COVID-19 in patients with rheumatic diseases in northern Italy: a single-centre observational and case–control study
Autor
Fredi, Micaela
Cavazzana, Ilaria
Moschetti, Liala
Andreoli, Laura
Franceschini, Franco
Institución
Resumen
Background The highest number of COVID-19 cases in Italy have been reported in Lombardy, a region in northern Italy.
We aimed to analyse the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients
with rheumatic and musculoskeletal diseases living in a district of Lombardy with a high prevalence of COVID-19.
Methods We did a single-centre observational study at the Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili of
Brescia, Italy. We collected data from patients with rheumatic and musculoskeletal diseases enrolled in our outpatient
clinic to identify confirmed or possible cases of SARS-CoV-2 infection. Data were collected through a survey that was
administered via telephone or in the outpatient clinic by rheumatologists. We also did a case–control study of all
patients with confirmed COVID-19 pneumonia and rheumatic and musculoskeletal diseases who were admitted to the
ASST Spedali Civili of Brescia during the study period. Cases were matched by age, sex, and month of hospital
admission to at least two controls admitted to the same hospital for COVID-19 pneumonia during the study period.
Findings Between Feb 24 and May 1, 2020, we collected data from 1525 patients with rheumatic and musculoskeletal
diseases: 117 (8%) presented with symptoms that were compatible with COVID-19. 65 patients had a swab confirmation
of SARS-CoV-2 infection, whereas 52 presented with a spectrum of symptoms indicative of COVID-19 but were not
swab tested. Patients with confirmed COVID-19 were older than those with suspected COVID-19 (median age
68 [IQR 55–76] years vs 57 [49–67] years; p=0·0010) and more likely to have arterial hypertension (33 [51%] vs 14 [27%]
patients; odds ratio [OR] 2·8 [95% CI 1·3–6·1]; p=0·031) and obesity (11 [17%] vs 1 [2%]; OR 11·0 [1·3–83·4]; p=0·0059).
We found no differences in rheumatological disease or background therapy between confirmed and suspected
COVID-19 cases. 47 (72%) of the 65 patients with confirmed COVID-19 developed pneumonia that required admission
to hospital. 12 (10%) deaths occurred among the 117 patients with confirmed or suspected COVID-19 (ten in those with
confirmed COVID-19 and two in those with suspected COVID-19). Deceased patients with confirmed COVID-19 were
older than survivors (median age 78·8 years [IQR 75·3–81·3] vs 65·5 years [53·3–74·0]; p=0·0002). We observed no
differences in sex, comorbidities, or therapies between the deceased patients and survivors. The case–control study
comprised 26 patients with rheumatic and musculoskeletal diseases and COVID-19 pneumonia and 62 matched
controls. We found no significant differences between cases and controls in duration of COVID-19 symptoms before
admission, duration of stay in hospital, or the local chest X-ray scoring system. Glucocorticoids were used for severe
respiratory manifestations related to lung involvement in 17 (65%) of 26 cases and tocilizumab in six (23%) of
26; thrombotic events occurred in four (15%) of 26 cases. Four (15%) of 26 cases and six (10%) of 62 controls died
during the study period.
Interpretation In this cohort of patients with rheumatic and musculoskeletal diseases in a geographical region with a
high prevalence of COVID-19, a poor outcome from COVID-19 seems to be associated with older age and the presence
of comorbidities rather than the type of rheumatic disease or the degree of pharmacological immunosuppression.