Document Type : RESEARCH PAPER
Rheumatic Diseases Research Center (RDRC), Mashhad Universality of Medical Sciences, Mashhad, Iran
Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Despite the effectiveness of using
combined conventional and biological disease-modifying anti-rheumatic drugs(bDMARDs) in managing rheumatic
diseases, there have been concerns that taking biological agents may have an additive effect on getting infected with
COVID-19. This study evaluates the impact of taking biological agents on altering the chance of getting infected with
SARS-CoV-2 in rheumatoloid and lupus patients compared to traditional DMARDs.
Methods: We carried out a cross-sectional survey study from February 2020 to January 2021 on patients diagnosed
with lupus and rheumatid arthritis. COVID-19 infection was confirmed by the presence of symptoms and signs of the disease
and para-clinical findings such as lymphopenia and elevated C-reactive protein (CRP) and positive chest CT scan
or polymerase chain reaction (PCR) of COVID-19.
Results: Out of 591 patients included in this study, 422 (71.4%) had rheumatoid arthritis (RA), and 169 (28.6%) had
systemic lupus erythematosus (SLE). Among them, 56 (9.5%) cases were diagnosed with COVID-19 infection. No
association was found between age, gender, or type of rheumatological diseases and SARS-CoV-2. There was a
significant association between COVID-19 infection and treatment with biological drugs (P-value<0.05) regardless of
the type of rheumatologic disease. Interestingly, the analysis revealed that the type of biologic drug also altered the
chance of COVID-19 infection; In fact, patients who took TNF inhibitors were significantly at a higher risk of disease
than those taking Rituximab (P-value=0.000). Identical results were observed among RA patients (P-value<0.001),
however, all 5 (3%) lupus cases treated with Rituximab infected with covid 19.
Conclusion: This study develops a better understanding of the risk of immunosuppressive medications for SARSCoV-
2 infection. Patients treated with conventional and biological medicine had a higher disease risk than those taking
exclusively conventional drugs. However, more studies are required to deliberate the relation of the reviewed factors
with the severity of COVID-19.
Level of evidence: II