, California, USA
  12. 12 Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
  13. 13 Research Unit, Argentine Society of Rheumatology, Buenos Aires, Argentina
  14. 14 Rheumatology, Hospital Garcia de Orta, Almada, Portugal
  15. 15 Rheumatology Research Unit. Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
  16. 16 Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada
  17. 17 Faculdade de Medicina, Universidade Federal do Amazonas, UFAM, Manaos, Amazonas, Brazil
  18. 18 Rheumatology Department, Hamad Medical Corp, Doha, Qatar
  19. 19 Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
  20. 20 Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital. Harvard Medical School, Boston, Massachusetts, USA
  21. 21 Division of Rheumatology, Mayo Clinic, Jacksonville, Florida, USA
  22. 22 Lund University, Lund, Sweden
  23. 23 Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy
  24. 24 Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
  25. 25 Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
  26. 26 Internal Medicine Department, Bichat Claude Bernard Hospital, APHP, Paris, France
  27. 27 Université de Paris, Paris, France
  28. 28 Internal Medicine Department, Poissy Saint-Germain-en-Laye Hospital, Poissy, France
  29. 29 Department of Rheumatology, Université Paris-Saclay, Assistance Publique - Hôpitaux de Paris, Le Kremlin Bicêtre, France
  30. 30 Department of Rheumatology, Pasteur 2 Hospital, University of Nice -Sophia- Antipolis, Nice, France
  31. 31 Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
  32. 32 Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
  33. 33 Centro Hospitalar Universitário do Algarve, Unidade de Faro, Faro, Portugal
  34. 34 Department of Rheumatology and Clinical Immunology. Campus Kerckhoff, Justus Liebig University Giessen, Bad Nauheim, Germany
  35. 35 Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
  36. 36 Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
  37. 37 Department of Rheumatology and Clinical Immunology, Kliniken Essen-Mitte, Essen, Germany
  38. 38 Hospital Francisco Lopez Lima, General Roca, Argentina
  39. 39 Sanatorio Güemes, Buenos Aires, Argentina
  40. 40 Hospital San Antonio de Padua, Rio Cuarto, Argentina
  41. 41 Hospital São Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
  42. 42 Hospital das Clínicas, Belo Horizonte, Brazil
  43. 43 Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  44. 44 Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
  45. 45 Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
  46. 46 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  47. 47 Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
  48. 48 Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  49. 49 Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA
  50. 50 Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center. Harvard Medical School, Boston, Massachusetts, USA
  51. 51 Healthpartners, St Paul, Minnesota, USA
  52. 52 Department of Medicine, University of Otago, Wellington, New Zealand
  53. 53 Pfizer, Inc, New York, New York, USA
  54. 54 Irish Children's Arthritis Network (iCAN), Tipperary, Ireland
  55. 55 Epidemiology and Health Services, German Rheumatism Research Center (DRFZ Berlin), Berlin, Germany
  56. 56 Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal
  57. 57 European League Against Rheumatism (EULAR) Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Kilchberg, Switzerland
  58. 58 Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
  59. 59 National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
  60. 60 Instituto de Salud Musculoesquelética, Madrid, Spain
  61. 61 Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
  62. 62 Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
  63. 63 Epidemiology and Health Care Research, German Rheumatism Research Center (DRFZ Berlin), Berlin, Germany
  64. 64 Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
  65. 65 National Institute for Health Research (NIHR), University College London Hospitals, London, UK
  66. 66 Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
  67. 67 Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
  68. 68 School of Clinical Medicine, The University of Queensland, Herston, Queensland, Australia
  69. 69 Department of Rheumatology. Metro North Hospital & Health Service, Royal Brisbane and Woman's Hospital, Herston, Queensland, Australia
  1. Correspondence to Manuel Francisco Ugarte-Gil, Universidad Cientifica del Sur, Miraflores, Peru; mugarte{at}cientifica.edu.pe

Abstract

Aim To determine characteristics associated with more severe outcomes in a global registry of people with systemic lupus erythematosus (SLE) and COVID-19.

Methods People with SLE and COVID-19 reported in the COVID-19 Global Rheumatology Alliance registry from March 2020 to June 2021 were included. The ordinal outcome was defined as: (1) not hospitalised, (2) hospitalised with no oxygenation, (3) hospitalised with any ventilation or oxygenation and (4) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics, comorbidities, medications and disease activity.

Results A total of 1606 people with SLE were included. In the multivariable model, older age (OR 1.03, 95% CI 1.02 to 1.04), male sex (1.50, 1.01 to 2.23), prednisone dose (1–5 mg/day 1.86, 1.20 to 2.66, 6–9 mg/day 2.47, 1.24 to 4.86 and ≥10 mg/day 1.95, 1.27 to 2.99), no current treatment (1.80, 1.17 to 2.75), comorbidities (eg, kidney disease 3.51, 2.42 to 5.09, cardiovascular disease/hypertension 1.69, 1.25 to 2.29) and moderate or high SLE disease activity (vs remission; 1.61, 1.02 to 2.54 and 3.94, 2.11 to 7.34, respectively) were associated with more severe outcomes. In age-adjusted and sex-adjusted models, mycophenolate, rituximab and cyclophosphamide were associated with worse outcomes compared with hydroxychloroquine; outcomes were more favourable with methotrexate and belimumab.

Conclusions More severe COVID-19 outcomes in individuals with SLE are largely driven by demographic factors, comorbidities and untreated or active SLE. Patients using glucocorticoids also experienced more severe outcomes.

  • lupus erythematosus
  • systemic
  • COVID-19
  • epidemiology

Data availability statement

Data are available on reasonable request. Data are available on reasonable request. Applications to access the data should be made to the C19-GRA Steering Committee.

This article is made freely available for personal 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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Data availability statement

Data are available on reasonable request. Data are available on reasonable request. Applications to access the data should be made to the C19-GRA Steering Committee.

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Footnotes

  • Handling editor Josef S Smolen

  • Twitter @mugartegil, @IzadiZara, @AliDuarteMD, @LeannaWiseMD, @gponsestel, @Dr_samaralemadi, @jeffsparks, @ChSpecker, @vane_castro_c, @emilysirotich, @rheum_cat, @hausmannmd, @drbeckyg, @zach_wallace_md, @carmona_loreto, @saskiaamber, @pedrommcmachado, @philipcrobinson

  • Collaborators The COVID-19 Global Rheumatology Alliance (GRA): Brahim Dahou (Association Rhumatologues Algériens Privés (ARAP), Algeria); Rosana Quintana (Argentine Society of Rheumatology, Argentina); Gimena Gómez (Argentine Society of Rheumatology, Argentina); Karen Roberts (Argentine Society of Rheumatology, Argentina); Vanessa Castro Coello (Argentine Society of Rheumatology, Argentina); María J. Haye Salinas (Argentine Society of Rheumatology, Argentina); Federico Nicolas Maldonado (Argentine Society of Rheumatology, Argentina); Alvaro Andres Reyes Torres (Argentine Society of Rheumatology, Argentina); Gelsomina Alle (Argentine Society of Rheumatology, Argentina); Romina Tanten (Argentine Society of Rheumatology, Argentina); Hernán Maldonado Ficco (Argentine Society of Rheumatology, Argentina); Romina Nieto (Argentine Society of Rheumatology, Argentina); Carla Gobbi (Argentine Society of Rheumatology, Argentina); Yohana Tissera (Argentine Society of Rheumatology, Argentina); Cecilia Pisoni (Argentine Society of Rheumatology, Argentina); Alba Paula (Argentine Society of Rheumatology, Argentina); Juan Alejandro Albiero (Argentine Society of Rheumatology, Argentina); Maria Marcela Schmid (Argentine Society of Rheumatology, Argentina); Micaela Cosatti (Argentine Society of Rheumatology, Argentina); Maria Julieta Gamba (Argentine Society of Rheumatology, Argentina); Carlevaris Leandro (Argentine Society of Rheumatology, Argentina); María Alejandra Cusa (Argentine Society of Rheumatology, Argentina); Noelia German (Argentine Society of Rheumatology, Argentina); Veronica Bellomio (Argentine Society of Rheumatology, Argentina); Lorena Takashima (Argentine Society of Rheumatology, Argentina); Mariana Pera (Argentine Society of Rheumatology, Argentina); Karina Cogo (Argentine Society of Rheumatology, Argentina); Maria Soledad Gálvez Elkin (Argentine Society of Rheumatology, Argentina); María Alejandra Medina (Argentine Society of Rheumatology, Argentina); Veronica Savio (Argentine Society of Rheumatology, Argentina); Ivana Romina Rojas Tessel (Argentine Society of Rheumatology, Argentina); Rodolfo Perez Alamino (Argentine Society of Rheumatology, Argentina); Marina Laura Werne (Argentine Society of Rheumatology, Argentina); Sofía Ornella (Argentine Society of Rheumatology, Argentina); Luciana Casalla (Argentine Society of Rheumatology, Argentina); Maria de la Vega (Argentine Society of Rheumatology, Argentina); María Severina (Argentine Society of Rheumatology, Argentina); Mercedes García (Argentine Society of Rheumatology, Argentina); Luciana Gonzalez Lucero (Argentine Society of Rheumatology, Argentina); Cecilia Romeo (Argentine Society of Rheumatology, Argentina); Sebastián Moyano (Argentine Society of Rheumatology, Argentina); Tatiana Barbich (Argentine Society of Rheumatology, Argentina); Ana Bertoli (Argentine Society of Rheumatology, Argentina); Andrea Baños (Argentine Society of Rheumatology, Argentina); Sandra Petruzzelli (Argentine Society of Rheumatology, Argentina); Carla Matellan (Argentine Society of Rheumatology, Argentina); Silvana Conti (Argentine Society of Rheumatology, Argentina); Ma. Alicia Lazaro (Argentine Society of Rheumatology, Argentina); Gustavo Fabián Rodriguez Gil (Argentine Society of Rheumatology, Argentina); Fabian Risueño (Argentine Society of Rheumatology, Argentina); Maria Isabel Quaglia (Argentine Society of Rheumatology, Argentina); Julia Scafati (Argentine Society of Rheumatology, Argentina); Natalia Lili Cuchiaro (Argentine Society of Rheumatology, Argentina); Jonathan Eliseo Rebak (Argentine Society of Rheumatology, Argentina); Susana Isabel Pineda (Argentine Society of Rheumatology, Argentina); María Elena Calvo (Argentine Society of Rheumatology, Argentina); Eugenia Picco (Argentine Society of Rheumatology, Argentina); Josefina Gallino Yanzi (Argentine Society of Rheumatology, Argentina); Pablo Maid (Argentine Society of Rheumatology, Argentina); Debora Guaglianone (Argentine Society of Rheumatology, Argentina); Julieta Silvana Morbiducci (Argentine Society of Rheumatology, Argentina); Sabrina Porta (Argentine Society of Rheumatology, Argentina); Natalia Herscovich (Argentine Society of Rheumatology, Argentina); José Luis Velasco Zamora (Argentine Society of Rheumatology, Argentina); Boris Kisluk (Argentine Society of Rheumatology, Argentina); Maria Sol Castaños Menescardi (Argentine Society of Rheumatology, Argentina); Rosana Gallo (Argentine Society of Rheumatology, Argentina); María Victoria Martire (Argentine Society of Rheumatology, Argentina); Carla Maldini (Argentine Society of Rheumatology, Argentina); Cecilia Goizueta (Argentine Society of Rheumatology, Argentina); Sabrina Solange de la Vega Fernandez (Argentine Society of Rheumatology, Argentina); Carolina Aeschlimann (Argentine Society of Rheumatology, Argentina); Gisela Subils (Argentine Society of Rheumatology, Argentina); Eva Rath (Hanusch Krankenhaus, Vienna, Austria); Yves Piette (AZ Sint-Jan Brugge, Belgium); Mieke Devinck (AZ Sint-Lucas Brugge, Belgium); Bea Maeyaert (AZ Sint-Lucas Brugge, Belgium); Francinne Machado Ribeiro (Hospital Universitário Pedro Ernesto Universidade do Estado do Rio de Janeiro, Brazil); Sandra Lucia Euzebio Ribeiro (Federal University of Amazonas, Brazil); Marcelo Pinheiro (Universidade Federal De São Paulo Escola Paulista de Medicina e Escola Paulista de Enfermagem, Brazil); Sebastián Ibáñez (Clínica Alemana de Santiago, Chile); Anne-Marie Chassin-Trubert (Complejo Hospitalario San José, Chile); Lingli Dong (Tongji Hospital, China); Lui Cajas (Clinica Universitaria Colombia—Centro Medico Providencia Sanitas, Colombia); Marko Barešić (University Hospital Center Zagreb, Croatia); Branimir Anić (Division of Clinical Immunology and Rheumatology; Department of Internal Medicine, School of Medicine Zagreb, University Hospital Center Zagreb, Croatia); Melanie-Ivana Čulo (University Hospital Dubrava, Zagreb, Croatia); Tea Ahel Pavelić (Clinical Hospital Center Rijeka, Croatia); Kristina Kovačević Stranski (University Hospital Osijek, Croatia); Boris Karanovic (UHC Zagreb, Croatia); Jiri Vencovsky (Institute of Rheumatology, Prague, Czechia); Marta Píchová (Medipont plus s.ro., České Budějovice, Czechia); Maria Filkova (Institute of Rheumatology, Prague, Czechia); Hesham Hamoud (Al Azhar University Hospitals, Egypt); Dimitrios Vassilopoulos (Hippokration General Hospital, Athens, Greece); Gabriela Maria, Guzman Melgar (Hospital del Valle, Honduras, Honduras); Ho So (Chinese University of Hong Kong, Hong Kong); Márta Király, (Petz Aladár University Teaching Hospital, Győr, Hungary); Mahdi Vojdanian (Iran Rheumatology Center, Iran); Alexandra Balbir-Gurman (Rambam Rheumatology Institute, Haifa, Israel); Fatemah Abutiban (Kuwait Rheumatology Association, Kuwait); Julija Zepa (Pauls Stradins Clinical University Hospital, Riga, Latvia); Inita Bulina (Pauls Stradins Clinical University hospital, Riga, Latvia); Loreta Bukauskiene (Klaipeda University Hospital, Lithuania); Beatriz Zaueta (Centro Medico del Angel, Mexico); Angel Alejandro Castillo Ortiz (Centro Medico Las Americas, Mexico); Erick Zamora Tehozol (Centro Medico Pensiones, Mexico); David Vega (Hospital General de Zona #17, Mexico); Diana Cervántes Rosete (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico); Eduardo Martín Nares (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico); Tatiana Sofia Rodriguez-Reyna (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico); Marina Rull Gabayet (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico); Deshiré Alpízar-Rodríguez (Mexican College of Rheumatology, Mexico); Fedra Irazoque (Private Practice, Mexico); Xochitl Jimenez (Centro Medico Naval, Mexico); Lenny Geurts-van Bon (Ziekenhuisgroep Twente, The Netherlands); Theo Zijlstra (Isala Hospital, Zwolle, The Netherlands); Monique Hoekstra (Isala Hospital, Zwolle, The Netherlands); Nasra Al-Adhoubi (Royal Hospital, Oman); Babur Salim (Fauji Foundation Hospital, Pakistan); Enrique Giraldo (Complejo Hospitalario, Panama); Ariel Salinas (Hospital Essalud Alberto Sabogal Sologuren, Peru); Manuel Ugarte-Gil (Universidad Científica del Sur-Hospital Guillermo Almenara Irigoyen, Peru); Jarosław Nowakowski (University Hospital, Krakow, Poland); Samar Al-Emadi (Hamad Medical Corporation, Qatar); Richard Conway (St James' Hospital, Dublin, Republic of Ireland); Rachael Flood (Tallaght University Hospital, Republic of Ireland); Geraldine McCarthy (Mater Misericordiae University Hospital, Republic of Ireland); Ioana Felea (County Emergency Hospital, Cluj Napoca, Romania); Ileana Filipescu (County Emergency Hospital, Cluj Napoca, Romania); Simona Rednic (County Emergency Hospital, Cluj Napoca, Romania); Laura Groseanu (Sf Maria Clinical Hospital, Bucharest, Romania); Maria Magdelena Tamas (County Emergency Hospital, Cluj Napoca, Romania); Vanda Mlynarikova (National Institute of Rheumatic Diseases, Piešťany, Slovak Republic); Martina Skamlova (FNSPFDR, Banská Bystrica, Slovak Republic); Martin Zlnay (National Institute of Rheumatic Diseases, Piešťany, Slovak Republic); Dagmar Mičeková (National Institute of Rheumatic Diseases, Piešťany, Slovak Republic); Lubica Capova (University Hospital, Bratislava, Slovak Republic); Zelmira Macejova (University Hospital, Košice, Slovak Republic); Emőke Šteňová (University Hospital Bratislava, Slovak Republic); Helena Raffayova (National Institute of Rheumatic Diseases, Piešťany, Slovak Republic); Gabriela Belakova (Medman s.r.o., Martin, Slovak Republic); Eva Strakova (Faculty Hospital Prešov, Slovak Republic); Marieta Senčarová (Louis Pasteur University Hospital, Košice, Slovak Republic); Soňa Žlnayová (Poliklinika MarMedico, s.r.o., Nové Mesto nad Váhom, Slovak Republic); Anna Sabová (súkromná reumatologická ambulancia, Vranov nad Topľou, Slovak Republic); Daniela Spisakova (University Hospital od L. Pasteur Kosice, Slovak Republic); Mária Oetterová (Safarik University Hospital, Kosice, Slovak Republic); Olga Lukacova (National Institute of Rheumatic Diseases, Piešťany, Slovak Republic); Martina Bakosova (UNB Nemocnica Stare Mesto, Bratislava, Slovak Republic); Alojzija Hocevar (UMC Ljubljana, Slovenia); Natalia de la Torre-Rubio (Hospital Universitario Puerta de Hierro Majadahonda, Spain); Juan José Alegre Sancho (Hospital Universitari Dr Peset, Valencia, Spain); Montserrat Corteguera Coro (Complejo Asistencial Avila, Spain); Juan Carlos Cobeta Garcia (Hospital Ernest Lluch, Calatayud, Spain); Maria Carmen Torres Martin (Hospital Nuestra Senora Sonsoles, Avila, Spain); Jose Campos (Hospital Universitario Puerta de Hierro, Spain); Jose A Gomez Puerta (Hospital Clinic Barcelona, Spain); Gozd Kubra Yardımcı (Hacettepe University Faculty of Medicine, Ankara, Turkey); Servet Akar (Izmir Katip Celebi University Atatürk Training and Research Hospital, Izmir, Turkey); Ozan Cemal Icacan (Bakırköy Dr Sadi Konuk Research and Training Hospital, Istanbul, Turkey); Selda çelİk (Bakirkoy Dr Sadi Konuk Educational and Research Hospital, Rheumatology Department, Istanbul, Turkey); Viktoriia Vasylets (Multifield Medical Centre, Odessa, Ukraine); Su-Ann Yeoh (University College London Hospital, London, UK); Claire Vandevelde (Leeds Teaching Hospitals NHS Trust, UK); Sasha Dunt (Countess of Chester NHS Foundation Trust, UK); Jane Leeder (Norfolk & Norwich University Hospital, UK); Elizabeth Macphie (Lancashire and South Cumbria NHS Foundation Trust, UK); Rosaria Salerno (King's College Hospital, UK); Christine Graver (Hampshire Hospitals NHS Trust, UK); Katie Williams (York District Hospital, UK); Sheila O'Reilly (Royal Derby Hospital, UK); Kirsty Devine (York/Scarborough Hospitals, UK); Jennifer Tyler (Royal United Hospital, Bath, UK); Elizabeth Warner (Lister Hospital, UK); James Pilcher (University Hospital Lewisham, UK); Samir Patel (Queen Elizabeth Hospital Woolwich, UK); Elena Nikiphorou (King's College Hospital, UK); Laura Chadwick (St Helens & Knowsley NHS Foundation Trust, UK); Caroline Mulvaney Jones (Llandudno Hospital, UK); Beverley Harrison (Salford Royal NHS FT, UK); Lucy Thornton (Bradford Royal Infirmary, UK); Diana O'Kane (RNHRD at Royal United Hospital Bath, UK); Lucia Fusi (King's College Hospital, UK); Audrey Low (Salford Royal NHS FT, UK); Sarah Horton (Minerva Health Centre, UK); Shraddha Jatwani (Albert Einstein Medical Center, Pennsylvania, USA); Sara Baig (Arthritis and Rheumatology Consultants, Pennsylvania, USA); Hammad Bajwa (Arthritis and Rheumatology Consultants, Pennsylvania, USA); Vernon Berglund (Arthritis and Rheumatology Consultants, Pennsylvania, USA); Angela Dahle (Arthritis and Rheumatology Consultants, Pennsylvania, USA); Walter Dorman (Arthritis and Rheumatology Consultants, Pennsylvania, USA); Jody Hargrove (Arthritis and Rheumatology Consultants, Pennsylvania, USA); Maren Hilton (Arthritis and Rheumatology Consultants, Pennsylvania, USA); Nicholas Lebedoff (Arthritis and Rheumatology Consultants, Pennsylvania, USA); Susan Leonard (Arthritis and Rheumatology Consultants, Pennsylvania, USA); Jennifer Morgan (Arthritis and Rheumatology Consultants, Pennsylvania, USA); Emily Pfeifer (Arthritis and Rheumatology Consultants, Pennsylvania, USA); Archibald Skemp (Arthritis and Rheumatology Consultants, Pennsylvania, USA); Jeffrey Wilson (Arthritis and Rheumatology Consultants, Pennsylvania, USA); Anne Wolff (Arthritis and Rheumatology Consultants, Pennsylvania, USA); Eduardo Cepeda (Austin Diagnostic Clinic, USA); Kristin D'Silva (Brigham and Women's Hospital, USA); Tiffany Hsu (Brigham and Women's Hospital, USA); Naomi Serling-Boyd (Brigham and Women's Hospital, USA); Jeffrey Sparks (Brigham and Women's Hospital, USA); Derrick Todd (Brigham and Women's Hospital, USA); Zachary Wallace (Brigham and Women's Hospital, USA); Denise Hare (Capital Health Rheumatology, USA); Cassandra Calabrese (Cleveland Clinic, USA); Christopher Adams (East Alabama Medical Center, USA); Arezou Khosroshahi (Emory University, USA); Adam Kilian (George Washington University, USA); Douglas White (Gundersen Health System, USA); Melanie Winter (Gundersen Health System, USA); Theodore Fields (Hospital for Special Surgery, USA); Caroline Siegel (Hospital for Special Surgery, USA); Nicole Daver (Institute of Rheumatic and Autoimmune Diseases, USA); Melissa Harvey (Institute of Rheumatic and Autoimmune Diseases, USA); Neil Kramer (Institute of Rheumatic and Autoimmune Diseases, USA); Concetta Lamore (Institute of Rheumatic and Autoimmune Diseases, USA); Suneya Hogarty (Integrative Arthritis and Pain Consultants, USA); Karen Yeter (Kaiser Permanente, USA); Leanna Wise (Los Angeles County+USC Medical Center, USA); Faizah Siddique (Loyola University Medical Center, USA); Byung Ban (Medstar Georgetown University Hospital, USA); Tamar Tanner (Montefiore Medical Center, USA); Eric Ruderman (Northwestern Memorial, USA); William Davis (Ochsner Medical Center Rheumatology Department, USA); Robert Quinet (Ochsner Medical Center Rheumatology Department, USA), Evangeline Scopelitis (Ochsner Medical Center Rheumatology Department, USA); Karen Toribio Toribio (Ochsner Medical Center Rheumatology Department, USA); Tameka Webb-Detiege (Ochsner Medical Center Rheumatology Department, USA); Jerald Zakem (Ochsner Medical Center Rheumatology Department, USA); Khurram Abbass (Private Practice, USA); Gilbert Kepecs (Private Practice, USA); Lilliam Miranda (Rheumatology Center INC, USA); Michael Guma (Riverside Medical Group, USA); Ammar Haikal (Riverside Medical Group, USA); Sushama Mody (Riverside Medical Group, USA); Daric Mueller (Shores Rheumatology PC, USA); Arundathi Jayatilleke (Temple University Hospital, USA); JoAnn Zell (University of Colorado, USA); Alison Bays (University of Washington, Seattle, USA); Kathryn Dao (UT Southwestern Medical Center, USA); Ezzati Fatemeh (UT Southwestern Medical Center, USA); Deborah Parks (Washington University Division of Rheumatology, USA); David Karp (UT Southwestern Medical Center, USA); Guillermo Quiceno (UT Southwestern Medical Center, USA).

  • Contributors MFU-G, GSA, MG and JY had access to the study data, developed the figures and tables and vouch for the data and analyses. AMG performed the statistical analyses and contributed to data quality control, data analysis and interpretation of data. All authors contributed to data collection, data analysis and interpretation of data. MFU-G, GSA, MG and JY directed the work, designed the data collection methods, contributed to data collection, data analysis and interpretation of data and had final responsibility for the decision to submit for publication. All authors contributed intellectual content during the drafting and revision of the work and approved the final version to be published. JY is the guarantor.

  • Funding The study received support from the American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR).

  • Competing interests MFU-G has received research grants from Pfizer and Janssen, not related to this manuscript. AD-G is supported by the Rheumatology Research Foundation (Scientist Development Award) and the Centers for Disease Control and Prevention. CR-S has received research grants from Janssen, not related to this manuscript. AEC has received consulting fees from AstraZeneca, BMS and GSK, all unrelated to this manuscript. LW has received consulting fees and speaker’s honoraria from Aurinia Pharma unrelated to this manuscript. GJP-E reports no competing interests related to this work. Outside of this work, he reports personal consulting and/or speaking fees from Pfizer, GSK, Janssen and Sanofi (all <US$10 000). MJS has received speaker’s fees from AbbVie, AstraZeneca, Novartis, Pfizer and Roche, all unrelated to this manuscript (all <US10 000). JAS is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K23 AR069688, R03 AR075886, L30 AR066953, P30 AR070253 and P30 AR072577), the Rheumatology Research Foundation (R Bridge Award) and the R. Bruce and Joan M. Mickey Research Scholar Fund. JS has received research support from Bristol-Myers Squibb and performed consultancy for Bristol-Myers Squibb, Gilead, Inova Diagnostics, Optum and Pfizer unrelated to this work. NJP has received consulting fees from FVC Health and is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (T32-AR-007258). XM has received consulting’s honorarium from BMS, Galapagos, GSK, Janssen, Novartis, Pfizer, UCB and grants from Ose Pharmaceutical and Pfizer, all unrelated to this manuscript. VQ has no disclosure related to this manuscript. RH was supported by the Justus-Liebig University Giessen (Germany) Clinician Scientist Program in Biomedical Research (JLU-CAREER) to work on the German COVID-19 registry. RH has received consulting/speaker’s fee from Pfizer, Novartis, Amgen, Medac, AbbVie, Gilead, Mylan, TAKEDA/Shire, Roche/Chugai, Bristol-Myers Squibb and Galapagos, all unrelated to this manuscript. REV reports no competing interests related to this work. He has received personal consulting and/or speaking fees from AbbVie, Amgen, Boehringer Ingelheim, BMS, Janssen-Cilag, GSK, Hexal, Neutrolis, Novartis, Pfizer (all <US$10 000" and "Pfizer and Roche, all unrelated to this manuscript (all <US$10 000. Institutional research grants were received from Amgen, BMS, Novartis, Pfizer. ETRN has received speaker’s fees from GSK, Novartis, Bracepharma, unrelated to this manuscript. GAAF has received speaker’s fees from Boehringer Ingelheim, unrelated to this manuscript. OAAM has received speaker’s fees from AbbVie, Boehringer Ingelheim, GSK, Janssen, Novartis, Pfizer, UCB and Roche, all unrelated to this manuscript. JL has received research funding from Pfizer outside the submitted work. JH is supported by grants from the Rheumatology Research Foundation and has salary support from the Childhood Arthritis and Rheumatology Research Alliance. He has performed consulting for Novartis, Sobi, Biogen, all unrelated to this work (<US$10 000). PS reports honorarium for doing social media for American College of Rheumatology journals (<US$10 000). RG reports non-financial support from Pfizer Australia, personal fees from Pfizer Australia, personal fees from Cornerstones, personal fees from Janssen New Zealand, non-financial support from Janssen Australia, personal fees from Novartis, outside the submitted work. SB reports non-branded consulting fees for AbbVie, Horizon, and Novartis (all <US$10 000), and is employed by Pfizer. ZSW reports grant support from Bristol-Myers Squibb and Principia/Sanofi and performed consultancy for Viela Bio and MedPace, outside the submitted work. His work is supported by grants from the National Institutes of Health. AS reports grants from a consortium of 13 companies (among them AbbVie, BMS, Celltrion, Fresenius Kabi, Lilly, Mylan, Hexal, MSD, Pfizer, Roche, Samsung, Sanofi-Aventis and UCB) supporting the German RABBIT register and personal fees from lectures for AbbVie, MSD, Roche, BMS, Pfizer, outside the submitted work. EFM reports that LPCDR received support for specific activities: grants from AbbVie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern, GAfPA; grants and non-financial support from Pfizer; non-financial support from Grünenthal GmbH, outside the submitted work. KLH has received speaker’s honoraria from AbbVie and grant support from Pfizer and BMS, all unrelated to this manuscript. KLH is also supported by the NIHR Manchester BRC. LC has not received fees or personal grants from any laboratory, but her institute works by contract for laboratories among other institutions, such as AbbVie, Gebro Pharma, MSD, Novartis, Pfizer, Roche, Sanofi-Aventis, Grünenthal and UCB. All unrelated to this work. PMM has received consulting/speaker’s fees from AbbVie, BMS, Celgene, Galapagos, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript. PCR reports personal fees from AbbVie, Atom Biosciences, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, Kukdong, Novartis, UCB, Roche, Pfizer; meeting attendance support from BMS, Pfizer and UCB and grant funding from Janssen, Novartis, Pfizer and UCB Pharma. MG is supported by grants from NIH/NIAM. SJY has received research grants from AstraZeneca, Gilead and BMS, and consulting fees from Aurinia, Pfizer and AstraZeneca. GSA, ZI, SB, SLER, SAE, JY-TH, ELG, MOV-A, AJ, GL, MF, TG, MD, VCR, GS, BH, CS, RB, VC-C, HMF, ES, WC, LJ, TT, CJ, SL-T, LK-F and MS have nothing to disclose.

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

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