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Correspondence
COVID-19 in patients with rheumatological diseases treated with anti-TNF
  1. Carlos Antunes Brito1,2,
  2. José Gerardo Paiva3,
  3. Fernando Nunes Pimentel2,
  4. Rosinete Santos Guimarães2,
  5. Mariana Ribeiro Moreira2
  1. 1 Internal Medicine, Federal University of Pernambuco, Recife, Brazil
  2. 2 Department of Immunology, Autoimmune Research Institute, Recife, Pernambuco, Brazil
  3. 3 Department of Rheumatology, General Hospital César Cals, Fortaleza, Ceará, Brazil
  1. Correspondence to Dr Carlos Antunes Brito, Internal Medicine, Federal University of Pernambuco, Recife, Pernambuco, Brazil; cbritoc{at}gmail.com

https://doi.org/10.1136/annrheumdis-2020-218171

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    We have read with great interest the recent article from Silva et al about the clinical course of COVID-19 in rheumatic disease.1 In this matched cohort study of patients with COVID-19 infection, although the authors found a similar proportion of symptoms, risk of hospitalisation and mortality between patients with and without rheumatic disease, there was a threefold higher odds of intensive care admission/mechanical ventilation in the former. The authors considered that certain immunosuppressive medications could explain the higher risk of respiratory complications. However, the risk associated with severe infections differs among immunosuppressive medications; therefore, the analysis of clinical disclosures must be individualised according to therapeutic class.2–4 In the study by Silva et al, there was no detailed comparison of the clinical behaviour of patients using different immunosuppressive medications. There is a record of corticosteroid use in 37 of 52 patients, probably combined with the use of other immunosuppressive medications.1 The use of corticosteroids in patients with rheumatological disease has been associated with a higher risk of infections for different aetiologic agents, including respiratory infection.2 Studies in patients infected with coronavirus and influenza virus treated with corticosteroids show a higher risk of complications and deaths.5

    In the study, the second most common group …

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    Footnotes

    • Contributors All authors have participated in the study to the conception or design of the work, or the acquisition, analysis or interpretation of cases; and subsequent revisions of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • 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.

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

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