ABSTRACT Background The impact of inflammatory rheumatic diseases MESHD on COVID-19 severity is poorly known. Here we compare the outcomes of a cohort of rheumatic patients with a matched control cohort to identify potential risk factors for severe illness. Methods In this comparative cohort study, we identified hospital PCR+ COVID-19 rheumatic patients with chronic inflammatory arthritis MESHD arthritis HP (IA) or autoimmune/immunomediated diseases MESHD (AI/IMID). Non-rheumatic controls were randomly sampled 1:1, and matched by age TRANS, sex, and PCR date. The main outcome was severe COVID-19, defined as death MESHD, invasive ventilation, ICU admission, or serious complications. We assessed the association between the outcome and potential prognostic variables, adjusted by COVID treatment, using logistic regression. Results The cohorts were composed of 456 rheumatic and non-rheumatic patients, in equal numbers. Mean age TRANS was 63 [IQR 53-78] and male TRANS sex 41% in both cohorts. Rheumatic diseases MESHD were IA (60%) and AI/IMID (40%). Most patients (74%) had been hospitalised, and the risk of severe COVID was 31.6% in the rheumatic and 28.1% in the non-rheumatic cohort. Ageing, male TRANS sex and previous comorbidity ( obesity MESHD obesity HP, diabetes, hypertension MESHD hypertension HP, cardiovascular, or lung disease MESHD) increased the risk in the rheumatic cohort by bivariate analysis. In logistic regression analysis, independent factors associated with severe COVID were increased age TRANS (OR 5.31; CI 3.14-8.95), male TRANS sex (2.13; CI 1.35-3.36) and having an AI/IMID (OR 1.98; CI 1.15-3.41). Conclusion In patients with chronic inflammatory rheumatic diseases MESHD aging, sex and having an AI/IMID but not IA nor previous immunosuppressive therapies were associated with severe COVID-19.