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OBJECTIVES: Autoimmune rheumatic diseases (AIRD) are concerned to be underlying affecting the severity of COVID-19 and post COVID-19 conditions. In this study, we assessed aggravation factors and post COVID-19 conditions in patients with AIRD who developed COVID-19 and were treated in our hospital. METHODS: From January 2020 to Augst 2023, we conducted a retrospective survey of 1567 patients with rheumatic diseases (RA: n=788, others: n=779) treated in our hospital. In addition, among them, 66 patients developed COVID-19, confirmed by SARS-Cov2-ART (RA patients: n=43, other patients: n=23). We divided these patients into two groups, moderate to severe group (n=24) and mild group (n=42), and compared exacerbating factors based on clinical features and laboratory parameters between the two groups. In addition, we also assessed the appearance of post-COVID-19 conditions such as symptoms, lasting for more than 3 months after the onset, and compared between the two groups. RESULTS: The moderate to severe group was significantly older than the mild group (73.7±15.2 vs 61.4±13.6 yrs, p=0.0014), received higher dose of corticosteroid (5.37±2.57 vs 2.95±1.45 mg/day, p=0.0398), and showed higher rate of complicating with interstitial pneumonia (33.3 vs 13.0 %, p=0.0216). Post COVID-19 conditions were observed in 15 patients (22.7%). Its incidence was significantly higher in the moderate to severe group (n=10; 41.7%), compared with the mild group (n=5; 11.9%) (p=0.0017). CONCLUSION: In COVID-19 patients complicated with autoimmune rheumatic diseases, older age, corticosteroid dosage, and interstitial pneumonia were thought to be aggravating factors. Post COVID-19 conditions were frequently observed in moderate to severe patients.

A 56-year-old woman was referred to our hospital because of dyspnea, wheezing, and a productive cough. Eight years before presentation, bronchial asthma was diagnosed and the patient received inhaled corticosteroids plus antiasthmatic agents (a long-acting inhaled p2-agonist, leukotriene modifiers, and theophylline). Chest radiography showed small diffuse nodular shadows, and a computed tomographic scan showed thickening of the bronchi and bronchioles, with diffuse centrilobular nodules in both lung fields. A blood test and microscopic examination of the bronchoalveolar fluid revealed marked eosinophilia. Transbronchial lung biopsy and transbronchial biopsy showed eosinophilic bronchitis and bronchiolitis. After treatment with oral prednisolone (40 mg daily) and inhaled corticosteroids, the symptoms, blood eosinophilia, and radiographic findings improved. Recently, several similar cases of eosinophilic bronchiolitis have been reported. Studies of further cases and elucidation of the pathophysiology of eosinophilic bronchiolitis are necessary to establish a concept for this disease and to determine whether it should be classified as a subtype of bronchial asthma or as a distinct entity.