Abstract

Background

The clinical manifestations of COVID-19 infection are very heterogeneous. Rheumatic patients should be more susceptible to develop severe forms of COVID-19 pneumonia due to an unbalanced immune response and treatment immunodepressants (disease modifying anti rheumatic drugs-DMARDs).

Aims and objectives

To investigate if the chronic use of biological DMARDs and small molecules may increase the susceptibility to COVID-19 and to developing severe disease.

Methods

We studied 43 consecutive patients on bDMARDs or small molecules from March 2020 to January 2022. Data collection included: rheumatic diagnosis, comorbidities, smoking history and COVID-19 clinical course according to MEWS (modifying early warning score) in 4 stages: 0=no symptoms at all; no hospitalization; 1=not complicated disease with mild or non-specific symptoms; no hospitalization; 2=mild pneumonia with clinical and/or radiological diagnosis, without any signs of severity; no hospitalization; 3=severe pneumonia with respiratory failure with need of hospitalization; 4=hospitalization in ICU or sub-ICU.

Results

30 patients (69.8%) got COVID infection: 26 were not hospitalized (MEWS 0=3.3%; 1=70%; 2=13.3%); of the four patients that required hospitalization, none was intubated. Hospitalized patients were obese and had hypertension, and 3 had a positive smoking history. Patients taking TNF-inhibitors compared to other treatment were not at major risk of COVID-19 infection (p=0.041).

Conclusions

Rheumatic patients taking bDMARDs or small molecules appear more susceptible to contract SARS-CoV-2 infection, but the development of severe forms appears to be rare.