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Epidemiology
Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry
  1. Anja Strangfeld1,
  2. Martin Schäfer1,
  3. Milena A Gianfrancesco2,
  4. Saskia Lawson-Tovey3,4,
  5. Jean W Liew5,
  6. Lotta Ljung6,7,
  7. Elsa F Mateus8,9,
  8. Christophe Richez10,
  9. Maria J Santos11,12,13,
  10. Gabriela Schmajuk2,
  11. Carlo A Scirè14,
  12. Emily Sirotich15,16,
  13. Jeffrey A Sparks17,
  14. Paul Sufka18,
  15. Thierry Thomas19,20,21,
  16. Laura Trupin2,
  17. Zachary S Wallace22,
  18. Sarah Al-Adely4,23,
  19. Javier Bachiller-Corral24,25,
  20. Suleman Bhana26,
  21. Patrice Cacoub27,28,29,
  22. Loreto Carmona30,
  23. Ruth Costello23,
  24. Wendy Costello31,
  25. Laure Gossec32,33,
  26. Rebecca Grainger34,
  27. Eric Hachulla35,
  28. Rebecca Hasseli36,
  29. Jonathan S Hausmann37,38,
  30. Kimme L Hyrich4,23,
  31. Zara Izadi2,
  32. Lindsay Jacobsohn2,
  33. Patricia Katz2,
  34. Lianne Kearsley-Fleet23,
  35. Philip C Robinson39,40,
  36. Jinoos Yazdany2,
  37. Pedro M Machado41,42,43
  38. COVID-19 Global Rheumatology Alliance
    1. 1 Epidemiology and Health Care Research, German Rheumatism Research Center (DRFZ Berlin), Berlin, Germany
    2. 2 Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA, USA
    3. 3 Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
    4. 4 National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
    5. 5 Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
    6. 6 Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
    7. 7 Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
    8. 8 Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal
    9. 9 European League Against Rheumatism (EULAR) Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Kilchberg, Switzerland
    10. 10 Club Rhumatismes et Inflammation (CRI) and Immune-Mediated Inflammatory Disease Alliance for Translational and Clinical Research Network (IMIDIATE), Bordeaux, France
    11. 11 Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal
    12. 12 Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisboa, Portugal
    13. 13 Rheumatic Diseases Portuguese Register (Reuma.pt), Portuguese Society of Rheumatology (SPR), Lisbon, Portugal
    14. 14 Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy and Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
    15. 15 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
    16. 16 Canadian Arthritis Patient Alliance, Toronto, ON, Canada
    17. 17 Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
    18. 18 Healthpartners, St. Paul, MN, USA
    19. 19 Société Française de Rhumatologie (SFR), Saint Etienne, France
    20. 20 Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
    21. 21 INSERM U1059, Université de Lyon-Université Jean Monnet, Saint-Etienne, France
    22. 22 Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
    23. 23 Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
    24. 24 Hospital Universitario Ramón y Cajal, Madrid, Spain
    25. 25 Instituto de investigación IRYCIS, Universidad de Alcalá, Madrid, Spain
    26. 26 Crystal Run Healthcare, Middletown, NY, USA
    27. 27 Département de Médecine Interne et Immunologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
    28. 28 Sorbonne Universités, UPMC Univ Paris 06, UMR 7211; Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France
    29. 29 Société Nationale Française de Médecine Interne (SNFMI), Paris, France
    30. 30 Instituto de Salud Musculoesquelética, Madrid, Spain
    31. 31 Irish Children's Arthritis Network (iCAN), Tipperary, Ireland
    32. 32 Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Université, Paris, France
    33. 33 AP-HP.Sorbonne Université, Rheumatology department, Pitié-Salpêtrière hospital, Paris, France
    34. 34 University of Otago, Wellington, New Zealand
    35. 35 Filière des maladies Auto-Immunes et Autoinflammatoires Rares (FAI2R), Lille University, France, Lille University, Lille, France
    36. 36 Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, ustus-Liebig-University Giessen, Giessen, Germany
    37. 37 Program in Rheumatology, Boston Children’s Hospital, Boston, MA, USA
    38. 38 Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
    39. 39 Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
    40. 40 Royal Brisbane & Women’s Hospital, Metro North Hospital & Health Service, Herston, Queensland, Australia
    41. 41 National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service (NHS) Trust, London, UK
    42. 42 Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS TrustLondon North West University Healthcare NHS Trust, London, UK
    43. 43 Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
    1. Correspondence to Dr Pedro M Machado, Centre for Rheumatology, UCL Division of Medicine, University College London, London WC1E 6JF, UK; p.machado{at}ucl.ac.uk

    Abstract

    Objectives To determine factors associated with COVID-19-related death in people with rheumatic diseases.

    Methods Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category.

    Results Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66–75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death.

    Conclusion Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.

    • antirheumatic agents
    • autoimmune diseases
    • epidemiology
    • glucocorticoids
    • outcome assessment
    • health care

    Data availability statement

    Data are available upon reasonable request. Applications to access the data should be made to the C19-GRA Steering Committee.

    https://creativecommons.org/licenses/by/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

    https://doi.org/10.1136/annrheumdis-2020-219498

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      Data availability statement

      Data are available upon reasonable request. Applications to access the data should be made to the C19-GRA Steering Committee.

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      • Supplementary Data

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      Footnotes

      • Handling editor Josef S Smolen

      • Twitter @rheum_cat, @rthritis, @emilysirotich, @zach_wallace_md, @carmona_loreto, @hausmannmd, @philipcrobinson, @pedrommcmachado

      • AS and MS contributed equally.

      • PCR, JY and PMM contributed equally.

      • Correction notice This article has been corrected since it published Online First. The collaborator names have been updated.

      • Collaborators COVID-19 Global Rheumatology Alliance Consortium: Brahim Dahou (Association Rhumatologues Algériens Privés; Algeria), Marcelo Pinheiro (Universidade Federal De São Paulo Escola Paulista de Medicina e Escola Paulista de Enfermagem; Brazil), Francinne M Ribeiro (Hospital Universitário Pedro Ernesto Universidade do Estado do Rio de Janeiro; Brazil), Anne-Marie Chassin-Trubert (Complejo Hospitalario San José; Chile), Sebastián Ibáñez (Clínica Alemana de Santiago, Chile), Lingli Dong (Tongji Hospital, China)

        Lui Cajas (Clinica Universitaria Colombia - Centro Medico Providencia Sanitas; Colombia), Hesham Hamoud (Al Azhar University Hospitals; Egypt), Jérôme Avouac (Rheumatology A Department, Cochin University Hospitals Paris-Centre, AP-HP; France), Véronique Belin (Department of Rheumatology, Hospital Center of Thonon-les-Bains; France), Raphaël Borie (Department of Pneumology, Bicha Hospital, AP-HP; France), Pascal Chazerain (Department of Rheumatology and Internal Medicine, Diaconesses Croix Saint Simon Hospital, Paris; France), Xavier Chevalier (Department of Rheumatology, Henri Mondor University Hospitals, AP-HP, Créteil; France), Pascal Claudepierre (Department of Rheumatology, Henri Mondor University Hospitals, AP-HP, Créteil; France), Gaëlle Clavel (Department of Internal Medicine, Rothschild Foundation, Paris; France), Marie-Eve Colette-Cedoz (Nord-Isère Rheumatology practice, Bourgoin-Jallieu; France), Bernard Combe (Department of Rheumatology, Lapeyronie University Hospital of Montpellier France), Elodie Constant (Department of Rheumatology, Hospital Center of Valence; France), Nathalie Costedoat-Chalumeau (Department of Internal Medicine, Cochin University Hospitals Paris-Centre, AP-HP; France), Marie Desmurs (Department of Rheumatology, Mulhouse-South Alsace hospital group; France), Valérie Devauchelle-Pensec (Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; France), Mathilde Devaux (Department of Internal Medicine, Intercommunal Hospital Center of Poissy-Saint Germain; France), Robin Dhote (Department of Internal Medicine, Avicenne University Hospital, AP-HP, Paris; France), Yannick Dieudonné (Department of Internal Medicine and Clinical Immunology, Strasbourg University Hospital; France), Fanny Domont (Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière Hospital, AP-HP; France), Pierre-Marie Duret (Department of Rheumatology, Colmar Civil Hospitals; France), Mikaël Ebbo (Department of Internal Medicine, La Timone Hospital, Aix-Marseille Univerity, AP-HM; France), Esther Ebstein (Department of Rheumatology, Bicha Hospital, AP-HP; France), Soumaya El Mahou (Department of Rheumatology and Internal Medicine, Hospital Center of Tourcoing; France), Bruno Fautrel (Department of Rheumatology, University Hospital Pitie Salpetriere, AP-HP, Paris; France), Renaud Felten (Department of Rheumatology, University Hospital of Strasbourg; France), René-Marc Flipo (Department of Rheumatology, University Hospital of Lille; France), Violaine Foltz (Department of Rheumatology, University Hospital Pitie Salpetriere, AP-HP; France), Antoine Froissart (Department of Internal Medicine, Intercommunal Hospital Center of Créteil; France), Joris Galland (Department of Internal Medicine, Lariboisière University Hospital, AP-HP, Paris; France), Véronique Gaud-Listrat (Rheumatology practice, Saint-Michel-sur-Orge; France), Sophie Georgin-Lavialle (Department of Internal Medicine, Tenon Hospital, AP-HP; France), Aude Giraud-Morelet (Val d'Ouest Clinical Medicine Center; France), Jeanine S Giraudet-Le Quitrec (Rheumatology A Department, Cochin University Hospitals Paris-Centre, AP-HP; France), Philippe Goupille (Department of Rheumatology, University Hospital of Tours; France), Sophie Govindaraju-Audouard (Rheumatology practice Les Haberges, Vesoul; France), Franck Grados (Department of Rheumatology, Amiens University Hospital; France), Séverine Guillaume-Czitrom (Department of Adolescent Medicine, University Hospital Paris-Sud, AP-HP, Le Kremlin-Bicêtre; France), Marion Hermet (Department of Internal Medicine, Hospital Center of Vichy; France), Ambre Hittinger-Roux (Department of Rheumatology, University Hospital of Reims; France), Christophe Hudry (Institute of Rheumatology Paris 8; France), Isabelle Kone-Paut (Department of Paediatric Rheumatology, University Hospital Paris-Sud, AP-HP, Le Kremlin-Bicêtre; France), Sylvain La Batide Alanore (Rheumatology practice, Paris; France), Pierre Lafforgue (Department of Rheumatology, Sainte-Marguerite Hospital, Aix-Marseille Univerity, AP-HM; France), Sophie Lahalle (Department of Rheumatology and Internal Medicine, Diaconesses Croix Saint Simon Hospital, Paris; France), Isabelle Lambrecht (Department of Rheumatology, Maison-Blanche Hospital, Reims University Hospitals; France), Vincent Langlois (Department of Infectious Diseases and Internal Medicine, Jacques Monod Hospital, Le Havre; France), Jean-Paul Larbre (Department of Rheumatology, Lyon-Sud Hospital, Hospices Civils Lyon; France), Emmanuel Ledoult (Department of Internal Medicine, Hospital Center of Tourcoing; France), Christophe Leroux (Department of Polyvalent Medicine, Dreux Hospital center; France), Frédéric Liote (Department of Rheumatology, Lariboisière University Hospital, AP-HP, Paris; France), Alexandre TJ Maria (Department of Internal Medicine and Multiorganic Diseases, Saint-Eloi University Hospital of Montpellier; France), Hubert Marotte (Department of Rheumatology, Saint-Etienne University Hospital; France), Arsène Mekinian (Department of Internal Medicine, Saint-Antoine Hospital, AP-HP, Paris; France), Isabelle Melki (Paediatric Hematology-Immunology and Rheumatology Department, Necker-Enfants-Malades University Hospital, AP-HP;France), Laurent Messer (Department of Rheumatology, Colmar Civil Hospitals; France), Catherine Michel (Department of Dermatology, Mulhouse-South Alsace hospital group; France), Gauthier Morel (Department of Rheumatology, Hospital Center of Valencienne; France), Jacques Morel (Department of Rheumatology, Lapeyronie University Hospital of Montpellier; France), Marie-Noelle Paris-Havard (Department of Rheumatology, Hospital Center of Argenteuil; France), Edouard Pertuiset (Department of Rheumatology, René Dubos Hospital Center, Pontoise; France), Thao Pham (Department of Rheumatology, Sainte-Marguerite Hospital, Aix-Marseille Univerity, AP-HM; France), Myriam Renard (Department of Rheumatology, Hospital Center of Aix-les-Bains, France), Sabine Revuz (Department of Internal Medicine and Clinical Immunology, Metz private Hospitals; France), Sébastien Rivière (Department of Internal Medicine and Inflammation-Immunopathology-Biotherapy,Saint-Antoine Hospital, AP-HP, Paris; France), Clémentine Rousselin (Department of Internal Medicine and Nephrology, Hospital Center of Valencienne; France), Christian Roux (Department of Rheumatology, Pasteur 2 University Hospital of Nice Sophia-Antipolis; France), Diane Rouzaud (Department of Internal Medicine, Bicha Hospital, AP-HP; France), Jérémie Sellam (Department of Rheumatology, Saint-Antoine Hospital, AP-HP, Paris; France), Raphaele Seror (Department of Rheumatology, University Hospitals Paris-Sud, AP-HP, Le Kremlin-Bicêtre; France), Amelie Servettaz (Department of Internal Medicine, University Hospital of Reims; France), Vincent Sobanski (Department of Internal Medicine and Clinical Immunology, University Hospital of Lille; France), Christelle Sordet (Department of Rheumatology, University Hospital of Strasbourg; France), Lionnel Spielmann (Department of Rheumatology, Colmar Civil Hospitals; France), Nathalie Tieulié (Department of Rheumatology, Pasteur 2 University Hospital of Nice Sophia-Antipolis; France), Alice Tison (Department of Rheumatology, University Hospital of Bordeaux; France), Sophie Trijau (Department of Rheumatology, Sainte-Marguerite Hospital, Aix-Marseille Univerity, AP-HM; France), Alexandre Virone (Department of Rheumatology, University Hospitals Paris-Sud, AP-HP, Le Kremlin-Bicêtre; France), Ursula Warzocha (Department of Internal Medicine, Avicenne University Hospital, AP-HP, Paris; France), Daniel Wendling (Department of Rheumatology, University Hospital of Besançon; France), Frederik N Albach (Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin,Berlin; Germany), Peer Aries (Rheumatology Struensee-Haus, Hamburg; Germany), Elvira Decker (Medical Care Center, Alsfeld; Germany), Urs Hartmann (Private Practice, Mainz; Germany), Joerg Henes (Department of Internal Medicine II, University of Tubingen; Germany), Bimba F Hoyer (University Hospital Schleswig-Holstein - Campus Kiel, Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I; Germany), Andreas Krause (Immanuel Hospital Berlin, Department of Rheumatology, Clinical Immunology and Osteology; Germany), Klaus Krüger (Private Practice, Munich; Germany), Hanns-Martin Lorenz (University of Heidelberg, Department of Rheumatology; Germany), Ulf Müller-Ladner (Campus Kerckhoff, Justus-Liebig-University Giessen, Department of Rheumatology and Clinical Immunology; Germany), Alexander Pfeil (Department of Internal Medicine III, University Hospital Jena; Germany), Anne Regierer (German Rheumatism Research Center Berlin; Germany), Jutta G Richter (Heinrich-Heine-University, Medical Faculty, Department of Rheumatology and Hiller Research Unit; Germany), Markus Rihl (Private Practice, Traunstein; Germany), Tim Schmeiser (Private Practice, Cologne; Germany), Hendrik Schulze-Koops (University of Munich, Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV; Germany), Christof Specker (KEM Kliniken Essen-Mitte, Department of Rheumatology and Clinical Immunology; Germany), Reinhard E Voll (University Medical Center Freiburg, Department of Rheumatology and Clinical Immunology; Germany), Stephanie Werner (RHIO, Dusseldorf; Germany), Gabriela MG Melgar (Hospital del Valle; Honduras), Mahdi Vojdanian (Iran Rheumatology Center; Iran), Laura Andreoli (UO di Reumatologia ed Immunologia Clinica, Spedali Civili di Brescia; Italy), Elena Bartoloni-Bocci (University of Perugia; Italy), Maurizio Benucci (Ospedale civile San Giovanni di Dio; Italy), Francesco Campanaro (ASST Sette Laghi, Varese; Italy), Marta Caprioli (Rheumatology, Humanitas Clinical and Research Center – IRCCS; Italy), Davide Carboni (Azienda ospedaliero-universitaria Careggi; Italy), Greta Carrara (Italian Society for Rheumatology; Italy), Edoardo Cipolletta (Università Politecnica delle Marche; Italy), Chiara Crotti (ASST Gaetano Pini; Italy), Gloria Dallagiacoma (Ospedale di Brunico; Italy), Paola Faggioli (ASST ovest milanese legnano; Italy), Rosario Foti (Policlinico-Vitt.Emanuele; Policinico San Marco; Italy), Franco Franceschini (UO di Reumatologia ed Immunologia Clinica, Spedali Civili di Brescia Italy), Micaela Fredi (UO di Reumatologia ed Immunologia Clinica, Spedali Civili di Brescia; Italy), Giacomo Guidelli (Rheumatology, Humanitas Clinical and Research Center – IRCCS; Italy), Florenzo Iannone (University of Bari; Italy), Gianpiero Landolfi (Italian Society for Rheumatology; Italy), Caludia Lomater (Azienda Ospedaliera Ordine Mauriziano di Torino; Italy), Ceciclia Nalli (UO di Reumatologia ed Immunologia Clinica, Spedali Civili di Brescia; Italy), Simone Parisi (AOU Città della Salute e della Scienza; Italy), Luca Quartuccio (Università degli Studi di Udine; Italy), Bernd Raffeiner (Ospedale di Bolzano; Italy), Rossella Reggia (Ospedale Maggiore di Cremona; Italy), Marta Riva (Ospedale San Gerardo di Monza; Italy), Nicoletta Romeo (Azienda Ospedaliera Santa Croce e Carle di Cuneo; Italy), Cinzia Rotondo (Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Foggia; Italy), Ettore Silvagni (University of Ferrara; Italy), Luigi Sinigaglia (Italian Society for Rheumatology; Italy), Ilaria Tinazzi (Ospedale Sacro Cuore don Calabria di Negrar a Verona; Italy), Anna Zanetti (Italian Society for Rheumatology; Italy), Giovanni Zanframundo (Fondazione IRCCS Policlinico San Matteo di Pavia; Italy), Fatemah Abutiban (Kuwait Rheumatology Association; Kuwait), Deshiré Alpízar-Rodríguez (Mexican College of Rheumatology; Mexico), Marina Rull-Gabayet (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico), Fedra Irazoque (Private Practice; Mexico), Xochitl Jimenez (Centro Medico Naval; Mexico), Eduardo Martín-Nares (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico), Angel Castillo-Ortiz (Centro Medico Las Americas; Mexico), Tatiana S Rodriguez-Reyna (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico), Diana C Rosete (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico), Erick A Zamora-Tehozol (Centro Medico Pensiones; Mexico), David Vega-Morales (Hospital General de Zona #17; Mexico), Beatriz Elena Zaueta-Montiel (Centro Medico del Angel; Mexico), Rebecca Grainger (University of Otago, Wellington; New Zealand), Nasra Al-Adhoubi (Royal Hospital; Oman), Babur Salim (Fauji Foundation Hospital; Pakistan), Enrique Giraldo (Complejo Hospitalario; Panama), Ariel Salinas (Hospital Essalud Alberto Sabogal Sologuren; Peru), Manuel Ugarte-Gil (Universidad Científica del Sur-Hospital Guillermo Almenara Irigoyen; Peru), Diogo Almeida (Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima; Portugal), Miguel Bernardes (Rheumatology Department, Centro Hopitalar São João, Porto; Portugal), Rita C Machado (Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Centre, Lisboa; Portugal), Maria Rato (Rheumatology Department, Centro Hopitalar São João, Porto; Portugal), Samar Al-Emadi (Hamad Medical Corporation; Qatar), Richard Conway (St. James's Hospital; Republic of Ireland), Rachael Flood (Tallaght University Hospital; Republic of Ireland), Juan J Alegre-Sancho (Hospital Universitari Dr Peset; Spain), Montserrat C Coro (complejo asistencial de Ávila; Spain), Natalia de la Torre-Rubio (Hospital Universitario Puerta de Hierro Majadahonda; Spain), Jose C Esteban (Hospital Universitario Puerta de Hierro; Spain), Maria del Carmen T Martin (HOSPITAL NUESTRA SEÑORA SONSOLES; Spain), Jose G Puerta (Hospital Clinic; Spain), Johan Back (Uppsala University Hospital, Uppsala; Sweden),Maryam Dastmalchi (Karolinska University Hospital, Stockholm; Sweden),Brigitte Dupré (Academic Specialist Center, Stockholm; Sweden),Emma Grenholm (Falu Lasarett, Region Dalarna, Falun; Sweden),Aase Hensvold (Academic Specialist Center, Stockholm; Sweden),Ann Knight (Uppsala University Hospital, Uppsala; Sweden),Servet Akar (Izmir Katip Celebi University Atatürk Training and Research Hospital; Turkey),Ozan C Icacan (Bakırköy Dr.Sadi Konuk Research and Training Hospital; Turkey),Laura Chadwick (St Helens & Knowsley NHS Trust; UK),Kirsty Devine (York Hospital; UK),Sasha Dunt (Countess of Chester NHS Foundation Trust; UK),Lucia Fusi (King's College Hospital; UK), Caroline M Jones (Llandudno Hospital; UK), Elizabeth Macphie (Lancashire and South Cumbria NHS Foundation Trust; UK), Elena Nikiphorou (King's College Hospital; UK), Diana O'Kane (Royal National Hospital For Rheumatic Diseases at Royal United Hospital; UK), Sheila O'Reilly (Royal Derby Hospital; UK), Samir Patel (Queen Elizabeth hospital; UK), Rosaria Salerno (King's College Hospital; UK), Lucy Thornton (Bradford Royal Infirmary; UK),Jenny Tyler (Royal United Hospital, Bath; UK), Claire Vandevelde (Leeds Teaching Hospitals Trust; UK), Elizabeth Warner (Lister Hospital; UK), Su-Ann Yeoh (University College London Hospitals NHS Foundation Trust; UK), Sara Baig (Arthritis and Rheumatology Consultants, PA; USA), Hammad Bajwa (Arthritis and Rheumatology Consultants, PA; USA), Byung Ban (Medstar Georgetown University Hospital; USA), Vernon Berglund (Arthritis and Rheumatology Consultants, PA; USA), Cassandra Calabrese (Cleveland Clinic; USA), Kristin D'Silva (Brigham and Women's Hospital; USA), Angela Dahle (Arthritis and Rheumatology Consultants, PA; USA), Kathryn Dao (UT Southwestern Medical Center; USA), Nicole Daver (Institute of Rheumatic and Autoimmune Diseases; USA), William Davis (Ochsner Medical Center Rheumatology Department; USA), Walter Dorman (Arthritis and Rheumatology Consultants, PA; USA), Ezzati Fatemeh (UT Southwestern Medical Center; USA), Theodore Fields (Hospital for Special Surgery; USA), Jody Hargrove (Arthritis and Rheumatology Consultants, PA; USA), Melissa Harvey (Institute of Rheumatic and Autoimmune Diseases; USA), Maren Hilton (Arthritis and Rheumatology Consultants, PA; USA), Tiffany Hsu (Brigham and Women's Hospital; USA), Zara Izadi (University of California, San Francisco, CA; USA), Arundathi Jayatilleke (Temple University Hospital; USA), David Karp (UT Southwestern Medical Center; USA), Gilbert Kepecs (Private Practice; USA), Neil Kramer (Institute of Rheumatic and Autoimmune Diseases; USA), Concetta Lamore (Institute of Rheumatic and Autoimmune Diseases; USA), Nicholas Lebedoff (Arthritis and Rheumatology Consultants, PA; USA), Susan Leonard (Arthritis and Rheumatology Consultants, PA;USA), Sushama Mody (Riverside Medical Group; USA), Jennifer Morgan (Arthritis and Rheumatology Consultants, PA; USA), Emily Pfeifer (Arthritis and Rheumatology Consultants, PA; USA), Guillermo Quiceno (UT Southwestern Medical Center; USA), Robert Quinet (Ochsner Medical Center Rheumatology Department; USA), Elliot Rosenstein (Institute of Rheumatic and Autoimmune Diseases; USA), Eric Ruderman (Northwestern Memorial; USA), Evangeline Scopelitis (Ochsner Medical Center Rheumatology Department; USA), Naomi Serling-Boyd (Brigham and Women's Hospital; USA), Faizah Siddique (Loyola University Medical Center; USA), Archibald Skemp (Arthritis and Rheumatology Consultants, PA; USA), Derrick Todd (Brigham and Women's Hospital; USA), Karen T Toribio (Ochsner Medical Center Rheumatology Department; USA), Rachel Wallwork (Brigham and Women's Hospital; USA), Tameka Webb-Detiege (Ochsner Medical Center Rheumatology Department; USA), Douglas White (Gundersen Health System; USA), Jeffrey Wilson (Arthritis and Rheumatology Consultants, PA; USA), Melanie Winter (Gundersen Health System; USA), Leanna Wise (Los Angeles County + USC Medical Center; USA), Anne Wolff (Arthritis and Rheumatology Consultants, PA; USA), Kristen Young (UT Southwestern Medical Center; USA), Jerald Zakem (Ochsner Medical Center Rheumatology Department; USA), JoAnn Zell (University of Colorado; USA), Kurt Zimmerman (Arthritis and Rheumatology Consultants, PA; USA).

      • Contributors AS, MS and PMM had access to the study data, developed the figures and tables, and vouch for the data and analyses. MS performed the statistical analyses and contributed to data quality control, data analysis and interpretation of the data. AS, MG, SL-T, JL, LL, CR, MJS, GS, CAS, SA-A, JB-C, LC, RC, LG, EH, RH, KLH, ZI, PK and LK-F, contributed to data collection, data quality control, data analysis and interpretation of the data. EFM, JS, ES, PS, LT, ZSW, SB, WC, RG, JH and LJ contributed to data collection, data analysis and interpretation of the data. PCR, JY and PMM, directed the work, designed the data collection methods, contributed to data collection, data analysis and interpretation of the data, and had final responsibility for the decision to submit for publication. All authors contributed intellectual content during the drafting and revision of the work and approved the final version to be published.

      • Funding Financial support from the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR).

      • Disclaimer The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance and do not necessarily represent the views of the American College of Rheumatology (ACR), the European League Against Rheumatism (EULAR), the (UK) National Health Service (NHS), the National Institute for Health Research (NIHR), or the (UK) Department of Health, or any other organisation.

      • Competing interests AS reports personal fees from lectures for AbbVie, MSD, Roche, BMS and Pfizer, all outside the submitted work. MG reports grants from National Institutes of Health, NIAMS, outside the submitted work. JL reports a research grant from Pfizer, outside of the submitted work. EFM reports that LPCDR received support for specific activities: grants from Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern and GAfPA; grants and non-financial support from Pfizer; non-financial support from Grünenthal GmbH, outside the submitted work. CR has received consulting/speaker’s fees from Abbvie, Amgen, AstraZeneca, BMS, Biogen, Eli Lilly, Glenmark, GSK, MSD, Mylan and Pfizer, and grants from Biogen, Lilly and Nordic Pharma, all unrelated to this manuscript. MJS is supported by unrestricted grants from AbbVie, Biogen, Gilead, Lilly, MSD, Novartis and Pfizer. Her work is supported by grants from the National Institutes of Health and Agency for Healthcare Research and Quality. She leads the Data Analytic Center for the American College of Rheumatology, which is unrelated to this work. ES reports non-financial support from Canadian Arthritis Patient Alliance, outside the submitted work. JS is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K23 AR069688, R03 AR075886, L30 AR066953, P30 AR070253 and P30 AR072577), the Rheumatology Research Foundation (R Bridge Award), the Brigham Research Institute, and the R. Bruce and Joan M. Mickey Research Scholar Fund. He has received research support from Amgen and Bristol-Myers Squibb and performed consultancy for Bristol-Myers Squibb, Gilead, Inova Diagnostics, Janssen, Optum and Pfizer unrelated to this work. PS reports personal fees from American College of Rheumatology/Wiley Publishing, outside the submitted work. TT reports personal fees for lectures and expertises from Amgen, Arrow, Biogen, BMS, Chugai, Expanscience, Gilead, Grunenthal, LCA, Lilly, Medac, MSD, Nordic, Novartis, Pfizer, Sandoz, Sanofi, Theramex, Thuasne, TEVA and UCB, and reports financial support or fees for research activities from Amgen, Bone Therapeutics, Chugai, MSD, Novartis, Pfizer and UCB, all unrelated to this manuscript. ZSW reports grant support from Bristol-Myers Squibb and consulting fees from Viela Bio. JB-C has received consulting/speaker’s fees from Abbvie, MSD, BMS and Roche, and grants from Pfizer, all unrelated to this manuscript. He reports non-branded marketing campaigns for Novartis. PC has received consulting and lecturing fees from Abbvie, AstraZeneca, Bristol-Myers Squibb, Gilead, Glaxo Smith Kline, Innotech, Janssen, Merck Sharp Dohme, Roche, Servier and Vifor. LC has not received fees or personal grants from any laboratory, but her institute works by contract for laboratories among other institutions, such as Abbvie Spain, Eisai, Gebro Pharma, Merck Sharp & Dohme España, S.A., Novartis Farmaceutica, Pfizer, Roche Farma, Sanofi Aventis, Astellas Pharma, Actelion Pharmaceuticals España, Grünenthal GmbH and UCB Pharma. LG reports personal consultant fees from AbbVie, Amgen, BMS, Biogen, Celgene, Gilead, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis and UCB, and grants from Amgen, Lilly, Janssen, Pfizer, Sandoz, Sanofi and Galapagos, all unrelated to this manuscript. RG reports non-financial support from Pfizer Australia, personal fees from Pfizer Australia, personal fees from Cornerstones, personal fees from Janssen New Zealand, non-financial support from Janssen Australia, personal fees from Novartis, outside the submitted work. EH reports personal consultant fees from Actelion, Sanofi-Genzyme and GSK, and grants from GSK, all unrelated to this manuscript. RH reports research grant from Pfizer and personal fees from AbbVie, Pfizer, Novartis, Amgen, Mylan, Gilead, Medac and Takeda, all outside the submitted work. JH reports grants from Rheumatology Research Foundation, grants from Childhood Arthritis and Rheumatology Research Alliance (CARRA), personal fees from Novartis, outside the submitted work. KLH reports she has received non-personal speaker’s fees from Abbvie and grant income from BMS, UCB and Pfizer, all unrelated to this manuscript. KLH is supported by the NIHR Manchester Biomedical Research Centre. PCR reports personal fees from Abbvie, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Roche and UCB, non-financial support from BMS, research funding from Janssen, Novartis, Pfizer and UCB, all outside the submitted work. JY reports consulting fees from AstraZeneca and Eli Lilly, and grants from Pfizer, outside the submitted work. PMM has received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript, and is supported by the National Institute for Health Research (NIHR), University College London Hospitals (UCLH) and Biomedical Research Centre (BRC).

      • Provenance and peer review Not commissioned; externally peer reviewed.

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