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Autoinflammatory disorders
Clinical features of rheumatic patients infected with COVID-19 in Wuhan, China
  1. Cong Ye1,
  2. Shaozhe Cai1,
  3. Guifen Shen1,
  4. Hanxiong Guan2,
  5. Liling Zhou1,
  6. Yangyang Hu1,
  7. Wei Tu1,
  8. Yu Chen1,
  9. Yikai Yu1,
  10. Xuefen Wu1,
  11. Yuxue Chen1,
  12. Jixin Zhong1,
  13. Lingli Dong1
  1. 1 Department of Rheumatology and Immunology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
  2. 2 Department of Radiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
  1. Correspondence to Professor Jixin Zhong, Department of Rheumatology and Immunology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China; zhongjixin620{at}163.com; Professor Lingli Dong, Department of Rheumatology and Immunology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China; tjhdongll{at}163.com

Abstract

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
  • autoimmunity
  • inflammation

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.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/annrheumdis-2020-217627

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    Footnotes

    • Handling editor Josef S Smolen

    • CY and SC contributed equally.

    • 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.