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COVID-19 in Italian patients with rheumatic autoimmune systemic diseases
  1. Clodoveo Ferri1,2,
  2. Dilia Giuggioli1,
  3. Vincenzo Raimondo2,
  4. Poupak Fallahi3,
  5. Alessandro Antonelli4
  6. on behalf of the COVID-19 & ASD Italian Study Group
    1. 1Rheumatology Unit, University of Modena & RE, School of Medicine, Modena, Italy
    2. 2Rheumatology Clinic ‘Madonna dello Scoglio’, Cotronei, Italy
    3. 3Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, School of Medicine, Pisa, Italy
    4. 4Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
    1. Correspondence to Professor Alessandro Antonelli, Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56100, Italy; alessandro.antonelli{at}

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    We followed with great interest the numerous reports published by the Annals1–9 as regards the impact of the COVID-19 pandemic on different rheumatic autoimmune systemic diseases (ASD), including the survey study by Costa et al9 that underlined the usefulness of telerheumatology in the management of patients with psoriatic arthritis in COVID-19 era. On the same topic, the world literature encompasses a large number of anecdotal observations, cohort studies and telephone surveys.1–15 Overall, the observed prevalence of symptomatic COVID-19, usually as mild-moderate disease, in patients with chronic arthritis was comparable to that found in the general population, while worse outcomes represented almost rare events.1–15 Conversely, increased percentages of symptomatic COVID-19 were observed in patient cohorts with connective tissue diseases, especially systemic lupus or systemic vasculitis.6 7 Of note, in ASD complicated by COVID-19, the baseline use of immune modifiers, namely, conventional synthetic (csDMARD), biological (bDMARD) and targeted synthetic disease-modifying antirheumatic drugs (tsDMARD), was not associated with worse COVID-19 disease outcomes.3–5 9 10 Almost invariably these monocentre studies focused on ASD patients’ populations from limited geographical areas.1–15 Given the heterogeneous distribution of pandemic infection within the same country, we investigated the impact of COVID-19 in ASD patients’ populations from three distinct regions of Italy (northern, Emilia Romagna; central, Tuscany; and southern, Calabria), characterised by different spread of the COVID-19 pandemic, prevalent in northern Italy with a marked gradient north-south.16 Our 6-week multicentre telephone survey of 1641 unselected patients with ASD confirmed the quite benign clinical course of COVID-19 in ASD, along with the safety of baseline use of either …

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    • Collaborators COVID-19 & ASD Italian Study Group: Clodoveo Ferri, MD, Dilia Giuggioli, MD, Amelia Spinella, MD: Rheumatology Unit, University of Modena & RE, School of Medicine, Modena; Vincenzo Raimondo, MD, Raffaele Brittelli, MD, Vincenzo Aiello, MD, Rodolfo Caminiti, MD: Rheumatology Clinic ‘Madonna dello Scoglio’ Cotronei, Crotone; Massimo L’Andolina, MD: Rheumatology Outpatient Clinic, ASP-Vibo Valentia – Tropea Hospital; Antonio Tavoni, MD, Silvia Bilia, MD, Daiana Giannini, MD, Giuseppa Pagano Mariano, MD: Clinical Immunology Unit, Universitiy of Pisa; Riccardo Cecchetti, MD: Ospedale di Portoferraio, Livorno; Serena Guiducci MD, Silvia Bellando-Randone, MD: Rheumatology Unit, University of Florence Francesco Ursini, MD, Veronica Brusi, MD, Riccardo Meliconi, MD: University of Bologna, Rizzoli Orthopaedic Institute Bologna; Maurizio Caminiti, MD, Giuseppa Pagano Mariano, MD: UOD Reumatologia-Grande Ospedale Metropolitano, Reggio Calabria; Giuseppe Varcasia, MD, Tommaso Ferrari MD: U.O.S. Reumatologia, Ospedale Castrovillari, Cosenza; Pietro Gigliotti, MD: U.O.T. Specialistica Ambulatoriale ASP 201, Cosenza; Roberta Pellegrini, MD: U.O.C. Medicina Interna "M.Valentini", P.O. Annunziata Cosenza; Domenico Olivo, MD: Rheumatology Outpatient Clinic, San Giovanni di Dio Hospital, Crotone, Italy; Michele Colaci, MD: Rheumatology Unit, University of Catania, Catania, Italy; Giuseppe Murdaca, MD; Department of Internal Medicine, University of Genoa, San Martino Policlinic Hospital, Genoa; Poupak Fallahi, MD: Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, School of Medicine, Pisa, Italy; Alessandro Antonelli, MD: Department of Clinical and Experimental Medicine, University of Pisa, School of Medicine, Pisa, Italy.

    • Contributors All authors contributed to the conception and to the draft of the work, revised it critically for important intellectual content and gave the final approval of the version to be published.

    • 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.