Factors influencing severe COVID-19 in systemic vasculitis patients: comment on the article by Rutherford et al.

We read with great interest the article by Dr. Rutherford and colleagues on the risk factors for severe COVID‐19 in patients with systemic vasculitis (1). This has been the first report to describe the features of COVID‐19 among a vasculitis‐specific cohort. We would like to address several points of interest.

First, 9% of patients with COVID‐19 in this study had a negative SARS–CoV‐2 polymerase chain reaction test result. Viral (including influenza) (2, 3) and bacterial (4) coinfections and various opportunistic superinfections (5) have been reported in the literature. Were these cases investigated for other causes of respiratory infections?

Second, vasculitis disease activity was determined using the physician's global assessment of disease activity. Given that the majority (85%) of the COVID‐19 cases were among patients with antineutrophil cytoplasmic antibody–associated vasculitis, validated scoring systems such as the Birmingham Vasculitis Activity Score (6) and its modification for granulomatosis with polyangiitis (7) could have been used to denote the level of disease activity.

Finally, no further information regarding the patients who died was provided in the report. For instance, given that the rate of active disease was high among these patients, did any of them die due to the complications of active vasculitis (rather than COVID‐19)?

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