COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series

Ferri, Clodoveo; Giuggioli, Dilia; Raimondo, Vincenzo; L’Andolina, Massimo; Tavoni, Antonio; Cecchetti, Riccardo; Guiducci, Serena; Ursini, Francesco; Caminiti, Maurizio; Varcasia, Giuseppe; Gigliotti, Pietro; Pellegrini, Roberta; Olivo, Domenico; Colaci, Michele; Murdaca, Giuseppe; Brittelli, Raffaele; Mariano, Giuseppa Pagano; Spinella, Amelia; Bellando-Randone, Silvia; Aiello, Vincenzo; Bilia, Silvia; Giannini, Daiana; Ferrari, Tommaso; Caminiti, Rodolfo; Brusi, Veronica; Meliconi, Riccardo; Fallahi, Poupak; Antonelli, Alessandro

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.