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COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series.
Clin Rheumatol. 2020 Nov; 39(11):3195-3204.CR

Abstract

INTRODUCTION

Covid-19 infection poses a serious challenge for immune-compromised patients with inflammatory autoimmune systemic diseases. We investigated the clinical-epidemiological findings of 1641 autoimmune systemic disease Italian patients during the Covid-19 pandemic.

METHOD

This observational multicenter study included 1641 unselected patients with autoimmune systemic diseases from three Italian geographical areas with different prevalence of Covid-19 [high in north (Emilia Romagna), medium in central (Tuscany), and low in south (Calabria)] by means of telephone 6-week survey. Covid-19 was classified as (1) definite diagnosis of Covid-19 disease: presence of symptomatic Covid-19 infection, confirmed by positive oral/nasopharyngeal swabs; (2) highly suspected Covid-19 disease: presence of highly suggestive symptoms, in absence of a swab test.

RESULTS

A significantly higher prevalence of patients with definite diagnosis of Covid-19 disease, or with highly suspected Covid-19 disease, or both the conditions together, was observed in the whole autoimmune systemic disease series, compared to "Italian general population" (p = .030, p = .001, p = .000, respectively); and for definite + highly suspected diagnosis of Covid-19 disease, in patients with autoimmune systemic diseases of the three regions (p = .000, for all comparisons with the respective regional general population). Moreover, significantly higher prevalence of definite + highly suspected diagnosis of Covid-19 disease was found either in patients with various "connective tissue diseases" compared to "inflammatory arthritis group" (p < .000), or in patients without ongoing conventional synthetic disease-modifying anti-rheumatic drugs treatments (p = .011).

CONCLUSIONS

The finding of a higher prevalence of Covid-19 in patients with autoimmune systemic diseases is particularly important, suggesting the need to develop valuable prevention/management strategies, and stimulates in-depth investigations to verify the possible interactions between Covid-19 infection and impaired immune-system of autoimmune systemic diseases. Key Points • Significantly higher prevalence of Covid-19 is observed in a large series of patients with autoimmune systemic diseases compared to the Italian general population, mainly due to patients' increased susceptibility to infections and favored by the high exposure to the virus at medical facilities before the restriction measures on individual movement. • The actual prevalence of Covid-19 in autoimmune systemic diseases may be underestimated, possibly due to the wide clinical overlapping between the two conditions, the generally mild Covid-19 disease manifestations, and the limited availability of virological testing. • Patients with "connective tissue diseases" show a significantly higher prevalence of Covid-19, possibly due to deeper immune-system impairment, with respect to "inflammatory arthritis group". • Covid-19 is more frequent in the subgroup of autoimmune systemic diseases patients without ongoing conventional synthetic disease-modifying anti-rheumatic drugs, mainly hydroxyl-chloroquine and methotrexate, which might play some protective role against the most harmful manifestations of Covid-19.

Authors+Show Affiliations

Rheumatology Unit, School of Medicine, University of Modena & RE, Modena, Italy. clferri@unimore.it. Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy. clferri@unimore.it.Rheumatology Unit, School of Medicine, University of Modena & RE, Modena, Italy.Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy.Rheumatology Outpatient Clinic, ASP-Vibo Valentia-Tropea Hospital, Tropea, Italy.Clinical Immunology Unit, University of Pisa, Pisa, Italy.Ospedale di Portoferraio, Livorno, Italy.Rheumatology Unit, University of Florence, Florence, Italy.Rizzoli Orthopaedic Institute Bologna, University of Bologna, Bologna, Italy.UOD Reumatologia, Grande Ospedale Metropolitano, Reggio Calabria, Italy.U.O.S. Reumatologia, Ospedale Castrovillari, Cosenza, Italy.U.O.T. Specialistica Ambulatoriale ASP 201, Cosenza, Italy.U.O.C. Medicina Interna "M.Valentini" P.O. Annunziata, Cosenza, Italy.Rheumatology Outpatient Clinic, San Giovanni di Dio Hospital, Crotone, Italy.Rheumatology Unit, University of Catania, Catania, Italy.Department of Internal Medicine, San Martino Policlinic Hospital, University of Genoa, Genoa, Italy.Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy.UOD Reumatologia, Grande Ospedale Metropolitano, Reggio Calabria, Italy.Rheumatology Unit, School of Medicine, University of Modena & RE, Modena, Italy.Rheumatology Unit, University of Florence, Florence, Italy.Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy.Clinical Immunology Unit, University of Pisa, Pisa, Italy.Clinical Immunology Unit, University of Pisa, Pisa, Italy.U.O.S. Reumatologia, Ospedale Castrovillari, Cosenza, Italy.Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy.Rizzoli Orthopaedic Institute Bologna, University of Bologna, Bologna, Italy.Rizzoli Orthopaedic Institute Bologna, University of Bologna, Bologna, Italy.Department of Translational Research and New Technologies in Medicine and Surgery, School of Medicine, University of Pisa, Pisa, Italy.Department of Clinical and Experimental Medicine, Immuno-Endocrine Section of Internal Medicine, Laboratory of Primary Human Cells, School of Medicine, University of Pisa, Via Savi, 10, I-56126, Pisa, Italy. alessandro.antonelli@med.unipi.it.No affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

32852623

Citation

Ferri, Clodoveo, et al. "COVID-19 and Rheumatic Autoimmune Systemic Diseases: Report of a Large Italian Patients Series." Clinical Rheumatology, vol. 39, no. 11, 2020, pp. 3195-3204.
Ferri C, Giuggioli D, Raimondo V, et al. COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series. Clin Rheumatol. 2020;39(11):3195-3204.
Ferri, C., Giuggioli, D., Raimondo, V., L'Andolina, M., Tavoni, A., Cecchetti, R., Guiducci, S., Ursini, F., Caminiti, M., Varcasia, G., Gigliotti, P., Pellegrini, R., Olivo, D., Colaci, M., Murdaca, G., Brittelli, R., Mariano, G. P., Spinella, A., Bellando-Randone, S., ... Antonelli, A. (2020). COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series. Clinical Rheumatology, 39(11), 3195-3204. https://doi.org/10.1007/s10067-020-05334-7
Ferri C, et al. COVID-19 and Rheumatic Autoimmune Systemic Diseases: Report of a Large Italian Patients Series. Clin Rheumatol. 2020;39(11):3195-3204. PubMed PMID: 32852623.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series. AU - Ferri,Clodoveo, AU - Giuggioli,Dilia, AU - Raimondo,Vincenzo, AU - L'Andolina,Massimo, AU - Tavoni,Antonio, AU - Cecchetti,Riccardo, AU - Guiducci,Serena, AU - Ursini,Francesco, AU - Caminiti,Maurizio, AU - Varcasia,Giuseppe, AU - Gigliotti,Pietro, AU - Pellegrini,Roberta, AU - Olivo,Domenico, AU - Colaci,Michele, AU - Murdaca,Giuseppe, AU - Brittelli,Raffaele, AU - Mariano,Giuseppa Pagano, AU - Spinella,Amelia, AU - Bellando-Randone,Silvia, AU - Aiello,Vincenzo, AU - Bilia,Silvia, AU - Giannini,Daiana, AU - Ferrari,Tommaso, AU - Caminiti,Rodolfo, AU - Brusi,Veronica, AU - Meliconi,Riccardo, AU - Fallahi,Poupak, AU - Antonelli,Alessandro, AU - ,, Y1 - 2020/08/27/ PY - 2020/05/26/received PY - 2020/07/17/accepted PY - 2020/07/13/revised PY - 2020/8/28/pubmed PY - 2020/10/24/medline PY - 2020/8/28/entrez KW - Arthritis KW - Autoimmune systemic diseases KW - COVID-19 KW - Connective tissue diseases KW - Rheumatic diseases KW - SARS-CoV-2 SP - 3195 EP - 3204 JF - Clinical rheumatology JO - Clin Rheumatol VL - 39 IS - 11 N2 - INTRODUCTION: Covid-19 infection poses a serious challenge for immune-compromised patients with inflammatory autoimmune systemic diseases. We investigated the clinical-epidemiological findings of 1641 autoimmune systemic disease Italian patients during the Covid-19 pandemic. METHOD: This observational multicenter study included 1641 unselected patients with autoimmune systemic diseases from three Italian geographical areas with different prevalence of Covid-19 [high in north (Emilia Romagna), medium in central (Tuscany), and low in south (Calabria)] by means of telephone 6-week survey. Covid-19 was classified as (1) definite diagnosis of Covid-19 disease: presence of symptomatic Covid-19 infection, confirmed by positive oral/nasopharyngeal swabs; (2) highly suspected Covid-19 disease: presence of highly suggestive symptoms, in absence of a swab test. RESULTS: A significantly higher prevalence of patients with definite diagnosis of Covid-19 disease, or with highly suspected Covid-19 disease, or both the conditions together, was observed in the whole autoimmune systemic disease series, compared to "Italian general population" (p = .030, p = .001, p = .000, respectively); and for definite + highly suspected diagnosis of Covid-19 disease, in patients with autoimmune systemic diseases of the three regions (p = .000, for all comparisons with the respective regional general population). Moreover, significantly higher prevalence of definite + highly suspected diagnosis of Covid-19 disease was found either in patients with various "connective tissue diseases" compared to "inflammatory arthritis group" (p < .000), or in patients without ongoing conventional synthetic disease-modifying anti-rheumatic drugs treatments (p = .011). CONCLUSIONS: The finding of a higher prevalence of Covid-19 in patients with autoimmune systemic diseases is particularly important, suggesting the need to develop valuable prevention/management strategies, and stimulates in-depth investigations to verify the possible interactions between Covid-19 infection and impaired immune-system of autoimmune systemic diseases. Key Points • Significantly higher prevalence of Covid-19 is observed in a large series of patients with autoimmune systemic diseases compared to the Italian general population, mainly due to patients' increased susceptibility to infections and favored by the high exposure to the virus at medical facilities before the restriction measures on individual movement. • The actual prevalence of Covid-19 in autoimmune systemic diseases may be underestimated, possibly due to the wide clinical overlapping between the two conditions, the generally mild Covid-19 disease manifestations, and the limited availability of virological testing. • Patients with "connective tissue diseases" show a significantly higher prevalence of Covid-19, possibly due to deeper immune-system impairment, with respect to "inflammatory arthritis group". • Covid-19 is more frequent in the subgroup of autoimmune systemic diseases patients without ongoing conventional synthetic disease-modifying anti-rheumatic drugs, mainly hydroxyl-chloroquine and methotrexate, which might play some protective role against the most harmful manifestations of Covid-19. SN - 1434-9949 UR - https://www.unboundmedicine.com/medline/citation/32852623/COVID_19_and_rheumatic_autoimmune_systemic_diseases:_report_of_a_large_Italian_patients_series_ L2 - https://dx.doi.org/10.1007/s10067-020-05334-7 DB - PRIME DP - Unbound Medicine ER -