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We appreciate the interest of Aydin et al1 in our study about risk factors for hospital admissions related to COVID-19 in patients with inflammatory rheumatic diseases (IRD).2 COVID-19 pandemic is a matter in constant update and certainly an enormous challenge for researchers, clinicians, healthcare workers and epidemiologists. In this sense, all together are making enormous efforts in their fields to overcome this global crisis. In relation to research advances, there has been an explosion in the publication of articles related to COVID-19. In this pandemic situation, it is true that it has been a challenge and a race against the clock for researchers and some publications could be less rigorous than expected.3 For this reason, and according to Aydin et al,1 the critical reading it is important to interpret the results, paying special attention to the limitations of each study.
The role of IRD, their therapies and other potential factors in the risk of SARS-CoV-2 infection and course of COVID-19 disease is a topic of major interest for health professionals in rheumatology and rheumatic patients. Similar to previous research, we concluded that patients with an autoimmune systemic condition have a higher risk of hospital admission related to COVID-19 compared with those with well-controlled chronic inflammatory arthritis in a real-world setting. Those patients were mainly elderly and with certain comorbidities. Regarding therapies, our data show that patients exposed to disease-modifying agents do not seem to be at higher risk of hospital admission related to COVID-19.2 4–7
The first concern of Aydin et al1 regarding to the way of COVID-19 infectious status confirmation and that it was not clearly explained in the study and that might generate confusion. 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 first wave pandemic COVID-19 in Madrid, epicentre of the outbreak in Spain. In consonance with other similar studies,8 PCR tests were not performed at primary care and they were only carried out in hospitals at the emergency room or once the patient was admitted. At emergency room, the patient was evaluated, and PCR test was performed if they were available. The patient was discharged or admitted based on patient’s health situation and clinical parameters regardless to the PCR test result that was obtained 24–72 hours later. In this sense, the decision to admit a patient was not affected by the positive test itself. Therefore, we did not consider necessary the inclusion of this parameter in the multivariate analysis. Moreover, with such a high percentage of missing values in PCR test, it was not a variable candidate for such analysis.
The second concern of Aydin et al1 regarding to the terminology used to describe the study design. It was an observational longitudinal study, and in fact it can be classified as retro prospective. Then we began to collect data, thus those study patients included on March were retrospective and those included until 15 April were prospective. For those admitted patients, we collected data until 24 April to obtain a more detailed clinical description for their hospital admission.
Finally, we appreciate the opportunity to share our experience regarding risk factors for hospital admissions related to COVID-19 in patients with IRD, and we welcome the comments by Aydin et al1 in our real-world setting study. The authors hope this article, despite their limitations described, can be a step to improve gaps of knowledge regarding susceptibility to moderate–severe infection related to COVID-19, and thus helping clinicians in the management of these patients.
Handling editor Josef S Smolen
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, Ministry of Health, Spain (CP16/00916, PI18/01188 and RD16/0012/0014) and cofunded by el Fondo Europeo de Desarrollo Regional.
Disclaimer 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.
Ethics approval The project was reviewed and approved by the Hospital Clínico San Carlos Ethics Committee on 30 March 30 2020 (no.20/268-E-BS).
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