Clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and rheumatic disease: a comparative cohort study from a US 'hot spot'

Ann Rheum Dis. 2020 Sep;79(9):1156-1162. doi: 10.1136/annrheumdis-2020-217888. Epub 2020 May 26.


Objective: To investigate differences in manifestations and outcomes of coronavirus disease 2019 (COVID-19) infection between those with and without rheumatic disease.

Methods: We conducted a comparative cohort study of patients with rheumatic disease and COVID-19 (confirmed by severe acute respiratory syndrome coronavirus 2 PCR), compared in a 1:2 ratio with matched comparators on age, sex and date of COVID-19 diagnosis, between 1 March and 8 April 2020, at Partners HealthCare System in the greater Boston, Massachusetts area. We examined differences in demographics, clinical features and outcomes of COVID-19 infection. The main outcomes were hospitalisation, intensive care admission, mechanical ventilation and mortality.

Results: We identified 52 rheumatic disease patients with COVID-19 (mean age, 63 years; 69% female) and matched these to 104 non-rheumatic disease comparators. The majority (39, 75%) of patients with rheumatic disease were on immunosuppressive medications. Patients with and without rheumatic disease had similar symptoms and laboratory findings. A similar proportion of patients with and without rheumatic disease were hospitalised (23 (44%) vs 42 (40%)), p=0.50) but those with rheumatic disease required intensive care admission and mechanical ventilation more often (11 (48%) vs 7 (18%), multivariable OR 3.11 (95% CI 1.07 to 9.05)). Mortality was similar between the two groups (3 (6%) vs 4 (4%), p=0.69).

Conclusions: Patients with rheumatic disease and COVID-19 infection were more likely to require mechanical ventilation but had similar clinical features and hospitalisation rates as those without rheumatic disease. These findings have important implications for patients with rheumatic disease but require further validation.

Keywords: autoimmune diseases; epidemiology; health services research; outcome and process assessment, health care.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Betacoronavirus*
  • COVID-19
  • Cohort Studies
  • Coronavirus Infections / mortality*
  • Coronavirus Infections / therapy
  • Coronavirus Infections / virology
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Massachusetts / epidemiology
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / mortality*
  • Pneumonia, Viral / therapy
  • Pneumonia, Viral / virology
  • Respiration, Artificial / statistics & numerical data*
  • Rheumatic Diseases / mortality*
  • Rheumatic Diseases / therapy
  • Rheumatic Diseases / virology
  • Risk Factors
  • SARS-CoV-2