Respiratory Complications of Coronavirus Disease 2019 (COVID-19) in Rheumatic Diseases

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented global health crisis. Globally, millions of people are living with systemic autoimmune rheumatic diseases (SARDs), defined as rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, systemic sclerosis, idiopathic inflammatory myositis, mixed connective tissue disease, and systemic vasculitis. Due to underlying interstitial lung disease and/or immunosuppressive use, patients with SARDs may be vulnerable to short- and long-term severe consequences of COVID-19 infections including respiratory failure, death, pulmonary fibrosis, and decreased healthrelated quality of life (QoL). Our central hypothesis is that patients with SARDs may have poor short- and long-term COVID-19 respiratory outcomes and health-related QoL after COVID-19 infection. In Aim 1, we will investigate short-term respiratory outcomes of COVID-19 infection retrospectively in patients with SARDs compared to age-, sex-, and date of COVID-19 diagnosis-matched patients without SARDs. The primary outcome of interest is mechanical ventilation, and all-cause mortality is a secondary outcome. In the cohort of COVID-19 infected patients with SARDs, we will assess key predictors of mechanical ventilation, such as pre-existing pulmonary disease and baseline glucocorticoid use. In Aim 2, we will prospectively determine long-term respiratory and general health-related quality of life twelve months after COVID-19 infection using validated survey instruments, including the St. George's Respiratory Questionnaire and Short Form 36-Item Health Survey. We will assess these outcomes in patients with SARDs infected with COVID-19 and patients with SARDs never infected with COVID-19 (matched on age, sex, type of SARD, and baseline oxygen use). The findings from this proposal will determine the shortand long-term impact of COVID-19 infection on patients with SARDs, a critical question for patients and rheumatologists during the ongoing COVID-19 pandemic.