Patients with rheumatoid arthritis (RA) were found to be at higher risk for severe or critical COVID-19, and systemic therapies, except nontumor necrosis factor inhibitor (TNFi) agents, did not further increase the risk, according to study results published in The Journal of Rheumatology.

In the current retrospective cohort study, the researchers included data from the United States Optum deidentified COVID-19 electronic health record dataset and was registered with ENCePP (Registration Number: EU PAS 35384). Incidence proportions of hospitalizations and clinical manifestations were calculated for 3 cohorts of adults with COVID-19 and RA, psoriatic arthritis (PsA), or ulcerative colitis (UC) and receiving systemic therapies. A comparator cohort of patients with COVID-19 without a diagnosis of RA, PsA, or UC, were also included in the study.

The primary endpoints were hospitalization and intensive care unit (ICU) admission within 30 days of COVID-19 diagnosis.

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Overall, 315,101 patients with COVID-19 were included between February 1 to December 9, 2020. The RA, PsA, UC, and comparator cohorts included 2306, 421, 811, and 311,563 patients, respectively. Compared with participants in the comparator cohort and after adjusting for demographics, patients with COVID-19 and RA were at increased risk for hospitalization (odds ratio [OR], 1.54; 95% CI, 1.39-1.70) and in-hospital death (OR, 1.61; 95% CI, 1.30-2.00). The increased risk was also observed after adjusting for demographics and comorbidities; OR for hospitalization was 1.25 (95% CI, 1.13-1.39) and for in-hospital death was 1.35 (95% CI, 1.09-1.68).

The hospitalization risk analyzed by baseline systemic immunomodulatory therapy and adjusted for demographics plus comorbidities was lower in patients with RA receiving TNFi biologics vs those receiving non-TNFi biologics (OR, 0.32; 95% CI, 0.20-0.53) and the comparator cohort (OR, 0.77; 95% CI, 0.51-1.17). Hospitalization risk was similar between the patients in the comparator cohort and patients receiving tofacitinib.

Study limitations included the use of electronic health record data and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for diagnosis; the short baseline period; and the small sample size. There was also potential for false SARS-CoV-2-positive results, and exposure to and testing for SARS-CoV-2 may have been associated with underlying conditions adding a potential bias. Finally, disease severity and body mass index were unknown, and the results were not generalizable to patients with less severe disease.

Researchers concluded, “Collectively, these data from patients with immune-mediated inflammatory conditions are important for informing medical management strategies, as well as COVID-19 vaccine priority decisions.”

Disclosure: This research was supported by Pfizer Inc. Please see the original reference for a full list of authors’ disclosures.


Curtis JR, Zhou X, Rubin DT, et al. Characteristics, comorbidities, and outcomes of SARS-CoV-2 infection in patients with autoimmune conditions treated with systemic therapies: a population-based study. J Rheumatol. Published online November 15, 2021. doi:10.3899/jrheum.210888