Prevalence of coronavirus disease 2019 in rheumatic patients and evaluation of the effect of disease-modifying anti-rheumatic drugs

Intern Emerg Med. 2021 Jun;16(4):919-923. doi: 10.1007/s11739-020-02535-5. Epub 2020 Oct 31.


One of the most controversial issues among rheumatologists is the best approach to managing a rheumatic patient (RP) with coronavirus disease 2019 (COVID-19). This study aims to evaluate the prevalence of COVID-19 in RPs compared to the general population and to relatively assess the potential role of RPs' treatment regimen against COVID-19. In a cross-sectional study, all RPs with an updated medical record between December 1, 2019, and February 29, 2020, at the rheumatology clinic of Shahid Beheshti Hospital, Qom, Iran were included (as the case group), and the prevalence of COVID-19 was compared to the paired control group-individuals without RDs, randomly selected from the Qom Health Network's database. Qom was the first city in Iran in which COVID-19 was identified and spread rapidly. Both groups were paired regarding sex, age, and underlying severe conditions. The prevalence of COVID-19 was lower in RPs than the control group (p = 0.028). Moreover, patients who were under treatment with disease-modifying anti-rheumatic drugs (DMARDs) and biologic agents seemed to possess a lower risk for COVID-19. Two RPs died from COVID-19, both of whom had granulomatosis and polyangiitis (GPA). The prevalence of COVID-19 in the RPs was lower than the control group, which could be associated with more adherence to the quarantine and social distancing rules by RPs and stricter routine follow-ups than the general population. Besides, taking DMARDs, such as leflunomide, might possess a protective effect against severe COVID-19, probably as a result of preventing cytokine storm.

Keywords: COVID-19; DMARDs; Rheumatic diseases; SARS-CoV-2.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antirheumatic Agents / therapeutic use*
  • Biological Factors / therapeutic use
  • COVID-19 / diagnosis
  • COVID-19 / epidemiology*
  • Case-Control Studies
  • Cross-Sectional Studies
  • Female
  • Humans
  • Iran
  • Male
  • Middle Aged
  • Prevalence
  • Rheumatic Diseases / complications*
  • Rheumatic Diseases / drug therapy*


  • Antirheumatic Agents
  • Biological Factors