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Response to: ‘COVID-19 in patients with rheumatic diseases: what is the real mortality risk?’ by Marques et al
  1. Kristin M D’Silva1,
  2. Naomi Serling-Boyd1,
  3. Rachel Wallwork1,
  4. Tiffany Y-T Hsu2,
  5. Jeffrey A Sparks2,
  6. Zachary Scott Wallace1
  1. 1 Division of Rheumatology, Allergy, and Immunology, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Zachary Scott Wallace, Rheumatology Unit, Massachusetts General Hospital, Boston, MA 02114, USA; zswallace{at}

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We appreciate the comments by Marques et al in response to our manuscript.1 Their description of a cohort of patients with rheumatic disease and COVID-19 is another important contribution to the literature during this quickly evolving pandemic. In this report of 130 patients with rheumatic diseases, the authors estimated a mortality rate of 9.2%, higher than the 4.7% mortality rate reported in the general population in Brazil.1 It is important to note that one must be cautious when comparing these two rates because the composition of these cohorts according to demographics and other confounding features likely differs but was unable to be accounted for in the analysis. However, there were several important features in this cohort which may explain the higher mortality rate including a large comorbidity burden among the deceased, frequent use of glucocorticoids and less frequent use of biologic disease-modifying antirheumatic drugs (DMARD).2 The authors hypothesise that factors …

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