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Response to: ‘Correspondence on ‘Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases’’ by Schulze-Koops et al
  1. Dalifer Dayanira Freites Nuñez1,
  2. Leticia Leon1,2,
  3. Arkaitz Mucientes1,
  4. Luis Rodriguez-Rodriguez1,
  5. Judit Font Urgelles3,
  6. Alfredo Madrid García1,
  7. Jose Ignacio Colomer1,
  8. Juan A Jover4,
  9. Benjamín Fernandez-Gutierrez3,
  10. Lydia Abasolo1
  1. 1IdISSC and Rheumatology, Hospital Clinico Universitario San Carlos, Madrid, Spain
  2. 2Health Sciences, Universidad Camilo Jose Cela, Villafranca del Castillo, Spain
  3. 3Rheumatology, Hospital Clinico Universitario San Carlos, Madrid, Spain
  4. 4Rheumatology, Universidad Complutense de Madrid Facultad de Medicina, Madrid, Spain
  1. Correspondence to Dr Leticia Leon, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Hospital Clinico Universitario San Carlos, Madrid 28040, Spain; lleon.hcsc{at}

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We appreciate the interest of Dr Schulze-Koops and colleagues in our article.1 The role of the inflammatory rheumatic diseases (IRDs), their therapies and other potential factors in the risk of SARS-CoV-2 infection and course of COVID-19 disease are a topic in a constant update. In this sense, we consider that our study provides additional evidence in patients with IRD regarding susceptibility to moderate-severe infection related to COVID-19.2

It is important to note that SARS-CoV-2/COVID-19 is a very changing epidemiological scenario. Our manuscript is a real-world longitudinal study performed during the period of maximum health emergency due to the COVID-19 pandemic in Madrid, the epicentre of the outbreak in Spain. We included all patients with IRD, attended and followed-up at the rheumatology outpatient clinic of our centre with clinical symptoms of COVID-19 during the study period. Our main results showed that 44% of them required hospital admission, mainly at the expense of systemic autoimmune diseases rather than chronic inflammatory arthritis. In addition, we corroborated the role of advanced age and certain comorbidities as important risk factors of moderate-severe COVID-19.3 Regarding therapies, we did not found association between exposition to disease-modifying agents and more risk of hospital admission related to COVID-19.4–7

Our key messages are in consonance with the different professional societies’ guidance for the management of patients with IRD during the SARS-CoV-2/COVID-19 pandemic, which have recommend maintaining treatment with disease-modifying agents in the absence of infection or unknown COVID-19 exposure.8–11

We fully agree with Dr Schulze-Koops and colleagues that patients with IRDs and COVID-19 have a high risk of hospitalisation due to parameters that cannot be easily influenced. In this sense and due to the novelty and the impact of the pandemic, a well disease control and a close monitoring carried out by the rheumatologist and team is mandatory, as well as a strict adherence to the hygiene, mask-wearing and social distance measures of patients with rheumatic disease.8–11

Finally, the authors contemplate that all their comments were very accurate and in line with our results. Therefore, until more definite data are available, the authors consider that SARS-CoV-2 infection should be carefully avoided in patients with IRD.

To conclude, we appreciate the opportunity to share our experience regarding risk factors for hospital admissions related to COVID-19 in patients with IRD,2 hoping this article can be a step to improve gaps of knowledge, and thus help clinicians in the management of these patients.



  • Handling editor Josef S Smolen

  • Twitter @Fergutbe2001

  • Contributors All authors have provided the initial draft, led the discussion and corrected the text.

  • Funding This work was supported by the Instituto de Salud Carlos III (ISCIII), Ministry of Health, Spain (CP16/00916, PI18/01188 and RD16/0012/0014) and co-funded by el Fondo Europeo de Desarrollo Regional (FEDER). The funders had no role in study design, data collection, analysis, manuscript preparation or decision to publish.

  • 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 Commissioned; internally peer reviewed.

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