1 Introduction
The pandemic of novel coronavirus disease 2019(COVID-19) caused by the
emerging severe acute respiratory syndrome coronavirus 2(sars-cov-2) has
become a global health crisis(WHO, 2020b), leading to a large number of
infections and deaths1. By March 20, 2023, over 608
million confirmed cases, including 6.50 million deaths, were
reported2. Patients with autoimmune rheumatic
diseases(ARD) are frequently treated with immunosuppressive drugs, which
raises concern for infectious complications, placing patients and
physicians at a crossroads concerning the continuation or cessation of
these disease-modifying therapies.
Nowadays, more attention has been paid to the impact of
disease-modifying antirheumatic drugs(DMARDs) on the prevalence of
COVID-19 and clinical outcomes in ARD patients. Some studies reported
fewer patients on low-or-medium-dose glucocorticoid(GC) therapy had
severe COVID-19 conditions compared to those without GC before the
COVID‐19 diagnosis3. Other studies found the use of
systemic glucocorticoids(sGC)(> 5 mg/day of prednisone) was
significantly associated with hospital admission caused by sars-cov-2
infection4. In some registry studies, patients with
baseline TNF inhibitor therapy had lower odds of severe COVID-19
outcomes5-7. Still, the risk of infection observed in
rheumatoid arthritis(RA) patients treated with biologic DMARDs(bDMARDs),
including TNF inhibitor therapy, was generally considered slightly
higher(from 1.5- up to 2-fold) compared with conventional synthetic
DMARDs(csDMARDs)8. Each
study or registry has a limited
sample size, and the analysis is not comprehensive. Therefore, there is
a need to integrate findings across studies to better understand the
risk of COVID-19 in patients with ARD.
This study aimed to determine the prevalence of COVID-19 in ARD patients
and investigate the effect of anti-rheumatic therapy on the clinical
outcome of ARD patients with COVID-19 to guide clinical treatment
better.