scholarly journals POS1260 FACTORS ASSOCIATED WITH SEVERE SARS-COV-2 INFECTION IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES IN MADRID: RESULTS FROM REUMA-COVID SORCOM REGISTRY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 914-914
Author(s):  
A. Boteanu ◽  
A. García Fernández ◽  
N. De la Torre ◽  
M. Pavia Pascual ◽  
O. Sanchez Pernaute ◽  
...  
Keyword(s):  
High Risk ◽  
Rheumatic Diseases ◽  
Connective Tissue Diseases ◽  
Severe Infection ◽  
Pulmonary Involvement ◽  
Inflammatory Rheumatic Diseases ◽  
Factors Associated ◽  
Risk Of Death ◽  
Cardiovascular Comorbidities ◽  
Male Sex

Background:Patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 may be at risk to develop a severe course of COVID-19 due to the immune dysregulation or the influence of immunomodulating drugs on the course of the infection. For a better understanding of SARS-CoV-2 infections in patients with IRD and due to the high incidence of COVID-19 in Madrid from the beginning of this pandemic infection in Spain, the Society of Rheumatology from Madrid (SORCOM) established a registry (REUMA-COVID SORCOM) shortly after the beginning of the pandemic in Spain.Objectives:To determine factors associated with severity of infection with SARS-CoV-2 in patients with inflammatory rheumatic diseases in MadridMethods:The REUMA-COVID SORCOM registry is a multicenter, retrospective, observational cohort study conducted in Madrid, a SORCOM initiative. All rheumatology departments from Madrid were invited to participate. The study includes patients with IRD presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020, and November 10, 2020. We consider severe infection death or need of hospitalization. Inclusion criteria was having an IRD and at least 1 of the following 4 criteria: (1) a biologically confirmed COVID-19 diagnosis based on a positive result of a SARS-CoV-2 polymerase chain reaction (PCR) test on a nasopharyngeal swab; (2) Detection of IgM or IgG anti SARS-CoV2 in a symptomatic or asymptomatic patients (3)typical thoracic computed tomography (CT) abnormalities (ground-glass opacities) in epidemic areas; (4) COVID19–typical symptoms in an epidemic zone of COVID-19.Results:As of November 10, 2020, 417 patients with IRD were included in the REUMA-COVID SORCOM registry. 5 patients were discharged for incomplete data. Of 412 patients (mean age 57 years, 87.4% Caucasian race, 66.3% female) 174 need hospitalization (42.2%) and 33 patients died (18.4% mortality in hospitalized patients). 82.3% had comorbidities. 234 (56.8%) patients were classified as inflammatory arthropathy, 133 (32.3%) had connective tissue diseases (CTD). 41.1% of the patients had a large history of IRD (> 10 years). 10.4% of patients had previously pulmonary involvement. The study includes 143 patients taking Methotrexate, 89 patients taking anti-TNFα therapy and 27 Rituximab. In the univariant analysis, no differences were seen in the severity of COVID-19 infection in patients taking methotrexate. 63% of the all patients taking Rituximab included in the registry need hospitalization and 22% of them died. Hypertension, COPD or cardiovascular disease was associated with hospitalization.Independent factors associated with COVID-19 hospitalization in the multivariate analysis was: age (>62 years), male sex, IMC >30, previous cardiovascular comorbidities and the IRD disease duration (> 10 years). Independent factors associated with COVID-19 related death was: age (> 62 years), having a CTD diagnose, pulmonary involvement before infection and chronical GC treatment.Conclusion:Patients with IRD represent a population of particular interest in the pandemic context because the baseline immunological alteration and the treated with immunosuppressants agents they receive, comorbidities and the well-known risk of severe infection. Older age, male sex, cardiovascular comorbidities were factors associated with high risk of hospitalization in IRD patients. CTD diseases, previously pulmonary involvement and chronical GC treatment with more than 10mg/day were associated with high risk of death. Neither anti TNF-α treatment nor Methotrexate were risk factor for hospitalization or death COVID-19 related in IRD patients.Disclosure of Interests:None declared

scholarly journals Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study

2020 ◽  
Vol 79 (12) ◽  
pp. 1544-1549 ◽  
Author(s):  
Jose L Pablos ◽  
María Galindo ◽  
Loreto Carmona ◽  
Ana Lledó ◽  
Miriam Retuerto ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Rheumatic Diseases ◽  
Connective Tissue Diseases ◽  
Severe Illness ◽  
Inflammatory Rheumatic Diseases ◽  
Hospitalised Patients ◽  
Male Sex ◽  
The Impact ◽  
Rheumatic Patients

ObjectivesThe impact of inflammatory rheumatic diseases on COVID-19 severity is poorly known. Here, we compare the outcomes of a cohort of patients with rheumatic diseases with a matched control cohort to identify potential risk factors for severe illness.MethodsIn this comparative cohort study, we identified hospital PCR+COVID-19 rheumatic patients with chronic inflammatory arthritis (IA) or connective tissue diseases (CTDs). Non-rheumatic controls were randomly sampled 1:1 and matched by age, sex and PCR date. The main outcome was severe COVID-19, defined as death, invasive ventilation, intensive care unit admission or serious complications. We assessed the association between the outcome and the potential prognostic variables, adjusted by COVID-19 treatment, using logistic regression.ResultsThe cohorts were composed of 456 rheumatic and non-rheumatic patients, in equal numbers. Mean age was 63 (IQR 53–78) years and male sex 41% in both cohorts. Rheumatic diseases were IA (60%) and CTD (40%). Most patients (74%) had been hospitalised, and the risk of severe COVID-19 was 31.6% in the rheumatic and 28.1% in the non-rheumatic cohort. Ageing, male sex and previous comorbidity (obesity, diabetes, hypertension, cardiovascular or lung disease) increased the risk in the rheumatic cohort by bivariate analysis. In logistic regression analysis, independent factors associated with severe COVID-19 were increased age (OR 4.83; 95% CI 2.78 to 8.36), male sex (1.93; CI 1.21 to 3.07) and having a CTD (OR 1.82; CI 1.00 to 3.30).ConclusionIn hospitalised patients with chronic inflammatory rheumatic diseases, having a CTD but not IA nor previous immunosuppressive therapies was associated with severe COVID-19.

scholarly journals Methods to improve medication adherence in patients with chronic inflammatory rheumatic diseases: a systematic literature review

RMD Open ◽  
2018 ◽  
Vol 4 (2) ◽  
pp. e000684 ◽  
Author(s):  
Matthieu Lavielle ◽  
Déborah Puyraimond-Zemmour ◽  
Xavier Romand ◽  
Laure Gossec ◽  
Eric Senbel ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Literature Review ◽  
Rheumatic Diseases ◽  
Systematic Literature Review ◽  
Lupus Erythematosus ◽  
Connective Tissue Diseases ◽  
Educational Interventions ◽  
Inflammatory Rheumatic Diseases ◽  
Improve Medication Adherence ◽  
Chronic Inflammatory Rheumatic Diseases

ObjectiveLack of adherence to treatment is frequent in chronic inflammatory rheumatic diseases and is associated with poorer outcomes. The objective of this study was to describe and evaluate interventions that have been proposed to enhance medication adherence in these conditions.MethodsA systematic literature review was performed in Pubmed, Cochrane, Embase and clinicaltrials.gov databases completed by the rheumatology meeting (ACR, EULAR and SFR) abstracts from last 2 years. All studies in English or French evaluating an intervention to improve medication adherence in chronic inflammatory rheumatic diseases (rheumatoid arthritis (RA), spondyloarthritis (SpA), crystal related diseases, connective tissue diseases, vasculitis and Still’s disease) were included. Interventions on adherence were collected and classified in five modalities (educational, behavioural, cognitive behavioural, multicomponent interventions or others).Results1325 abstracts were identified and 22 studies were finally included (18 studies in RA (72%), 4 studies in systemic lupus erythematosus (16%), 2 studies in SpA (8%) and 1 study in gout (4%)). On 13 randomised controlled trials (RCT) (1535 patients), only 5 were positive (774 patients). Educational interventions were the most represented and had the highest level of evidence: 8/13 RCT (62%, 1017 patients) and 4/8 were positive (50%). In these studies, each patient was individually informed or educated by different actors (physicians, pharmacists, nurses and so on). Supports and contents of these educational interventions were heterogenous.ConclusionDespite the importance of medication adherence in chronic inflammatory rheumatic disorders, evidence on interventions to improve medication adherence is scarce.

Outcome of Acute Hypoxaemic Respiratory Failure. Insights from the Lung Safe Study

2020 ◽  
pp. 2003317
Author(s):  
Tài Pham ◽  
Antonio Pesenti ◽  
Giacomo Bellani ◽  
Gordon Rubenfeld ◽  
Eddy Fan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Distress Syndrome ◽  
Pulmonary Involvement ◽  
Positive End Expiratory Pressure ◽  
Factors Associated ◽  
Risk Of Death ◽  
Increased Risk ◽  
Current Incidence

BackgroundThe current incidence and outcome of patients with acute hypoxaemic respiratory failure requiring mechanical ventilation in intensive care unit are unknown, especially for patients not meeting criteria for acute respiratory distress syndrome (ARDS).MethodsAn international, multicentre, prospective cohort study of patients presenting with hypoxemia early in the course of mechanical ventilation, conducted during four consecutive weeks in the winter of 2014 in 459 ICUs from 50 countries (LUNG SAFE). Patients were enrolled with PaO2/FiO2 ≤300 mmHg, new pulmonary infiltrates and need for mechanical ventilation with a positive end-expiratory pressure (PEEP) of at least 5 cm H2O. ICU prevalence, causes of hypoxemia, hospital survival, factors associated with hospital mortality were measured. Patients with unilateral versus bilateral opacities were compared.Findings12 906 critically ill patients received mechanical ventilation and 34.9% with hypoxaemia and new infiltrates were enrolled, separated into ARDS (69.0%), unilateral infiltrate (22.7%) and congestive heart failure (8.2%, CHF). The global hospital mortality was 38.6%. CHF patients had a mortality comparable to ARDS (44.1%versus 40.4%). Patients with unilateral-infiltrate had lower unadjusted mortality but similar adjusted mortality than ARDS. The number of quadrants on chest imaging was associated with an increased risk of death. There was no difference in mortality comparing patients with unilateral-infiltrate and ARDS with only 2 quadrants involved.InterpretationMore than one third of the patients receiving mechanical ventilation have hypoxaemia and new infiltrates with an hospital mortality of 38.6%. Survival is dependent on the degree of pulmonary involvement whether or not ARDS criteria are reached.

Factors Associated with Severe Skin Infections in Patients Treated with Biologic Therapies for Inflammatory Rheumatic Diseases

Dermatology ◽  
2012 ◽  
Vol 224 (1) ◽  
pp. 72-83 ◽  
Author(s):  
E. Régnier-Rosencher ◽  
D. Farhi ◽  
A. Lebrun ◽  
C. Salliot ◽  
M. Dougados ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Inflammatory Rheumatic Diseases ◽  
Skin Infections ◽  
Biologic Therapies ◽  
Factors Associated

scholarly journals Organ Manifestation and Systematic Organ Screening at the Onset of Inflammatory Rheumatic Diseases

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 67
Author(s):  
Tobias Hoffmann ◽  
Peter Oelzner ◽  
Martin Busch ◽  
Marcus Franz ◽  
Ulf Teichgräber ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Clinical Laboratory ◽  
Connective Tissue Diseases ◽  
Diagnostic Algorithm ◽  
Small Vessel Vasculitis ◽  
Inflammatory Rheumatic Diseases ◽  
Solid Organ ◽  
Newly Diagnosed ◽  
Cross Sectional ◽  
Organ Manifestations

Background: Inflammatory rheumatic diseases (IRD) are often associated with the involvement of various organs. However, data regarding organ manifestation and organ spread are rare. To close this knowledge gap, this cross-sectional study was initiated to evaluate the extent of solid organ manifestations in newly diagnosed IRD patients, and to present a structured systematic organ screening algorithm. Materials and Methods: The study included 84 patients (63 women, 21 men) with newly diagnosed IRD. None of the patients received any rheumatic therapy. All patients underwent a standardised organ screening programme encompassing a basic screening (including lungs, heart, kidneys, and gastrointestinal tract) and an additional systematic screening (nose and throat, central and peripheral nervous system) on the basis of clinical, laboratory, and immunological findings. Results: Represented were patients with connective tissue diseases (CTD) (72.6%), small-vessel vasculitis (16.7%), and myositis (10.7%). In total, 39 participants (46.5%) had one or more organ manifestation(s) (one organ, 29.7%; two organs, 10.7%; ≥three organs, 6.0%). The most frequently involved organs were the lungs (34.5%), heart (11.9%), and kidneys (8.3%). Lastly, a diagnostic algorithm for organ manifestation was applied. Conclusion: One-half of the patients presented with a solid organ involvement at initial diagnosis of IRD. Thus, in contrast to what has been described in the literature, organ manifestations were already present in a high proportion of patients at the time of diagnosis of IRD rather than after several years of disease. Therefore, in IRD patients, systematic organ screening is essential for treatment decisions.

scholarly journals Mortality in Inflammatory Rheumatic Diseases: Lithuanian National Registry Data and Systematic Review

2021 ◽  
Vol 18 (23) ◽  
pp. 12338
Author(s):  
Jolanta Dadonienė ◽  
Greta Charukevič ◽  
Gabija Jasionytė ◽  
Karolina Staškuvienė ◽  
Dalia Miltinienė
Keyword(s):  
General Population ◽  
Life Expectancy ◽  
Literature Review ◽  
Rheumatic Diseases ◽  
Systematic Literature Review ◽  
Causes Of Death ◽  
Connective Tissue Diseases ◽  
Standardized Mortality Ratio ◽  
Inflammatory Rheumatic Diseases ◽  
Total Cohort

Despite significant improvement in survival, rheumatic diseases (RD) are associated with premature mortality rates comparable to cardiovascular and neoplastic disorders. The aim of our study was to assess mortality, causes of death, and life expectancy in an inflammatory RD retrospective cohort and compare those with the general population as well as with the results of previously published studies in a systematic literature review. Patients with the first-time diagnosis of inflammatory RD during 2012–2019 were identified and cross-checked for their vital status and the date of death. Sex- and age-standardized mortality ratios (SMR) as well as life expectancy for patients with inflammatory RDs were calculated. The results of a systematic literature review were included in meta-standardized mortality ratio calculations. 11,636 patients with newly diagnosed RD were identified. During a total of 43,064.34 person-years of follow-up, 950 death cases occurred. The prevailing causes of death for the total cohort were cardiovascular diseases and neoplasms. The age- and sex-adjusted SMR for the total cohort was calculated to be 1.32 (1.23; 1.40). Patients with rheumatoid arthritis if diagnosed at age 18–19 tend to live for 1.63 years less than the general population, patients with spondyloarthritis—for 2.7 years less, patients with connective tissue diseases—for almost nine years less than the general population. The findings of our study support the hypothesis that patients with RD have a higher risk of mortality and lower life expectancy than the general population.

scholarly journals Nomogram for Prediction of fatal outcome in Patients with Severe COVID-19 Pneumonia: A Multicenter Study

2020 ◽  
Author(s):  
Yun Yang ◽  
Xiaofei Zhu ◽  
Jian Huang ◽  
Cui Chen ◽  
Yang Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Validation Cohort ◽  
Fatal Outcome ◽  
Treatment Strategies ◽  
Training Cohort ◽  
Factors Associated ◽  
Risk Of Death ◽  
High Risk Factors ◽  
Cox Analysis

Abstract Background & Aims: To develop an effective model of predicting fatal Outcome in the severe coronavirus disease 2019 (COVID-19) patients.Methods: Between February 20, 2020 and April 4, 2020, consecutive COVID-19 patients from three designated hospitals were enrolled in this study. Independent high- risk factors associated with death were analyzed using Cox proportional hazard model. A prognostic nomogram was constructed to predict the survival of severe COVID-19 patients.Results: There were 124 severe patients in the training cohort, and there were 71 and 76 severe patients in the two independent validation cohorts, respectively. Multivariate Cox analysis indicated that age ≥ 70 years (HR 1.184, 95% CI 1.061-1.321), Panting(breathing rate ≥ 30/min) (HR 3.300, 95% CI 2.509-6.286), lymphocyte count < 1.0 × 109/L (HR 2.283, 95% CI 1.779-3.267), and IL-6 >10pg/mL (HR 3.029, 95% CI 1.567-7.116) were independent high-risk factors associated with fatal outcome. We developed the nomogram for identifying survival of severe COVID-19 patients in the training cohort (AUC 0.900, [95% CI 0.841-0.960], sensitivity 95.5%, specificity 77.5%); in validation cohort 1 (AUC 0.862, [95% CI 0.763-0.961], sensitivity 92.9%, specificity 64.5%); in validation cohort 2 (AUC 0.811, [95% CI 0.698-0.924], sensitivity 77.3%, specificity 73.5%). The calibration curve for probability of death indicated a good consistence between prediction by the nomogram and the actual observation. Conclusions: This nomogram could help clinicians to identify severe patients who have high risk of death, and to develop more appropriate treatment strategies to reduce the mortality of severe patients.

scholarly journals Risk factors associated with the development of death events during the first year of follow-up after pulmonary thromboembolism

2019 ◽  
pp. 80-85
Author(s):  
S. A. Berns ◽  
E. A. Schmidt ◽  
A. G. Neeshpapa ◽  
A. A. Potapenko ◽  
K. V. Smirnov ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Anticoagulant Therapy ◽  
Severe Heart Failure ◽  
First Year ◽  
Factors Associated ◽  
Risk Of Death ◽  
One Year ◽  
The One

Purpose: to identify the factors associated with the development of death events during the year follow-up after hospitalization for pulmonary embolism (PE). Materials and methods: 93 patients with PE discharged to the outpatient stage of observation were studied. 45 (61,6%) patients were female with an average age of 66 years. The examination of patients at the stage of inclusion in the study consisted of standard methods of examination for this pathology. The diagnosis was confirmed by multislice computed tomography. Follow-up was 12 months. Statistical analysis was performed using the MedCalc Version 16.2.1. Results: during the one-year follow-up period 62 (66,7%) patients with PE were alive but 11 patients (11,8%) died, and no information was obtained about 20 patients. The causes of death were as follows: the development of recurrent PE – 4 (36,4%) patients, cancer – 3 patients (27,3%), stroke – 2 (18,1%), one patient (9,1%) died due to severe heart failure and one – myocardial infarction. A comparative analysis in the groups of alive patients (n = 62) and patients with a fatal events (n = 11) showed that the dead patients were older (78 (68; 81) vs. 65 (49; 75) years; p = 0,003), had a higher PESI score (119,0 (99,7; 137,2) vs. 88,0 (68,0; 108,0); p = 0,016) and were less compliant to prolonged anticoagulant therapy during the one year of observation (45,5% of patients (n = 5) vs. 82,3% ( = 51); p = 0,015). The ROC curve determined that a high risk of death during the one year after PE is associated with age over 70 years (p = 0,0001) and more than 95 points by PESI in the hospital period (p = 0,0001). Conclusion: The death events were developed in 11,8% of cases in patients with pulmonary embolism during the first year of follow-up. The death outcomes were significantly associated with elderly age, intermediate and high risk by PESI in the hospital period and low compliance to anticoagulant therapy extended during the year after pulmonary embolism.

scholarly journals Nomogram for Prediction of fatal outcome in Patients with Severe COVID-19: A Multicenter Study

2021 ◽  
Author(s):  
Yun Yang ◽  
Xiaofei Zhu ◽  
Jian Huang ◽  
Cui Chen ◽  
Yang Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Validation Cohort ◽  
Fatal Outcome ◽  
Treatment Strategies ◽  
Training Cohort ◽  
Factors Associated ◽  
Risk Of Death ◽  
High Risk Factors ◽  
Cox Analysis

Abstract Background & Aims: To develop an effective model of predicting fatalOutcome in the severe coronavirus disease 2019 (COVID-19) patients.Methods: Between February 20, 2020 and April 4, 2020, consecutive COVID-19 patients from three designated hospitals were enrolled in this study. Independent high- risk factors associated with death were analyzed using Cox proportional hazard model. A prognostic nomogram was constructed to predict the survival of severe COVID-19 patients.Results: There were 124 severe patients in the training cohort, and there were 71 and 76 severe patients in the two independent validation cohorts, respectively. Multivariate Cox analysis indicated that age ≥ 70 years (HR 1.184, 95% CI 1.061-1.321), Panting(breathing rate ≥ 30/min) (HR 3.300, 95% CI 2.509-6.286), lymphocyte count < 1.0 × 109/L (HR 2.283, 95% CI 1.779-3.267), and IL-6 >10pg/mL (HR 3.029, 95% CI 1.567-7.116) were independent high-risk factors associated with fatal outcome. We developed the nomogram for identifying survival of severe COVID-19 patients in the training cohort (AUC 0.900, [95% CI 0.841-0.960], sensitivity 95.5%, specificity 77.5%); in validation cohort 1 (AUC 0.811, [95% CI 0.763-0.961], sensitivity 77.3%, specificity 73.5); in validation cohort 2 (AUC 0.862, [95% CI 0.698-0.924], sensitivity 92.9%, specificity 64.5%). The calibration curve for probability of death indicated a good consistence between prediction by the nomogram and the actual observation. The prognosis of severe COVID-19 patients with high levels of interleukin-6 (IL-6) receiving tocilizumab was better than that of those patients without tocilizumab both in the training and validation cohorts, but without difference (p = 0.105 for training cohort, p = 0.133 for validation cohort 1, and p = 0.210 for validation cohort 2).Conclusions: This nomogram could help clinicians to identify severe patients who have high risk of death, and to develop more appropriate treatment strategies to reduce the mortality of severe patients. Tocilizumab may improve the prognosis of severe COVID-19 patients with high levels of IL-6.

scholarly journals Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry

2021 ◽  
pp. annrheumdis-2020-219498 ◽  
Author(s):  
Anja Strangfeld ◽  
Martin Schäfer ◽  
Milena A Gianfrancesco ◽  
Saskia Lawson-Tovey ◽  
Jean W Liew ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Disease Activity ◽  
Rheumatic Diseases ◽  
Smoking Status ◽  
Disease Diagnosis ◽  
High Disease Activity ◽  
Disease Category ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Male Sex

ObjectivesTo determine factors associated with COVID-19-related death in people with rheumatic diseases.MethodsPhysician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category.ResultsOf 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66–75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death.ConclusionAmong people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.

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