Patients with Rheumatoid Arthritis At Greater Risk of COVID-19, Hospitalization and Death

Patients with rheumatoid arthritis (RA) have an increased risk of contracting COVID-19, as well as hospitalization and death associated with the virus, according to a study.

“While rheumatoid arthritis (RA) and its treatments are associated with an increased infection risk, it remains unclear whether these factors impact the risk or severity of COVID‐19,” the authors of the study explained.

They collected Veterans Affairs (VA) data on all patients who were still alive as of Jan. 1, 2020, and received VA care in 2019. Patients with RA were matched to patients without RA on a 1:1 basis by age, sex, and VA site. A national VA COVID-19 surveillance database was queried to identify cases of COVID-19 as well as severe cases, defined as hospitalization or death, through Dec. 10, 2020. Multivariable Cox models were used to compare the risks of COVID-19 and severe disease among patients with versus without RA, adjusting for demographics, comorbidities, health behaviors, and county level COVID‐19 incidence rates.

Final analysis included 33,886 patients each with and without RA. The cohort was primarily male, and the mean age was 67.8 years. A total of 1,503 COVID-19 diagnoses were identified. There were 388 cases of severe COVID-19 and 228 non-COVID-19-related deaths.

Per the researchers’ adjusted analyses, patients with RA, compared to those without RA, were at a greater risk of COVID-19 (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.13-1.39) and associated hospitalization or death (HR, 1.25; 95% CI, 1.10-1.66). Factors associated with COVID-19 and associated hospitalization or death included disease-modifying antirheumatic drugs, prednisone, Black race, Hispanic ethnicity, and certain chronic conditions. The researchers noted, however, that RA autoantibody seropositivity did not increase the risks of COVID-19 or severe COVID-19.

The study was published in Arthritis & Rheumatology.

“Patients with RA are at higher risk for COVID‐19 and COVID‐19 hospitalization or death than non‐RA. With a COVID‐19 risk that approaches other recognized chronic conditions, these findings suggest RA patients should be prioritized for COVID‐19 prevention and management,” the study authors wrote in their conclusion.