Self-reported SARS-CoV2 testing and COVID-19 disease in patients with rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis in a Swiss observational cohort

Objectives: Assess and compare the rate of COVID-19 infection and SARS-CoV2 testing in patients with RA, rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA) association with their treatment and, for testing, the number of symptoms in a Swiss cohort of patients. Methods: Inclusion of patients with RA, AxSpA and PsA from the SCQM using a smartphone app (mySCQM) to record information between March and December 2020. Outcomes of interest were self-reported SARS-CoV2 testing, symptoms compatible with COVID-19 during the previous month and confirmed COVID-19 through PCR nasopharyngeal swab. Outcomes were compared between diseases groups, using logistic regression. We also evaluated the association of baseline treatment (TNF-inhibitors, b/tsDMARDs with other modes of action, no b/tsDMARDs) on the odds of symptoms and testing and the association of the number of symptoms (0-9) on the odds of testing. The analyses of SARS-CoV2 testing and COVID-19 symptoms were additionally adjusted for age, gender, glucocorticoids and csDMARDs. Confirmed cases were not adjusted for treatment and other covariates considering the low number of events. Results: We included 927 patients with RA, 805 with AxSpa and 453 with PsA. 1010 patients reported COVID-19-like symptoms (mostly fever, runny nose and cough), but only 455 of them (45%) reported being tested. 151 patients were tested without symptoms. In between March and December 2020, 7.6% of RA, 8.5% of AxSpA and 10.5% of PsA patients were tested positive for COVID-19 (p = 0.678). The odds of testing, symptoms and confirmed COVID-19 were similar between diseases and not associated with treatment for testing and. The number of symptoms was associated with the odds of testing (OR 1.43, 95%CI 1.37- 1.50 by symptom). Conclusion: Prevalence of COVID-19 symptoms and confirmed cases was similar between diseases, and for symptoms, was not associated with treatment. Despite strong advice from health authorities, less than 50% of patients with inflammatory rheumatic diseases and COVID-19 symptoms were tested. This proportion was not significantly different between diseases and not influenced by type of treatment. Efforts should be made to improve rates of SARS-CoV2 testing in patients with rheumatic diseases.