METHODS: We included people partially or fully vaccinated against SARS-CoV-2 who developed COVID-19 between 5 January and 30 September 2021 and were reported to the Global Rheumatology Alliance registry. Breakthrough infections were defined as occurring ≥14 days after completion of the vaccination series, specifically 14 days after the second dose in a two-dose series or 14 days after a single-dose vaccine. We analysed patients' demographic and clinical characteristics and COVID-19 symptoms and outcomes.

RESULTS: SARS-CoV-2 infection was reported in 197 partially or fully vaccinated people with rheumatic disease (mean age 54 years, 77% female, 56% white). The majority (n=140/197, 71%) received messenger RNA vaccines. Among the fully vaccinated (n=87), infection occurred a mean of 112 (±60) days after the second vaccine dose. Among those fully vaccinated and hospitalised (n=22, age range 36-83 years), nine had used B cell-depleting therapy (BCDT), with six as monotherapy, at the time of vaccination. Three were on mycophenolate. The majority (n=14/22, 64%) were not taking systemic glucocorticoids. Eight patients had pre-existing lung disease and five patients died.

METHODS: A cross-sectional online survey of rheumatologists and allied health professionals was conducted between January 2023 and May 2024. The 38-item survey covered demographics, gender discrimination, sexual harassment, work-family interface, and career advancement. It was translated into eight languages and disseminated through professional organisations, mailing lists and social media channels in 105 countries. Analyses included descriptive statistics and comparative tests, with gender differences evaluated after adjustment for years of work experience. Subgroup analyses included country Human Development Index (HDI), professional roles, and caregiving responsibilities, with statistical significance set at p<0.05.

RESULTS: Among 1,945 respondents (66.4% female), pronounced gender-based disparities were observed. Male professionals demonstrated higher rates of full-time employment, leadership positions, and clinical experience. Female rheumatology professionals more frequently encountered career barriers, including tasks below their expertise, hostility from colleagues, lacking leadership training opportunities, lower remuneration, and difficulties securing research funding. Women reported greater domestic responsibilities (47.5% vs 36.2%, p<0.001) and higher work-family conflict, with nearly four times the odds of experiencing sexual harassment and double the odds of experiencing bullying. Perceived experiences were more pronounced among respondents from high-HDI countries and those with caregiving responsibilities, but did not differ by professional role.