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.