Clinical features of rheumatic patients infected with COVID-19 in Wuhan, China

Ann Rheum Dis. 2020 Aug;79(8):1007-1013. doi: 10.1136/annrheumdis-2020-217627. Epub 2020 May 22.


Objective: The clinical features of rheumatic patients with coronavirus disease 2019 (COVID-19) have not been reported. This study aimed to describe the clinical features of COVID-19 in rheumatic patients and provide information for handling this situation in clinical practice.

Methods: This is a retrospective case series study. Deidentified data, including gender, age, laboratory and radiological results, symptoms, signs, and medication history, were collected from 2326 patients diagnosed with COVID-19, including 21 cases in combination with rheumatic disease, in Tongji Hospital between 13 January and 15 March 2020.

Results: Length of hospital stay and mortality rate were similar between rheumatic and non-rheumatic groups, while the presence of respiratory failure was more common in rheumatic cases (38% vs 10%, p<0.001). Symptoms of fever, fatigue and diarrhoea were seen in 76%, 43% and 23% of patients, respectively. There were four rheumatic patients who experienced a flare of rheumatic disease during hospital stay, with symptoms of muscle aches, back pain, joint pain or rash. While lymphocytopaenia was seen in 57% of rheumatic patients, only one patient (5%) presented with leucopenia in rheumatic cases. Rheumatic patients presented with similar radiological features of ground-glass opacity and consolidation. Patients with pre-existing interstitial lung disease showed massive fibrous stripes and crazy-paving signs at an early stage. Five rheumatic cases used hydroxychloroquine before the diagnosis of COVID-19 and none progressed to critically ill stage.

Conclusions: Respiratory failure was more common in rheumatic patients infected with COVID-19. Differential diagnosis between COVID-19 and a flare of rheumatic disease should be considered.

Trial registration number: ChiCTR2000030795.

Keywords: autoimmune diseases; autoimmunity; inflammation.

MeSH terms

  • Adult
  • Aged
  • Betacoronavirus*
  • COVID-19
  • China
  • Coronavirus Infections / complications*
  • Coronavirus Infections / pathology
  • Coronavirus Infections / virology
  • Diarrhea / virology
  • Fatigue / virology
  • Female
  • Fever / virology
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / pathology
  • Pneumonia, Viral / virology
  • Respiratory Insufficiency / virology
  • Retrospective Studies
  • Rheumatic Diseases / virology*
  • SARS-CoV-2
  • Symptom Flare Up