Background and objective Patients with rheumatic disease taking long-term disease-modifying anti-rheumatic drugs (DMARDs) are expected to have a higher risk of infection due to the alterations in cellular immunity associated with these medications. However, the potential risks associated with these drugs remain unclear. This study aimed to estimate the risk of COVID-19 infection in patients with rheumatic disease taking disease-modifying anti-rheumatic drugs. Methods Patients with autoimmune rheumatic disease taking DMARDs with or without long-term (> 6 months) HCQ treatment prior to the COVID-19 outbreak were selected consecutively. The diagnosis of COVID-19 was made based on the history of symptoms suggestive of the disease and/or serum IgG positivity. During statistical analysis, the risk of COVID-19 infection was calculated in rheumatic patients taking DMARDs versus controls, as well as in patients taking HCQ versus those who are not. The ORs and 95% CIs were also calculated. The participants in the control group were selected from individuals without RD. Results A total of 800 patients with RD and 449 controls were analyzed. COVID-19 infection was detected in 16.8% of rheumatic patients versus 17.6% of controls (OR 0.95; 95% CI 0.7–1.28). The proportions of COVID-19 infection in HCQ users versus non-users were 15.3% and 18.1%, respectively (OR 0.87; 95% CI 0.61–1.26). These results remained unchanged after adjusting for all covariates using logistic regression analysis. Conclusion These findings indicate that rheumatic patients taking DMARDs are not at a higher risk of COVID-19 infection, and that HCQ therapy has no influence on the risk of COVID-19 infection. Key points • The risk of COVID-19 infection is not higher in patients with RD on DMARD therapy. • The prevalence of COVID-19 infection in HCQ users has not significant difference relative to non-users. • Significant percent of RD patients taking DMARDs had asymptomatic infection. • There was a positive association between leflunamide therapy and the risk of COVID-19 infection.

Background Rheumatoid arthritis is a systemic inflammatory disease that mainly affects small joints. It has a destructive potential, then early diagnosis and treatment can prevent deformities and extra articular manifestations. According to the studies ACCP test is the most sensitive and specific biological marker of the disease, but in some studies Anti MCV is comparable with ACCP as a specific marker. Objectives In this study we compared the sensitivity and specificity of the above mentioned tests. Methods This cross sectional study was carried out on 150 rheumatoid arthritis patients and 75 controls. In the patients group there were 34 males and 116 females with the mean age of 49.57±11.98 and in the control group 17 males and 58 females with mean age of 48.85±11.98years old. For each and every subject approximately 8cc of blood was drawn, serums were separated. Then, ACCP and Anti MCV by using Elisa method were measured. The results were analyzed with SPSS software. Results In this study the sensitivity of ACCP and Anti MCV were 85% and 81%. Furthermore, the specificity of these tests was 96% and 95% respectively. The positive predictive value for ACCP, 98% and for Anti MCV 97% and negative predictive value for ACCP 76% and for Anti MCV 71%were calculated. Only 4out of 23 patients (17.39%) with negative ACCP test were Anti MCV positive and 10 out of 29 patients (34.48%) with negative Anti MCV were ACCP positive. In our study there was no significant difference between sensitivity and specificity of these two tests, although in general ACCP was superior to Anti MCV. But it does not appear that Anti MCV will help more in ACCP negative patients. Disclosure of Interest None Declared

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