Covid-19 And Rheumatic Autoimmune Systemic Diseases: Role of Pre-Existing Lung Involvement and Ongoing Treatments
Authors: Ferri Clodoveo , Giuggioli Dilia , Raimondo Vincenzo , L’Andolina Massimo , Dagna Lorenzo , Tavoni Antonio , Caso Francesco , Ursini Francesco , Ruscitti Piero , Caminiti Maurizio , Foti Rosario , Riccieri Valeria , Guiducci Serena , Pellegrini Roberta , Zanatta Elisabetta , Varcasia Giuseppe , Olivo Domenico , Gigliotti Pietro , Cuomo Giovanna , Murdaca Giuseppe , Cecchetti Riccardo , De Angelis Rossella , Romeo Nicoletta , Ingegnoli Francesca , Cozzi Franco , Codullo Veronica , Cavazzana Ilaria , Colaci Michele , Abignano Giuseppina , De Santis Maria , Lubrano Ennio , Fusaro Enrico , Rossa Alessandra Della , Spinella Amelia , Lumetti Federica , De Luca Giacomo , Bellando-Randone Silvia , Visalli Elisa , Dal Bosco Ylenia , Amato Giorgio , Giannini Daiana , Bilia Silvia , Masini Francesco , Pellegrino Greta , Pigatto Erika , Generali Elena , Mariano Giuseppa Pagano , Pettiti Giorgio , Zanframundo Giovanni , Brittelli Raffaele , Aiello Vincenzo , Caminiti Rodolfo , Scorpiniti Daniela , Ferrari Tommaso , Campochiaro Corrado , Brusi Veronica , Fredi Micaela , Moschetti Liala , Cacciapaglia Fabio , Gragnani Laura , Monti Monica , Lorini Serena , Paparo Sabrina Rosaria , Ragusa Francesca , Mazzi Valeria , Elia Giusy , Ferrari Silvia Martina , Di Cola Ilenia , Vadacca Marta , Lorusso Sebastiano , Barsotti Simone , Aprile Maria Letizia , Marco Tasso , Miccoli Mario , Bosello Silvia , Matucci-Cerinic Marco , D'Angelo Salvatore , Doria Andrea , Franceschini Franco , Meliconi Riccardo , Iannone Florenzo , Giacomelli Roberto , Zignego Anna Linda , Fallahi Poupak , Antonelli Alessandro 
Published: September 2021

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:
This study aims 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.

Methods:
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 the 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 the absence of a swab testing).

Results:
A significantly higher prevalence of definite plus highly suspected Covid-19 compared to the 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 a 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.