TY - JOUR T1 - Correspondence on ‘Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis’ JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis DO - 10.1136/annrheumdis-2020-219309 SP - annrheumdis-2020-219309 AU - Elisa Gremese AU - Giovanni Brondani AU - Luca Apollonio AU - Gianfranco Ferraccioli Y1 - 2020/11/03 UR - http://ard.bmj.com/content/early/2020/11/03/annrheumdis-2020-219309.abstract N2 - We read with great interest the meta-analysis by Akiyama et al showing that out of 62 studies with over 300 000 patients with autoimmune diseases, glucocorticosteroids (GC) therapy was significantly associated with an increased risk of COVID-19.1These data raise interest on the use of GC in the therapeutic approach to inflammatory pneumonia associated with SARS-CoV-2 infection. A recent editorial entitled ‘Curing COVID-19’ in the October issue of the Lancet Infectious Disease discussed in fact the role of steroids to treat COVID-19 pneumonia. Dexamethasone is suggested by the WHO as part of the therapeutic approach.2 The evidence is that data on steroids are partly positive (RECOVERY and REMAP-CAP doi:10.1001/jama0.2020.17022) and partly negative (CAPE-COD-doi:10.1001/jama. 2020.16761), yet the meta-analysis of the randomised trials shows a statistical effect on mortality in very severe cases, with differences among the different steroids.3 The differences between steroids and standard of care treatment are significant, yet far away from solving the puzzle of the best therapy. Certainly, the inflammation occurring in SARS-CoV-2 pneumonia, certified by increased C-reactive protein (CRP), interleukin (IL)-6 and sometimes by ferritin, strongly suggests that GC might help to control the course of the disease. Yet recent data by Carsana et al4 and Grasselli et al5 suggest that pneumonitis may have at least two pathophysiology backgrounds and that ‘subsetting’ might … ER -