OBJECTIVE: The outcome of patients with COVID-19 improved over the pandemic, including patients with systemic rheumatic diseases. However, data on patients with systemic sclerosis (SSc) are lacking. This study aimed to assess the outcome of patients with both SSc and COVID-19 over several waves. METHODS: Patients with both SSc and COVID-19 who were registered in the European Scleroderma Trials and Research group (EUSTAR) were collected between April 2020 and April 2021. Patients were assigned to waves 1, 2, or 3 depending on the date of their COVID-19 diagnosis. Primary endpoints were death, intensive care unit stay, or ventilatory support (severe outcome). Subgroup analyses of patients who were hospitalized or died were conducted. General and SSc-specific characteristics and treatment were compared over the waves. Descriptive statistics and multivariate logistic regression were applied. RESULTS: A total of 333 patients were included; 57 patients (17%) had a severe outcome, and 30 patients (9%) died. Compared to wave 1, significantly fewer patients with SSc suffered from severe COVID-19 in waves 2 and 3 (28.2% vs 9.8% and 12.7%; P < 0.001), fewer patients required hospitalization (46.7% vs 19.6% and 25.5%; P < 0.001) or ventilatory support (24.0% vs 8.7% and 10.9%; P = 0.001), and fewer patients died (15.7% vs 5.0% and 7.5%; P = 0.011). Patients were significantly younger, more often men, had less frequent arterial hypertension, and less SSc cardiac involvement over waves 1 to 3. Patients received significantly less medium to high doses of corticosteroids as they did SSc treatment. CONCLUSION: The outcome of patients with both SSc and COVID-19 improved significantly over time because of intrinsic and extrinsic factors.

1st Medical School Charles University Praha Czech Republic

A O U Policlinico S Marco Catania Catania Italy

ASST G Pini CTO University of Milan Milan Italy

ASST Grande Ospedale Metropolitano Niguarda Milano Italy

ASST Spedali Civili of Brescia University of Brescia Italy

Azienda Ospedaliero Universitaria di Cagliari Cagliari Italy

B Shine Rheumatology Institute and Technion Haifa Israel

Centre de Référence des Maladies Autoimmunes Systémiques Rares Est Sud Ouest Nouvel Hôpital Civil Strasbourg France

Centre for Interdisciplinary Clinical Immunology Rheumatology and Auto inflammatory Diseases University Hospital Tuebingen Tuebingen Germany

Centre National de Référence des Maladies Auto immunes et Systémiques Rares Est Sud Ouest Strasbourg France

Centro Hospital e Universitário de Coimbra University of Coimbra Portugal

Centro Hospitalar Universitário Lisboa Central Lisboa Portugal

Cochin Hospital Université de Paris Paris France

e Octubre University Hospital Madrid Spain

Firoozgar Hospital Tehran Iran

Ghent University Ghent University Hospital and VIB Inflammation Research Center Ghent Belgium

Hôpital Saint Antoine Paris France

Hospital Universitari de la Santa Creu 1 Sant Pau Barcelona Spain

Hospital Universitari Mútua de Terrassa Barcelona Catalonia Spain

Hospital Universitario Dr Peset Comunitat Valenciana Spain

Hospital Universitario Vall d'Hebron Barcelona Spain

IRCCS Humanitas Research Hospital Rozzano Milan Italy and Humanitas University Pieve Emanuele Milan Italy

IRCCS Policlinico S Matteo University Hospital Pavia Italy

IRCCS San Raffaele Hospital Milan Italy

Istanbul University Istanbul Turkey

Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Biomedical Research Centre University of Leeds Leeds UK

Leiden University Medical Center Leiden The Netherlands

National and Kapodistrian University of Athens Medical School Athens Greece

Nippon Medical School Tokyo Japan

Oslo University Hospital Oslo Norway

Pomeranian Medical University in Szczecin Szczecin Poland

Radboud University Medical Center Nijmegen The Netherlands

Royal Free and University College London Medical School London UK

Sapienza University of Rome Rome Italy

Sechenov 1st Moscow State Medical University Moscow Russian Federation

Thomas Jefferson University Philadelphia Pennsylvania

Universidade Federal de Pelotas Pelotas Brazil

Università Politecnica delle Marche Polo Didattico University of Ancona Ancona Italy

Universitätsspital Basel Basel Switzerland

Université de Bordeaux Bordeaux Aquitaine France

University Clinic Schleswig Holstein Lübeck University of Lübeck Lübeck Germany

University Hospital Zurich University of Zurich Zurich Switzerland

University Hospital Zurich University of Zurich Zurich Switzerland and Oslo University Hospital Oslo Norway

University Hospital Zurich University of Zurich Zurich Switzerland and University of Padova Padova Italy

University Medical Center Utrecht Utrecht The Netherlands

University of Bari Aldo Moro Bari Italy

University of California Los Angeles

University of Debrecen Debrecen Hungary

University of Florence Florence Italy and IRCCS San Raffaele Hospital Milan Italy

University of Genova and IRCCS Ospedale Policlinico San Martino Genova Italy

University of Genova Genova Italy

University of Marmara Istanbul Turkey

University of Medicine and Pharmacy Iuliu Hatieganu Cluj Cluj Napoca Romania

University of Messina Messina Italy

University of Padova Padova Italy

University of Verona Verona Italy

VA Nasonova Research Institute of Rheumatology Moscow Russian Federation

Zobrazit více v PubMed

Hoffmann-Vold AM, Distler O, Bruni C, et al. Systemic sclerosis in the time of COVID-19 [review]. Lancet Rheumatol 2022;4:e566-e575.

World Health Organization. Weekly epidemiological update on COVID-19 - 30 November 2022 (Edition 120). November 30, 2022. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---30-november-2022

Conway Morris A, Tong A. Novel treatments and trials in COVID-19. COVID-19 Pandemic 2022;109-120.

Kolifarhood G, Aghaali M, Mozafar Saadati H, et al. Epidemiological and clinical aspects of COVID-19; a narrative review. Arch Acad Emerg Med 2020;8:e41.

Booth A, Reed AB, Ponzo S, et al. Population risk factors for severe disease and mortality in COVID-19: a global systematic review and meta-analysis. PLoS One 2021;16:e0247461.

Bechman K, Yates M, Mann K, et al. Inpatient COVID-19 mortality has reduced over time: results from an observational cohort. PLoS One 2022;17:e0261142.

Jorge A, D'Silva KM, Cohen A, et al. Temporal trends in severe COVID-19 outcomes in patients with rheumatic disease: a cohort study. Lancet Rheumatol 2021;3:e131-e137.

Kawano Y, Patel NJ, Wang X, et al. Temporal trends in COVID-19 outcomes among patients with systemic autoimmune rheumatic diseases: from the first wave through the initial Omicron wave. Ann Rheum Dis 2022;81:1742-1749.

Denton CP, Khanna D. Systemic sclerosis. 2017;390:1685-1699.

Elhai M, Meune C, Boubaya M, et al. Mapping and predicting mortality from systemic sclerosis. Ann Rheum Dis 2017;76:1897-1905.

Allanore Y, Simms R, Distler O, et al. Systemic sclerosis. Nat Rev Dis Primers 2015;1:15002.

Tyndall AJ, Bannert B, Vonk M, et al. Causes and risk factors for death in systemic sclerosis: a study from the EULAR scleroderma trials and research (EUSTAR) database. Ann Rheum Dis 2010;69:1809-1815.

Hoffmann-Vold AM, Brunborg C, Tirelli F, et al. POS0054 the impact and outcome of COVID-19 on systemic sclerosis patients from the European scleroderma trial and research group (EUSTAR). Ann Rheum Dis 2021;80 Suppl 1:232-233.

Avouac J, Airo P, Carlier N, et al. Severe COVID-19-associated pneumonia in 3 patients with systemic sclerosis treated with rituximab. Ann Rheum Dis 2021;80:e37.

Bournia VK, Fragoulis GE, Mitrou P, et al. Different COVID-19 outcomes among systemic rheumatic diseases: a nation-wide cohort study. Rheumatology (Oxford) 2023;62:1047-1056.

Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020;584:430-436.

Shi C, Wang L, Ye J, et al. Predictors of mortality in patients with coronavirus disease 2019: a systematic review and meta-analysis. BMC Infect Dis 2021;21:663.

Kroon FPB, Najm A, Alunno A, et al. Risk and prognosis of SARS-CoV-2 infection and vaccination against SARS-CoV-2 in rheumatic and musculoskeletal diseases: a systematic literature review to inform EULAR recommendations. Ann Rheum Dis 2022;81:422-432.

Strangfeld A, Schäfer M, Gianfrancesco MA, et al. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2021;80:930-942.

Landewe RBM, Kroon FPB, Alunno A, et al. EULAR recommendations for the management and vaccination of people with rheumatic and musculoskeletal diseases in the context of SARS-CoV-2: the November 2021 update. Ann Rheum Dis 2022;81:1628-1639.

Alunno A, Najm A, Mariette X, et al. Immunomodulatory therapies for the treatment of SARS-CoV-2 infection: an update of the systematic literature review to inform EULAR points to consider. RMD Open 2021;7:e001899.

Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis 2020;20:533-534.

Serling-Boyd N, D'Silva KM, Hsu TY, et al. Coronavirus disease 2019 outcomes among patients with rheumatic diseases 6 months into the pandemic. Ann Rheum Dis 2021;80:660-666.

Conway R, Grimshaw AA, Konig MF, et al. SARS-CoV-2 infection and COVID-19 outcomes in rheumatic diseases: a systematic literature review and meta-analysis. Arthritis Rheumatol 2022;74:766-775.

Dorjee K, Kim H, Bonomo E, Dolma R. Prevalence and predictors of death and severe disease in patients hospitalized due to COVID-19: a comprehensive systematic review and meta-analysis of 77 studies and 38,000 patients. PLoS One 2020;15:e0243191.

Bruni C, Ross L. Cardiac involvement in systemic sclerosis: getting to the heart of the matter. Best Pract Res Clin Rheumatol 2021;35:101668.