COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series

{ 'indexed': {'date-parts': [[2024, 5, 17]], 'date-time': '2024-05-17T13:40:17Z', 'timestamp': 1715953217662}, 'reference-count': 35, 'publisher': 'Springer Science and Business Media LLC', 'issue': '11', 'license': [ { 'start': { 'date-parts': [[2020, 8, 27]], 'date-time': '2020-08-27T00:00:00Z', 'timestamp': 1598486400000}, 'content-version': 'tdm', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}, { 'start': { 'date-parts': [[2020, 8, 27]], 'date-time': '2020-08-27T00:00:00Z', 'timestamp': 1598486400000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}], 'funder': [{'DOI': '10.13039/501100007514', 'name': 'Università di Pisa', 'doi-asserted-by': 'crossref'}], 'content-domain': {'domain': ['link.springer.com'], 'crossmark-restriction': False}, 'published-print': {'date-parts': [[2020, 11]]}, 'abstract': '<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>Covid-19 ' 'infection poses a serious challenge for immune-compromised patients with inflammatory ' 'autoimmune systemic diseases. We investigated the clinical-epidemiological findings of 1641 ' 'autoimmune systemic disease Italian patients during the Covid-19 ' 'pandemic.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>This ' 'observational multicenter study included 1641 unselected patients with autoimmune systemic ' 'diseases from three Italian geographical areas with different prevalence of Covid-19 [high in ' 'north (Emilia Romagna), medium in central (Tuscany), and low in south (Calabria)] by means of ' 'telephone 6-week survey. Covid-19 was classified as ' '(1)<jats:italic>definite</jats:italic>diagnosis of Covid-19 disease: presence of symptomatic ' 'Covid-19 infection, confirmed by positive oral/nasopharyngeal swabs; (2)<jats:italic>highly ' 'suspected</jats:italic>Covid-19 disease: presence of highly suggestive symptoms, in absence ' 'of a swab test.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A ' 'significantly higher prevalence of patients with<jats:italic>definite</jats:italic>diagnosis ' 'of Covid-19 disease<jats:italic>,</jats:italic>or with<jats:italic>highly ' 'suspected</jats:italic>Covid-19 disease, or both the conditions together, was observed in the ' 'whole autoimmune systemic disease series, compared to “Italian general population” ' '(<jats:italic>p</jats:italic>\u2009=\u2009.030,<jats:italic>p</jats:italic>\u2009=\u2009' '.001,<jats:italic>p</jats:italic>\u2009=\u2009.000, respectively); and ' 'for<jats:italic>definite\u2009+\u2009highly suspected</jats:italic>diagnosis of Covid-19 ' 'disease, in patients with autoimmune systemic diseases of the three regions ' '(<jats:italic>p</jats:italic>\u2009=\u2009.000, for all comparisons with the respective ' 'regional general population)<jats:italic>.</jats:italic>Moreover, significantly higher ' 'prevalence of<jats:italic>definite\u2009+\u2009highly suspected</jats:italic>diagnosis of ' 'Covid-19 disease was found either in patients with various “connective tissue diseases” ' 'compared to “inflammatory arthritis group” (<jats:italic>p</jats:italic>\u2009&lt;\u2009' '.000), or in patients without ongoing conventional synthetic disease-modifying anti-rheumatic ' 'drugs treatments (<jats:italic>p</jats:italic>\u2009=\u2009' '.011).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The finding ' 'of a higher prevalence of Covid-19 in patients with autoimmune systemic diseases is ' 'particularly important, suggesting the need to develop valuable prevention/management ' 'strategies, and stimulates in-depth investigations to verify the possible interactions ' 'between Covid-19 infection and impaired immune-system of autoimmune systemic ' 'diseases.<jats:table-wrap><jats:table><jats:tbody><jats:tr><jats:td ' 'colspan="2"><jats:bold>Key Points</jats:bold><jats:italic>• Significantly higher prevalence ' 'of Covid-19 is observed in a large series of patients with autoimmune systemic diseases ' 'compared to the Italian general population, mainly due to patients’ increased susceptibility ' 'to infections and favored by the high exposure to the virus at medical facilities before the ' 'restriction measures on individual movement.</jats:italic><jats:italic>• The actual ' 'prevalence of Covid-19 in autoimmune systemic diseases may be underestimated, possibly due to ' 'the wide clinical overlapping between the two conditions, the generally mild Covid-19 disease ' 'manifestations, and the limited availability of virological ' 'testing.</jats:italic><jats:italic>• Patients with “connective tissue diseases” show a ' 'significantly higher prevalence of Covid-19, possibly due to deeper immune-system impairment, ' 'with respect to “inflammatory arthritis group”.</jats:italic><jats:italic>• Covid-19 is more ' 'frequent in the subgroup of autoimmune systemic diseases patients without ongoing ' 'conventional synthetic disease-modifying anti-rheumatic drugs, mainly hydroxyl-chloroquine ' 'and methotrexate, which might play some protective role against the most harmful ' 'manifestations of ' 'Covid-19.</jats:italic></jats:td></jats:tr></jats:tbody></jats:table></jats:table-wrap></jats:p></jats:sec>', 'DOI': '10.1007/s10067-020-05334-7', 'type': 'journal-article', 'created': {'date-parts': [[2020, 8, 27]], 'date-time': '2020-08-27T10:03:57Z', 'timestamp': 1598522637000}, 'page': '3195-3204', 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'source': 'Crossref', 'is-referenced-by-count': 96, 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