Prevalence of coronavirus disease 2019 in rheumatic patients and evaluation of the effect of disease-modifying anti-rheu
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Prevalence of coronavirus disease 2019 in rheumatic patients and evaluation of the effect of disease‑modifying anti‑rheumatic drugs Soroush Moradi1 · Maryam Masoumi2 · Somayeh Mohammadi2 · Jamshid Vafaeimanesh3 · Mohaddeseh Mohseni2 · Hossein Mahdavi4 · Armin Aryannejad1 Received: 23 June 2020 / Accepted: 10 October 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract 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 · SARS-CoV-2 · Rheumatic diseases · DMARDs Abbreviations COVID-19 Coronavirus disease 2019 CT Computed tomography DMARD Disease-modifying anti-rheumatic drug GPA Granulomatosis with polyangiitis HRCT High-resolution computed tomography IS Immunosuppressive RD Rheumatic disease * Maryam Masoumi [email protected] 1
Tehran University of Medical Sciences, Tehran, Iran
2
Clinical Research and Development Center, Qom University of Medical Sciences and Health Services, Qom, Iran
3
Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
4
Shahid Beheshti University of Medical Sciences, Tehran, Iran
RP Rheumatic patient RT-PCR Reverse-transcription polymerase chain reaction SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 TNF Tumor necrosis factor
Introduction The global risk for the coronavirus disease 2019 (COVID19) was assessed by World Health Organization (WHO) as very high; it was then considered as a pandemic that affected more than two million people worldwi
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