Incidence of COVID-19 in a cohort of adult and paediatric patients with rheumatic diseases treated with targeted biologic and synthetic disease-modifying anti-rheumatic drugs

Semin Arthritis Rheum. 2020 Aug;50(4):564-570. doi: 10.1016/j.semarthrit.2020.05.001. Epub 2020 May 16.


Objectives: To investigate the incidence of COVID-19 in a cohort of adult and paediatric patients with rheumatic diseases receiving targeted biologic and synthetic disease modifying anti-rheumatic drugs (tDMARDs) and to explore the possible effect of these treatments in the clinical expression of COVID-19.

Methods: A cross-sectional study comprising of a telephone survey and electronic health records review was performed including all adult and paediatric patients with rheumatic diseases treated with tDMARDs in a large rheumatology tertiary centre in Barcelona, Spain. Demographics, disease activity, COVID-19 related symptoms and contact history data were obtained from the start of the 2020 pandemic. Cumulative incidence of confirmed cases (SARS-CoV-2 positive PCR test) was compared to the population estimates for the same city districts from a governmental COVID-19 health database. Suspected cases were defined following WHO criteria and compared to those without compatible symptoms.

Results: 959 patients with rheumatic diseases treated with tDMARDs were included. We identified 11 confirmed SARS-CoV-2 positive cases in the adult cohort and no confirmed positive cases in the paediatric cohort. COVID-19 incidence rates of the rheumatic patient cohort were very similar to that of the general population [(0.48% (95% CI 0.09 to 0.87%)] and [0.58% (95% CI 0.56 to 0.60%)], respectively. We found significant differences in tDMARDs proportions between the suspected and non-suspected cases (p=0.002).

Conclusion: Adult and paediatric patients with rheumatic diseases on tDMARDs do not seem to present a higher risk of COVID-19 or a more severe disease outcome when compared to general population.

Keywords: COVID-19; Epidemiology; Pediatric rheumatology; Rheumatic diseases; Targeted disease modifying anti-rheumatic drugs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antirheumatic Agents / therapeutic use*
  • Betacoronavirus / drug effects
  • Biological Products / therapeutic use*
  • COVID-19
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / physiopathology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Incidence
  • Infant
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / physiopathology
  • Retrospective Studies
  • Rheumatic Diseases / drug therapy*
  • Rheumatic Diseases / epidemiology
  • SARS-CoV-2
  • Spain / epidemiology
  • Young Adult


  • Antirheumatic Agents
  • Biological Products