Clinical characteristics associated with hospitalization and mortality of coronavirus disease-2019 (COVID-19) infection in rheumatic patients: a cross-sectional study from Iran

This study was designed to describe COVID-19 infection in rheumatic patients and to investigate possible risk factors for hospital admission and death related to COVID-19 infection considering the type of rheumatic disease and medications used to treat it. In this observational cross-sectional study, patients under follow-up in Kermanshah rheumatology units were investigated in a 6-month period between February 18 and August 22, 2020. Confirmed COVID-19 cases were collected. The following data were obtained: age, sex, rheumatic disease diagnosis, rheumatic disease medication (glucocorticoids, csDMARDs, ts/bDMARDs). Rheumatic patients were divided into two groups of hospitalized and non-hospitalized. The data from the two groups were compared. In total, 221 patients were enrolled in this study. Of these, 38 patients (17.19%) were hospitalized, and 9 patients (4.07%) died. No significant difference was observed between hospitalized and non-hospitalized patients except for vasculitis and prior use of Janus kinase inhibitors (Tofacitinib). A greater rate of hospitalized patients had vasculitis (6 (15.79%) vs. 1 (0.55%), p < 0.0001 ). A greater rate of them were on Tofacitinib therapy (2 (1.09%) vs. 0, p value = 0.03). A greater rate of patients who died used Tofacitinib (2 (22.22%) vs. 0, p value = 0.001) and Mycophenolate Mofetil (4 (44.44%) vs. 23 (10.85%), p value = 0.014). Hospitalization and mortality rates in rheumatic patients are comparable to the general population. A higher risk for hospitalization was observed only in vasculitis patients and users of Tofacitinib, and a higher risk for mortality was seen only in users of Mycophenolate Mofetil and Tofacitinib, though this finding should be interpreted with caution due to the small size of these subgroups. In conclusion, most rheumatic patients do not seem to be at higher risk for severe COVID-19.