The COVID-19 pandemic deeply affected northern-Italian regions. 1 Lombardy and Emilia-Romagna had the highest cumulative incidence with 627.1 and 470.53 cases/100 000 inhabitants respectively on 16 April 2020 according to Italian ‘Istituto Superiore di Sanità’(ISS). While a mild course has been reported in patients with chronic arthritis treated with targeted immunosuppressive agents, 2 few and controversial data are available about COVID-19 in systemic lupus erythematosus (SLE). 3 4 To this purpose, since 6 April 2020, given the mobility restriction imposed nationwide, we initiated a telemedicine project aimed at ensuring regular follow-up, starting from SLE patients. 5 During the visit, we conducted a survey to investigate any COVID-19 related symptoms that occurred since 15 February 2020 and the results of available nasopharyngeal swabs. The survey was addressed to patients coming from Lombardy and Emilia-Romagna. We evaluated 165 patients (112 females, 84%, median age 52.5 years, range 25–81; median disease duration 13 years, range 1–53). Among them, 127 (77%) were on hydroxychloroquine (HCQ), 93 (56%) on prednisone (in 88≤ 7.5 mg/day), 41 (25%) on mycophenolate mofetil (MMF) and 12 (7%) on other immunosuppressants (methotrexate, cyclosporine or azathioprine). In all cases, treatment was ongoing for more than 6 months. Among them, 12 patients (7.2%) developed COVID-19: four patients (2.5% of the total population) had swab-confirmed COVID-19 and eight (4.8%) had clinical-COVID-19 (at least three out of four symptoms among fever, dyspnoea, cough and dysgeusia/anosmia plus established contact with a COVID-19 patient, no swab performed). Cohort characteristics and therapies are reported in table 1.

Among the four confirmed patients only one, a 27-year-old woman, needed intensive care for the development of acute respiratory distress syndrome. She has severe SLE (end-stage renal disease on haemodialysis) and was on MMF (2 g/day), HCQ (200 mg/day) and oral prednisone (7.5 mg/day) before COVID-19. MMF was withdrawn at COVID-19 diagnosis, and after deterioration, methylprednisolone (1 mg/kg/day for 5 days then tapered) and non-invasive ventilation were initiated with prompt amelioration and discharge from intensive