Table 1

Studies with data on the incidence of severe COVID-19 in patients with RMDs compared with persons without RMDs

First authorCountryCohortStudy periodStudy typeSettingStudy population, recruitmentCase definition RMDCase definition COVID-19Source population of base incidenceTotal (N)Incidence in patients with RMDBase incidenceIncidence in patients with RMD versus base population (higher, equal, lower)RoB
(A) Outcome: Hospitalisation for COVID-19
Bachiller-Corral72 Spain1 March–30 April 2020RetrospectiveSecondary carePatients with inflammatory RMD in hospital area of care, hospital recordsPhysician diagnosisPCR+ or typical imagingNon-RMD population in hospital area of care459241/4592 (0.89%) (all), 16/1708 (0.94%) (RA), 3/862 (0.35%) (SpA), 4/515 (0.78%) (PsA), 4/254 (1.57%) (SLE), 4/175 (2.29%) (SjS), 3/165 (1.82%) (vasculitis), 1/88 (1.14%) (IM), 6/474 (1.27%) (PMR)2274/488 153 (0.47%)Higher for all (OR 1.91, 95% CI 1.41 to 2.61), RA (OR 2.01, 95% CI 1.23 to 3.28), SLE (OR 3.38, 95% CI 1.28 to 8.95), SjS (OR 4.90, 95% CI 1.86 to 12.94), vasculitis (OR 3.90, 95% CI 1.27 to 11.99), PMR (OR 2.71, 95% CI 1.23 to 6.02);
equal for SpA (OR 0.74, 95% CI 0.24 to 2.31), PsA (OR 1.66, 95% CI 0.63 to 4.43), IM (OR 2.43, 95% CI 0.35 to 17.13)
Bjornsson11 IcelandICEBIOUntil 3 June 2020Retrospective, registry, matchedPopulation-basedtsDMARD/bDMARD- treated patients with RMD and MTX-treated patients with RMD; data from national registriesPhysician diagnosisPCR+General population registries, matched (age, sex, location)39 9613/9 (33%)(tsDMARD/bDMARD), 1/5 (20%) (MTX)3/84 (3.6%)(tsDMARD/bDMARD controls), 13/134 (9.7%) (MTX controls)Higher for tsDMARD/bDMARD (RR 9.33, 95% CI 2.20 to 39.6) and MTX (RR 6.22, 95% CI 1.19 to 32.46)
Bower15 SwedenMay–September 2020Retrospective, registry, matchedPopulation-basedPatients with inflammatory arthritis, data from national registriesPhysician diagnosisICD-10General population registries, matched (age, sex, location)110 567581/110 567 (0.5%) (all), 379/53 455 (0.7%) (RA), 202/57 112 (0.4%) (other IJD)1443/484 277 (0.3%) (all controls), 784/484 277 (0.4%) (RA controls), 659/484 277 (0.3%) (other IJD controls)Higher for all (fully adjusted HR 1.32, 95% CI 1.19 to 1.46), RA (HR 1.40, 95% CI 1.22 to 1.60), other IJD (HR 1.20, 95% CI 1.02 to 1.41)
Comparable to increased all-cause hospitalisation risk
Comarmond14 France4–20 May 2020RetrospectiveSecondary carePatients with TAK or GCA, followed up at outpatient clinicPhysician diagnosisPCR+ or typical CT imaging or serology+Modelled risk in country1483/8 (37.5%)9.6% (age 70–79), 21% (age>80)Higher
Cordtz17 DenmarkDANBIO1 March–12 August 2020Retrospective, registryPopulation-basedtsDMARD/bDMARD-treated patients with RA, SpA, CTD or vasculitis; data from national registriesPhysician diagnosisICD-10General population registries58 05269/58 052 (age-adjusted and sex-adjusted IR per 1000 py 1.73, 95% CI 1.34 to 2.23)2536/4.5 mln (age- and sex-adjusted IR per 1000 py 1.26, 95% CI 1.21 to 1.31)Higher (HR 1.46, 95% CI 1.15 to 1.86)
Fernandez-Gutierrez26 Spain1 March–15 Apr 2020RetrospectiveSecondary carePatients with Inflammatory RMD with COVID-19; all patients followed up at outpatient clinic from March 2019 to March 2020ICD-10PCR+or physician diagnosisGeneral population in region3951 (5896 patient-months)54/3,951 (1.36%; cumulative incidence 15 per 1000 patients; IR 9.15 (7–11.9) per 1000 patient-months)1059/325 900 (cumulative incidence 3.2 per 1000 persons; IR 4.6 (3.4–6.1) per 1000 person-months)Higher (p<0.001)
Flood73 IrelandUntil 3 June 2020RetrospectiveSecondary carePatients with RMD, all patients followed up at outpatient clinicPhysician diagnosisPCR+ or physician diagnosisGeneral population in city750015% (Inflammatory RMD)13%Equal
Jovani74 SpainUntil 2 May 2020RetrospectiveSecondary caretsDMARD/bDMARD-treated patients with RMD, followed up at outpatient clinicPhysician diagnosisPCR+General population in city10373/1037 (0.29%)306/274 122 (0.11%)Equal (OR 2.61, 95% CI 0.84 to 8.16)
Ramirez16 (COVID-19 in)Italy17 April to 27 April 2020RetrospectiveSecondary carePatients with SLE, all patients followed up at three outpatient clinicsPhysician diagnosisSelf-reported PCR+General population in region4171/417 (0.24%)42 889 hospitalised (0.43%)Equal
Salvarani5 (Susceptibility and)ItalyUntil 24 April 2020RetrospectiveSecondary caretsDMARD/bDMARD-treated patients with RMD, treated since December 2019 (pharmacy data)Physician diagnosisPCR+General population in region11954/9 (44.4%)1342/3746 (35.8%)Equal (p=0.73)
Santos75 (Biological agents)SpainNRRetrospectiveSecondary carebDMARD-treated patients with RMD, treated between December 2019 and December 2020 (hospital records)Physician diagnosisPCR+General population in region8204/820 (0.48%)4464 hospitalised (3.6%)Lower
(B) Outcome: COVID-19-related death
Aries18 GermanyHamburg COVID-19 registryUntil 9 June 2020Cross-sectional, registrySecondary careDMARD-treated patients with RMD with COVID-19, cases reported by rheumatologistsPhysician diagnosisSymptoms and PCR+ or IgG+General population in region11 7710/30 (0%)226/5120 (4.4%)Lower
Bower15 SwedenMay–September 2020Retrospective, registry, matchedPopulation-basedPatients with inflammatory arthritis, data from national registriesPhysician diagnosisICD-10General population registries, matched (age, sex, location)110 567161/110 567 (0.1%) (all), 134/53 455 (0.3%) (RA), 27/57 112 (0.05%) (other IJD)338/484 277 (0.07%) (all controls), 245/484 277 (0.11%) (RA controls), 93/484 277 (0.04%) (other IJD controls)Higher for RA (fully adjusted HR 1.27, 95% CI 1.02 to 1.59)
Equal for all (fully adjusted HR 1.18, 95% CI 0.97 to 1.44), other IJD (0.83, 95% CI 0.54 to 1.28)
Comparable to increased all-cause mortality risk and not different from 2015 to 2019
Cleaton76 UK1 Febuary–1 May 2020RetrospectiveSecondary carePatients with RMD, followed up at outpatient clinicPhysician diagnosisPCR+General population in region10 38712/10 387 (0.12%)4131/7 415 149 (0.12%)Equal
Comarmond14 France4 May–20 May 2020RetrospectiveSecondary carePatients with TAK or GCA, followed up at outpatient clinicPhysician diagnosisPCR+ or typical CT imaging or serology+Modelled risk in country1481/8 (12.5%)2.2% (age 70–79), 8% (age >80)Lower
FAI Consortium19 FranceFrench COVID-19 registryUntil 18 May 2020Retrospective, matched (age, sex, comorbidities)Secondary carePatients with inflammatory RMD and COVID-19; cases reported by rheumatologistsPhysician diagnosisPCR+ or serology+ or typical CT imaging or highly suspected based on clinical symptomsPatients with COVID-19 from the Lille University Hospital COVID-19 Research Network69458/256 hospitalised subgroup (22.6%); death rate in matched subgroup (n=175) 25.1% (95% CI 18.7% to 31.6%)Death rate 18.9% (95% CI 13.1% to 24.7%)Equal (OR 1.45, 95% CI 0.87 to 2.42)
Salvarani5 (Susceptibility and)ItalyUntil 24 April 2020RetrospectiveSecondary caretsDMARD/bDMARD-treated patients with RMD, treated since Dec 2019 (pharmacy data)Physician diagnosisPCR+General population in region11951/9 (11.1%)383/3746 (10.2%)Equal (p=1.0)
(C) Outcome: Other (ICU or ‘severe COVID-19’)
Aries18 GermanyHamburg COVID-19 registryUntil 9 June 2020Cross-sectional, registrySecondary careDMARD-treated patients with RMD with COVID-19, cases reported by rheumatologistsPhysician diagnosisSymptoms and PCR+ or IgG+General population in region11 771 ICU admission
3/30 (10%)
227/5120 (4.4%)Lower
Bower15 SwedenMay–September 2020Retrospective, registry, matchedPopulation-basedPatients with inflammatory arthritis, data from national registriesPhysician diagnosisICD-10General population registries, matched (age, sex, location)110 567 ICU admission
45/110 567 (0.04%) (all), 31/53 455 (0.06%) (RA), 14/57 112 (0.6%) (other IJD)
162/484 277 (0.01%) (all controls), 79/484 277 (0.02%) (RA controls), 83/484 277 (0.03%) (other IJD controls)Equal for all (fully adjusted HR 1.18, 95% CI 0.97 to 1.44), RA (1.53, 95% CI 0.98 to 2.40), other IJD (0.83, 95% CI 0.54 to 1.28)
Cordtz17 DenmarkDANBIO1 March–12 August 2020Retrospective, registryPopulation-basedtsDMARD/bDMARD-treated patients with RA, SpA, CTD or vasculitis, data from national registriesPhysician diagnosisICD-10General population registries29 440 ‘Severe COVID-19’*
22/47 (age-djusted and sex-adjusted IR per 1000 py 35.2, 95% CI 20.8 to 59.4)
945/2536 (age-adjusted and sex-adjusted IR per 1000 py 32.7, 95% CI 30.7 to 34.9)Higher (HR 1.43, 95% CI 0.80 to 2.53)
  • *Severe COVID-19 was only assessed in patients with RA and defined as need for mechanical ventilation (procedure code), ICD-10 code of acute respiratory distress syndrome due to COVID-19 or death following COVID-19. Colours denote overall RoB assessment of each study (green denotes low RoB; orange denotes unclear RoB; and red denotes high RoB).

  • bDMARD, biological disease-modifying antirheumatic drug; CTD, connective tissue disease; DMARD, disease-modifying antirheumatic drug; FAI, Filière des Maladies Autoimmunes et Autoinflammatoires Rares; GCA, giant cell arteritis; ICD-10, International Classification of Diseases, 10th Revision; ICU, intensive care unit; IJD, inflammatory joint disease; IM, inflammatory myopathy; IR, incidence rate; mln, million; MTX, methotrexate; NR, not reported; PMR, polymyalgia rheumatica; PsA, psoriatic arthritis; py, person years; RA, rheumatoid arthritis; RMD, rheumatic and musculoskeletal disease; RoB, risk of bias; SjS, Sjögren syndrome; SLE, systemic lupus erythematosus; SpA, spondyloarthritis; TAK, Takayasu arteritis; tsDMARD, targeted synthetic disease-modifying antirheumatic drug.