Patients With RA and Interstitial Lung Disease Have Increased Risk for Severe COVID-19

coronavirus disease 2019 covid lungs illustration
3D Rendering,COVID-19 virus infection of human lungs
Researchers compared severe COVID-19 outcomes among patients with rheumatoid arthritis across phenotypic subgroups.

Patients with rheumatoid arthritis (RA), especially those with interstitial lung disease (ILD), are at higher risk for severe COVID-19 outcomes, according to study results published in The Lancet.

The retrospective multicenter cohort study included individuals with RA and COVID-19 as well as comparators with COVID-19 alone. Data were collected from Mayo Clinic and Mass General Brigham. Study inclusion criteria included RA and a diagnosis of COVID-19 between March 2020 and June 2021.

Subgroup analysis was performed by phenotypic features, including RA-associated ILD; bone erosions; and seropositivity for rheumatoid factor (RF), anticyclic citrullinated peptide (anti-CCP), or both.

Severe COVID-19 was defined as mortality and/or hospitalization. Cox regression was used to compute hazard ratios (HRs) for severe COVID-19. A total of 582 individuals with RA and COVID-19 (mean age, 62±14 years; 72% women; 79% White) and 2875 individuals with COVID-19 alone (mean age, 61±14 years; 72% women; 80% White) were included in the study. Among those in the RA group, 22% (n=126) had severe COVID-19 compared with 13% (n=363) in the comparator group (HR, 1.75; 95% CI, 1.45-2.10; P <.0001). In the RA group, 9% (n=50) had comorbid ILD; 58% (n=312) were seropositive for anti-CCP; 68% (n=388) were seropositive for RF; and 27% (n=159) had bone erosions.

Compared with the comparators, those with RA-associated ILD were at a significantly greater risk for severe COVID-19 (HR, 2.50; 95% CI, 1.66-3.77; P <.0001), as well as those with RA who had erosive disease (HR, 1.93; 95% CI, 1.41-2.63; P <.0001) and those who were seropositive (HR, 1.97; 95% CI, 1.58-2.46; P <.0001).

Study limitations included the underrepresentation of certain minority/ethnic groups, the small number of participants with both RA and ILD, the small number of mortality and mechanical ventilation outcomes, limited generalizability among the fully vaccinated population, and potential collider bias.

The study authors concluded that “interstitial lung disease, or its treatment, might be a major contributor to severe COVID-19 outcomes in patients with [RA].”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Figueroa-Parra G, Gilbert EL, Valenzuela-Almada MO, et al. Risk of severe COVID-19 outcomes associated with rheumatoid arthritis and phenotypic subgroups. Lancet. Published online September 13, 2022. doi:10.1016/S2665-9913(22)00227-2