Are Patients with Connective Tissue Disease More At-Risk for COVID-19?

Every day, we learn more and more about COVID-19. This viral pandemic has nearly 4.9 million diagnosed cases worldwide, with 1.5 million in the United States alone. As more about the virus is discovered, we also better understand its intersection with other health conditions. But according to Healio, those with connective tissue disease (like systemic sclerosis or Sjögren’s syndrome) need not worry. Italian researchers determined that this group, while on rheumatic therapy, is not more at risk of contracting COVID-19. Check out their findings in the Journal of Rheumatology.

Connective Tissue Disease

Basically, your body is made up of many parts or structures. Connective tissue links these all together. It is formed from collagen and elastin. In a patient with connective tissue disease, these proteins become inflamed, causing damage to the tissue. There are over 200 types of connective tissue disease. However, the three below were the main ones examined in this study.

Systemic Lupus Erythematosus

You may know this by a much simpler name: lupus. This autoimmune disorder causes the body to mistakenly attack its own tissues and organs. It may affect many organs. As a result, people with lupus may experience a range of symptoms, as well as variations in severity. Some patients may even experience temporary symptoms, while others have symptoms for life. These include:

  • Fever
  • Fatigue
  • Joint pain and stiffness
  • Skin lesions
  • A butterfly-shaped rash on the face
  • Chest pain and difficulty breathing
  • Confusion and memory loss
  • Raynaud’s phenomenon

Additional complications may include organ inflammation, infection, bone tissue death, and cancer. Lupus can be triggered by sunlight, infections, or medications. Risk factors include age (15 to 45 years old) and biological sex (females have a higher risk than males). Learn more about lupus.

Systemic Sclerosis

Also called systemic scleroderma, this autoimmune disorder causes the skin to tighten and thicken. Scar tissue, called fibrosis, builds up on the skin and in organs. There is no clear cause, but most cases are not inherited. However, it is 4x more likely to impact females. Symptom onset usually occurs by mid-adulthood. These include:

  • Gastrointestinal distress
  • Joint pain and stiffness
  • Raynaud’s phenomenon
  • Swelling in the extremities
  • Heartburn
  • Difficulty swallowing
  • Open sores on the fingers or painful lumps beneath the skin
  • Kidney failure

Learn more about systemic sclerosis.

Sjögren’s Syndrome

Sjögren’s syndrome is an autoimmune disease in which the body’s immune system mistakenly attacks glands that produce some sort of moisture or liquid. Doctors do not know the cause of Sjögren’s syndrome. However, genetics are believed to play a role. The condition impacts females 10x more than males. The condition is either primary (gradual progression, no other rheumatic diseases) or secondary (appears alongside other autoimmune disorders, dry eyes and mouth).

Symptom onset usually occurs between ages 45 and 55. These include changes in smell and taste, gingivitis, stiff and painful joints, fatigue, acid reflux, irritated and painful eyes, and dry mouth, lips, throat, vagina, and skin. Learn more about Sjogren’s syndrome.


Researchers wanted to understand how COVID-19 intersected with connective tissue disease, particularly if patients were on rheumatic therapy. This is because the therapy includes immunosuppressants.

To start, researchers conducted a survey on clinical information, respiratory symptoms, COVID-19 status, and patient behavior. Patients comprised of the following demographics:

  • 123 total patients. Of these, 49.6% (61) had systemic lupus erhythematosus. 34.97% (43) had systemic sclerosis. 8.13% (10) had Sjögren’s syndrome. 7.3% (9) had undifferentiated connective tissue disease.
  • 81.3% (100) were female.
  • Mean Age: 49.3 years
  • Mean Disease Duration: 10.2 years
  • Patients with diagnosed COVID-19: 1 patient, age 33, systemic sclerosis. COVID-19 was fatal following pneumonia development.
  • Patients with respiratory symptoms: 14 patients
  • Patients working from home or practicing social distancing: 103 patients

Researchers determined that 60% (73) patients were treated with disease modifying anti-rheumatic drugs (DMARDs). These not only help to reduce pain and swelling, but also slow the progression of connective tissue disease. Of these:

  • 42.5% (31) took hydroxychloroquine.
  • 30% (22) took mycophenolate.
  • 15% (11) took methotrexate.
  • 11% (8) took azathioprine.
  • 1.4% (1) took cyclosporine.

20% (25) patients were treated with biologics, a drug therapy created from biological sources. Of these, 72% (18) took belimumab. 20% (5) took rituximab. 8% (2) took tocilizumab. Additionally, 64.2% (79) also took corticosteroids.

At the end of the study, 5 patients discontinued therapy. 115 have maintained a stable disease state with no flare-ups. Only 2 patients experienced symptom flares. Ultimately, researchers determined that:

“encouraging CTD patients to maintain ongoing rheumatological therapy and adhere strictly to the norms to prevent infection has avoided rheumatic disease relapse without increasing the risk of COVID-19.”

Jessica Lynn

Jessica Lynn

Jessica Lynn has an educational background in writing and marketing. She firmly believes in the power of writing in amplifying voices, and looks forward to doing so for the rare disease community.

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