COVID-19 in rheumatic diseases: A random cross-sectional telephonic survey

Kumar, U.; Goswami, R. P.; Bhadu, D.; Kanjilal, M.; Nagar, S.; Vij, P.; Mittal, D.; Meena, L.; Roy, D.

Objective. To describe the incidence, clinical course, and predictive factors of coronavirus 2019 (COVID-19) infection in a cohort of rheumatological patients residing in New Delhi (National Capital Region), India. Methods. We performed a cross-sectional, random telephonic survey from 20th April to 20th July 2020 on patients with rheumatic diseases. Patients were interviewed with a predesigned questionnaire. The incidence of COVID-19 in the general population was obtained from open access government data repository. Report of reverse transcriptase polymerase chain reaction report was taken as confirmatory of COVID-19 infection. Results. Among the 900 contacted patients 840 responded (713 with rheumatoid arthritis (RA), 100 with systemic lupus erythematosus (SLE), 20 with spondylarthritis (SpA) and 7 with others; mean age 45 years, mean duration 11.3 years; 86% female). Among them 29 reported flu-like symptoms and four RA patients had confirmed COVID-19 infection. All of them were hospitalized with uneventful recovery. Rheumatological drugs were discontinued during the infectious episode. Disease modifying agents and biologics were equally received by those with or without COVID-19. The incidence of COVID-19 was similar to general Delhi population (0.476% vs 0.519% respectively, p=0.86). Two patients had relapse of rheumatic disease after recovery. After recovery from COVID-19 or Flu-like illness, eight patients (27.6%, 95% confidence interval 14.7-45.7) reported disease flare. Conclusion. Patients with rheumatic diseases in India have similar incidence of COVID-19 infection compared to the community. Relapse of underlying rheumatic disease after recovery is not uncommon and continuation of glucocorticoid through the infection should be considered.