SARS-CoV-2 infection among patients with systemic autoimmune diseases

Autoimmun Rev. 2020 Jul;19(7):102575. doi: 10.1016/j.autrev.2020.102575. Epub 2020 May 5.


Objectives: This study aimed to evaluate the prevalence of clinically overt SARS-CoV-2 infection (COVID-19) among patients with systemic autoimmune diseases residing in Tuscany, and to compare it with that observed in the general Tuscan population.

Methods: In this cross-sectional study, Tuscan outpatients with systemic autoimmune diseases followed at a tertiary referral centre were telephonically interviewed between April 1st-14th 2020 to collect demographic and clinical data, information on ongoing immunomodulating/immunosuppressive treatments, and on the presence of symptoms suspected of SARS-CoV-2 or of a confirmed infection.

Results: 458 patients were interviewed [74% female, median age 56 years (IQR 43-68)]; 56% of them were receiving corticosteroids, 44% traditional disease-modifying anti-rheumatic drugs (DMARDs), of whom 23% hydroxychloroquine, 5% colchicine, while 41% were on biologic DMARDs (of whom 9% on tocilizumab). Thirteen patients reported symptoms suggesting SARS-CoV-2 infection. Of them, 7 had undergone nasopharyngeal swab and only one was positive and developed severe SARS-CoV-2 complications. Within our cohort, the prevalence of SARS-CoV-2 infection was therefore 0.22% (0.01-1.21%), comparable to that observed in the general population of Tuscany [0.20% (0.20-0.21%), p = .597].

Conclusions: Patients with systemic autoimmune diseases do not seem to carry an increased risk of SARS- CoV-2 infection as compared to the general population.

Keywords: COVID-19; Hydroxychloroquine; Immunosuppressants; Systemic autoimmune diseases; Tocilizumab.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antirheumatic Agents / therapeutic use
  • Autoimmune Diseases / complications*
  • Autoimmune Diseases / drug therapy
  • Betacoronavirus
  • COVID-19
  • Colchicine / therapeutic use
  • Coronavirus Infections / complications*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Italy
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / complications*
  • SARS-CoV-2


  • Adrenal Cortex Hormones
  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents
  • Hydroxychloroquine
  • tocilizumab
  • Colchicine