Introduction Covid-19 infection poses a serious challenge for immune-compromised patients with inflammatory autoimmune systemic diseases. We investigated the clinical-epidemiological findings of 1641 autoimmune systemic disease Italian patients during the Covid-19 pandemic. Method This observational multicenter study included 1641 unselected patients with autoimmune systemic diseases from three Italian geographical areas with different prevalence of Covid-19 [high in north (Emilia Romagna), medium in central (Tuscany), and low in south (Calabria)] by means of telephone 6-week survey. Covid-19 was classified as (1) definite diagnosis of Covid-19 disease: presence of symptomatic Covid-19 infection, confirmed by positive oral/nasopharyngeal swabs; (2) highly suspected Covid-19 disease: presence of highly suggestive symptoms, in absence of a swab test. Results A significantly higher prevalence of patients with definite diagnosis of Covid-19 disease, or with highly suspected Covid-19 disease, or both the conditions together, was observed in the whole autoimmune systemic disease series, compared to “Italian general population” (p = .030, p = .001, p = .000, respectively); and for definite + highly suspected diagnosis of Covid-19 disease, in patients with autoimmune systemic diseases of the three regions (p = .000, for all comparisons with the respective regional general population). Moreover, significantly higher prevalence of definite + highly suspected diagnosis of Covid-19 disease was found either in patients with various “connective tissue diseases” compared to “inflammatory arthritis group” (p < .000), or in patients without ongoing conventional synthetic disease-modifying anti-rheumatic drugs treatments (p = .011). Conclusions The finding of a higher prevalence of Covid-19 in patients with autoimmune systemic diseases is particularly important, suggesting the need to develop valuable prevention/management strategies, and stimulates in-depth investigations to verify the possible interactions between Covid-19 infection and impaired immune-system of autoimmune systemic diseases. Key Points• Significantly higher prevalence of Covid-19 is observed in a large series of patients with autoimmune systemic diseases compared to the Italian general population, mainly due to patients’ increased susceptibility to infections and favored by the high exposure to the virus at medical facilities before the restriction measures on individual movement.• The actual prevalence of Covid-19 in autoimmune systemic diseases may be underestimated, possibly due to the wide clinical overlapping between the two conditions, the generally mild Covid-19 disease manifestations, and the limited availability of virological testing.• Patients with “connective tissue diseases” show a significantly higher prevalence of Covid-19, possibly due to deeper immune-system impairment, with respect to “inflammatory arthritis group”.• Covid-19 is more frequent in the subgroup of autoimmune systemic diseases patients without ongoing conventional synthetic disease-modifying anti-rheumatic drugs, mainly hydroxyl-chloroquine and methotrexate, which might play some protective role against the most harmful manifestations of Covid-19.

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease influenced by both genetic, epigenetic and environmental factors. The discovery of new gene polymorphisms and their association with disease susceptibility have added new elements to better clarify RA pathogenesis. In the last year, important elements have been added to the current knowledge of mechanisms regulating innate and adaptive immunity in RA, leading to discovering new targets for the development of diseasemodifying therapies. Thus, in this review we summarise the new insights resulting from a literature research of the data published in the last year.

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HLA-B27 status was obtained in only 21 (31.8%) patients, of which one in the polyarthritis subgroup tested positive.Most patients were treated with glucocorticoids (50%-78%), non-steroidal anti-inflammatory drugs (33%-52%) or analgesics (14%-28%), while disease-modifying antirheumatic drugs were used in five (28%) patients with polyarthritis, five (24%) patients with oligoarthritis and only three (11%) patients with PMR-like presentation.Despite the limitation of a very short follow-up, the clinical course seemed excellent in patients with PMR-like onset with 74% achieving full remission of symptoms after 2 weeks; on the other hand, 67% of patients with polyarthritis had active disease after an average follow-up of 6 weeks.In conclusion, despite the fact that a clear cause-effect relationship is far to be ascertained, our data suggest that inflammatory musculoskeletal symptoms may occasionally develop in close temporal association with COVID-19 vaccine administration. However, even assuming a direct causal relationship, we feel that the overall safety of COVID-19 vaccines remains unaffected, and the benefits of vaccination largely outweigh the minimal risks associated with such uncommon inflammatory complications, probably reflecting a transient reactogenic response to the vaccine rather than a structured, chronic inflammatory joint disease.

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