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Older age, comorbidity, glucocorticoid use and disease activity are risk factors for COVID-19 hospitalisation in patients with inflammatory rheumatic and musculoskeletal diseases
  1. Rebecca Hasseli1,
  2. Ulf Mueller-Ladner1,
  3. Bimba F Hoyer2,
  4. Andreas Krause3,
  5. Hanns-Martin Lorenz4,
  6. Alexander Pfeil5,
  7. Jutta Richter6,
  8. Martin Schäfer7,
  9. Tim Schmeiser8,
  10. Anja Strangfeld7,
  11. Hendrik Schulze-Koops9,
  12. Reinhard E Voll10,
  13. Christof Specker11 and
  14. Anne Constanze Regierer7
  1. 1Department of Rheumatology and Clinical Immunology, Campus Kerkhoff, Justus-Liebig-University, Giessen, Giessen, Germany
  2. 2Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University of Schleswig-Holstein at Kiel, Kiel, Germany
  3. 3Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital, Berlin, Germany
  4. 4Department of Rheumatology, University Hospital, Heidelberg, Germany
  5. 5Department of Internal Medicine III, Universitatsklinikum Jena, Jena, Germany
  6. 6Department of Rheumatology and Hiller Research Unit, Medical Faculty, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
  7. 7Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
  8. 8Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
  9. 9Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
  10. 10Dep. of Rheumatology and Clinical Immunology, University of Freiburg Faculty of Medicine, Freiburg, Germany
  11. 11Department of Rheumatology and Clinical Immunology, Kliniken Essen-Mitte, Essen, Germany
  1. Correspondence to Dr Anne Constanze Regierer; Anne.Regierer{at}


Introduction Whether patients with inflammatory rheumatic and musculoskeletal diseases (RMD) are at higher risk to develop severe courses of COVID-19 has not been fully elucidated. Aim of this analysis was to describe patients with RMD according to their COVID-19 severity and to identify risk factors for hospitalisation.

Methods Patients with RMD with PCR confirmed SARS-CoV-2 infection reported to the German COVID-19 registry from 30 March to 1 November 2020 were evaluated. Multivariable logistic regression was used to estimate ORs for hospitalisation due to COVID-19.

Results Data from 468 patients with RMD with SARS-CoV-2 infection were reported. Most frequent diagnosis was rheumatoid arthritis, RA (48%). 29% of the patients were hospitalised, 5.5% needed ventilation. 19 patients died. Multivariable analysis showed that age >65 years (OR 2.24; 95% CI 1.12 to 4.47), but even more>75 years (OR 3.94; 95% CI 1.86 to 8.32), cardiovascular disease (CVD; OR 3.36; 95% CI 1.5 to 7.55), interstitial lung disease/chronic obstructive pulmonary disease (ILD/COPD) (OR 2.79; 95% CI 1.2 to 6.49), chronic kidney disease (OR 2.96; 95% CI 1.16 to 7.5), moderate/high RMD disease activity (OR 1.96; 95% CI 1.02 to 3.76) and treatment with glucocorticoids (GCs) in dosages >5 mg/day (OR 3.67; 95% CI 1.49 to 9.05) were associated with higher odds of hospitalisation. Spondyloarthritis patients showed a smaller risk of hospitalisation compared with RA (OR 0.46; 95% CI 0.23 to 0.91).

Conclusion Age was a major risk factor for hospitalisation as well as comorbidities such as CVD, ILD/COPD, chronic kidney disease and current or prior treatment with GCs. Moderate to high RMD disease activity was also an independent risk factor for hospitalisation, underlining the importance of continuing adequate RMD treatment during the pandemic.

  • epidemiology
  • arthritis
  • glucocorticoids

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  • CS and ACR contributed equally.

  • Contributors RH and UM-L: Substantial contributions to the conception of the work and the acquisition, analysis and interpretation of data for the work, drafting the work. MS: substantial contributions to the conception of the work, statistical analysis and interpretation of data for the work. BFH, AK, H-ML, AP, JR, TS, AS, HS-K and REV: Substantial contributions to the conception of the work and the interpretation of data for the work. Revising the work critically for important intellectual content. CS and ACR: substantial contributions to the conception and design of the work and the analysis, and interpretation of data for the work. Drafting the work. All authors: final approval of the version to be published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding RH was supported by the Justus-Liebig University Giessen Clinician Scientist Programme in Biomedical Research (JLU-CAREER) to work on this registry.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the ethics committee of the Justus-Liebig-University Giessen (#52–50).

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

  • Data availability statement Data are available on reasonable request.