Patients With RA Have Higher Risk for COVID-19 and Related Death, Hospitalization

A study has found that patients with rheumatoid arthritis (RA) may have a higher risk for developing COVID-19 and experiencing COVID-19-related hospitalization or death compared with people without RA. Findings from this matched cohort study were published in Arthritis & Rheumatology.

Patients with rheumatic diseases, particularly those taking immunosuppressive agents, may be at a higher risk for severe infections. To date, few studies have clarified the risk of poor COVID-19 outcomes in this patient population.

In a recent study, a team of US researchers sought to evaluate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and subsequent COVID-19-related outcomes reported in national Veterans Affairs (VA) data. The investigators identified patients with RA who were active in the Veterans Health Administration system as of January 2020 and had received care in the VA in 2019.

A total of 33,886 patients with RA in the retrospective study were matched to 33,886 patients without RA in regard to age (mean age, 67.8 years), sex (men, 84.5%), and VA site.

A national VA COVID-19 surveillance database was used to obtain data on COVID-19 and severe COVID-19, the latter of which was characterized by the incidence of hospitalization or death. Multivariable Cox models were used to compare the 2 groups in terms of the risk for COVID-19 and severe COVID-19 in analyses adjusted for demographics, comorbidities, health behaviors, and county-level incidence rates of COVID-19.

Approximately 60.5% of patients with RA were seropositive for rheumatoid factor or anti-cyclic citrullinated protein. Most patients with RA (73%) had received disease-modifying anti-rheumatic drugs (DMARDs) within the previous 180 days, and 34.2% of these patients received a biologic or targeted DMARD.

A total of 1503 COVID-19 diagnoses were recorded over 62,894 patient-years of follow-up. In addition, the researchers identified 388 severe cases of COVID-19, characterized by 345 hospitalizations and 84 deaths. There were also 288 deaths not related to COVID-19 during the observation period.

In the multivariable adjusted analysis, patients with RA had a 25% higher risk for developing COVID-19 compared with those without RA (adjusted hazard ratio [aHR], 1.25; 95% CI, 1.13-1.39). Patients with RA also had a 35% higher risk for hospitalization or death related to COVID-19 (aHR, 1.35; 95% CI, 1.10-1.66).

Certain characteristics were associated with higher rates of COVID-19, including Black race (aHR, 1.22; 95% CI, 1.07-1.39; P <.05), Hispanic ethnicity (aHR, 1.48; 95% CI, 1.23-1.78), greater Elixhauser comorbidity scores (aHR, 1.12; 95% CI, 1.09-1.15; P <.05), presence of a service-connected condition (aHR, 1.22; 95% CI, 1.10-1.37; P <.05), lack of insurance (aHR, 1.40; 95% CI, 1.24-1.58; P <.05), being underweight (aHR, 1.78; 95% CI, 1.01-3.15; P <.05) or obese with body mass index of 30 to 35 kg/m² (aHR, 1.36; 95% CI, 1.08-1.72; P <.05) and greater than 35 kg/m² (aHR, 1.51; 95% CI, 1.19-1.90; P <.05), greater number of hospitalizations in the previous year (aHR, 1.11; 95% CI, 1.05-1.16; P <.05), and higher county-level COVID-19 incidence rates (aHR, 1.00; 95% CI, 1.00-1.00; P <.05).

Factors associated with COVID-19-related hospitalization or death included greater Elixhauser comorbidity scores (aHR, 1.24; 95% CI, 1.20-1.30; P <.05), lack of insurance (aHR, 1.88; 95% CI, 1.49-2.37; P <.05), higher number of hospitalizations in the previous year (aHR, 1.13; 95% CI, 1.06-1.21; P <.05), and higher county-level COVID-19 incidence rates (aHR, 1.00; 95% CI, 1.00-1.00; P <.05).

Limitations of the study were the lack of dosing data on DMARDs and prednisone as well as the dominance of mostly patients who were men.

Based on these findings, the researchers suggest greater “consideration should be given to establishing RA, and potentially other conditions that require treatment with similar immunosuppressive medications, as a chronic condition that receives prioritization for COVID-19 prevention and management strategies.”

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.

Reference

England BR, Roul P, Yang Y, et al. Risk of COVID-19 in rheumatoid arthritis: A national veterans affairs matched cohort study in at-risk individuals. Arthritis Rheumatol. Published online May 5, 2021. doi:10.1002/art.41800