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Covid-19 And Rheumatic Autoimmune Systemic Diseases: Role of Pre-Existing Lung Involvement and Ongoing Treatments

Author(s):

Clodoveo Ferri, Dilia Giuggioli, Vincenzo Raimondo, Massimo L’Andolina, Lorenzo Dagna, Antonio Tavoni, Francesco Caso, Francesco Ursini, Ruscitti Piero, Maurizio Caminiti, Rosario Foti, Valeria Riccieri , Serena Guiducci, Roberta Pellegrini, Elisabetta Zanatta, Giuseppe Varcasia, Domenico Olivo, Pietro Gigliotti, Giovanna Cuomo, Giuseppe Murdaca, Riccardo Cecchetti, Rossella De Angelis, Nicoletta Romeo, Francesca Ingegnoli, Franco Cozzi, Veronica Codullo, Ilaria Cavazzana, Michele Colaci, Giuseppina Abignano, Maria De Santis, Ennio Lubrano, Enrico Fusaro, Alessandra Della Rossa, Amelia Spinella, Federica Lumetti, Giacomo De Luca, Silvia Bellando-Randone, Elisa Visalli, Ylenia Dal Bosco, Giorgio Amato, Daiana Giannini, Silvia Bilia, Francesco Masini, Greta Pellegrino, Erika Pigatto, Elena Generali, Giuseppa Pagano Mariano, Giorgio Pettiti, Giovanni Zanframundo, Raffaele Brittelli, Vincenzo Aiello, Rodolfo Caminiti, Daniela Scorpiniti, Tommaso Ferrari, Corrado Campochiaro, Veronica Brusi, Micaela Fredi, Liala Moschetti, Fabio Cacciapaglia, Laura Gragnani, Monica Monti, Serena Lorini, Sabrina Rosaria Paparo, Francesca Ragusa, Valeria Mazzi, Giusy Elia, Silvia Martina Ferrari, Ilenia Di Cola, Marta Vadacca, Sebastiano Lorusso, Simone Barsotti, Maria Letizia Aprile, Tasso Marco, Mario Miccoli , Silvia Bosello, Marco Matucci-Cerinic, Salvatore D'Angelo, Andrea Doria, Franco Franceschini, Riccardo Meliconi, Florenzo Iannone, Roberto Giacomelli, Anna Linda Zignego, Poupak Varcasia and Alessandro Antonelli*  

Abstract:


Background. The Covid-19 pandemic may have a deleterious impact on patients with autoimmune systemic diseases (ASD) due to their deep immune-system alterations.

Objective. To investigate the prevalence of symptomatic Covid-19 and its correlations with both organ involvement and ongoing treatments in a large series of Italian ASD patients during the first wave of pandemic.

Method. Our multicenter telephone 6-week survey included 3,029 unselected ASD patients enrolled at 36 tertiary referral centers of northern, central, and southern Italian macro-areas with different diffusion of pandemic. Symptomatic SARS-CoV-2 infection was classified as definite Covid-19 (presence of symptoms plus positive oral/nasopharyngeal swabs) or highly suspected Covid-19 (highly suggestive symptoms, in absence of a swab testing).

Results. A significantly higher prevalence of definite plus highly suspected Covid-19 compared to Italian general population was detected in the whole ASD series (p=.000), as well as in patients from the three macro-areas (p=.000 in all). Statistically higher prevalence of Covid-19 was also found in connective tissue diseases compared to chronic arthritis subgroup (p=.000) and in ASD patients with pre-existing interstitial lung involvement (p=.000). Patients treated with either conventional disease modifying anti-rheumatic drugs (DMARDs) and/or biological DMARDs showed a significantly lower prevalence of Covid-19 (p=.000 in both). Finally, scleroderma patients undergoing low-dose aspirin showed significantly lower rate of Covid-19 compared to those without (p=0.003).

Conclusion. The higher prevalence of Covid-19 in ASD patients along with the significant correlations with important clinical features and therapeutic regimens suggests the need to develop targeted prevention/management strategies during the current pandemic wave.

Keywords:

COVID-19, SARS-CoV-2, autoimmune systemic diseases, rheumatic diseases, arthritis, connective tissue diseases, systemic sclerosis, interstitial lung disease

Affiliation:

Rheumatology Unità, University of Modena and Reggio Emilia, School of Medicine, Modena, Rheumatology Unità, University of Modena and Reggio Emilia, School of Medicine, Modena, Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Croton, Rheumatology Outpatient Clinic, ASP- Vibo Valentia-Tropea Hospital, Ospedale S. Raffaele, Milano, Clinical Immunology, University of Pisa, Pisa, Rheumatology Unità, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, University of Bologna, Rizzoli Orthopaedic Institute Bologna, Bologna, Rheumatology Unità,Department of Biotechnological & Applied Clinical Sciences,University of L'Aquila, L'Aquila, UOD Reumatologia- Grande Ospedale Metropolitano, Reggio Calabria, AOU Policlinico Vittorio Emanuele, Catania, Rheumatology, Sapienza-University of Rome, Roma, Rheumatology, University of Florence, Firenze, U.O.C. Medicina Interna "M.Valentini" P.O. Annunziata, Cosenza, Rheumatology, University of Padova, Padova, U.O.S. Reumatologia, Ospedale Castrovillari, Cosenza, Rheumatology Outpatient Clinic, San Giovanni di Dio Hospital, Crotone, U.O.T. Specialistica Ambulatoriale ASP 201, Cosenza, University of Campania, Luigi Vanvitelli, Napoli, Ospedale Policlinico S. Martino-University of Genova, Genova, Ospedale di Portoferraio, Livorno, Rheumatology Clinic, Department of Clinical & Molecular Sciences, Marche Polytechnic University, Ancona, ASO S. Croce e Carle, Cuneo, Rheumatology, University of Milano, Milano, Ospedale 'Villa Salus', Mestre, Rheumatology, Policlinico San Matteo, Pavia, Rheumatology, Spedali Civili di Brescia, Brescia, Rheumatology, University of Catania, Catania, AOR San Carlo di Potenza, Potenza, Humanitas Clinical and Research Center IRCCS, Milano, Rheumatology, Universit del Molise, Campobasso, Rheumatology Unità, Azienda Ospedaliero Universitaria Citt? della Salute e della Scienza, Torino, Rheumatology, University of Pisa, Pisa, Italy; 33UO Reumatologia ? DETO, Universit? di Bari, Bari, Rheumatology Unità, University of Modena and Reggio Emilia, School of Medicine, Modena, Rheumatology Unità, University of Modena and Reggio Emilia, School of Medicine, Modena, Ospedale S. Raffaele, Milano, Rheumatology, University of Florence, Firenze, Clinical Immunology, University of Pisa, Pisa, Clinical Immunology, University of Pisa, Pisa, University of Campania, Luigi Vanvitelli, Napoli, Rheumatology, Sapienza-University of Rome, Roma, Ospedale 'Villa Salus', Mestre, Humanitas Clinical and Research Center IRCCS, Milano, UOD Reumatologia- Grande Ospedale Metropolitano, Reggio Calabria, ASO S. Croce e Carle, Cuneo, Rheumatology, Policlinico San Matteo, Pavia, Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, U.O.S. Reumatologia, Ospedale Castrovillari, Cosenza, Ospedale S. Raffaele, Milano, University of Bologna, Rizzoli Orthopaedic Institute Bologna, Bologna, Rheumatology, Spedali Civili di Brescia, Brescia, Italy; 27 Rheumatology, University of Catania, Catania, Rheumatology, Spedali Civili di Brescia, Brescia, Italy; 27 Rheumatology, University of Catania, Catania, UO Reumatologia DETO, Università di Bari, Bari, University of Florence, Firenze, University of Florence, Firenze, University of Florence, Firenze, Department of Clinical and Experimental Medicine, University of Pisa, School of Medicine, Pisa, Department of Clinical and Experimental Medicine, University of Pisa, School of Medicine, Pisa, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, School of Medicine, Pisa, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, School of Medicine, Pisa, Department of Clinical and Experimental Medicine, University of Pisa, School of Medicine, Pisa, Rheumatology Unità,Department of Biotechnological & Applied Clinical Sciences,University of L'Aquila, L'Aquila, Unità Operativa di Immunoreumatologia - Area Medicina Clinica Policlinico Universitario Campus Bio-Medico di Roma, Roma, Unità Operativa di Immunoreumatologia - Area Medicina Clinica Policlinico Universitario Campus Bio-Medico di Roma, Roma, Rheumatology, University of Pisa, Pisa, Rheumatology, University of Catania, Catania, Rheumatology Unità, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Department of Clinical and Experimental Medicine, University of Pisa, School of Medicine, Pisa, Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, and Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Rheumatology, University of Florence, Firenze, AOR San Carlo di Potenza, Potenza, Rheumatology, University of Padova, Padova, Rheumatology, Spedali Civili di Brescia, Brescia, University of Bologna, Rizzoli Orthopaedic Institute Bologna, Bologna, UO Reumatologia DETO, Università di Bari, Bari, Unità Operativa di Immunoreumatologia - Area Medicina Clinica Policlinico Universitario Campus Bio-Medico di Roma, Roma, Department of Clinical Experimental Medicine, Interdepartmental Hepatology Center MASVE, University of Florence, Firenze, Department of Translational Research & New Technologies in Medicine and Surgery, University of Pisa, School of Medicine, Pisa, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, School of Medicine, Pisa



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