Severe COVID-19 in Rheumatoid Arthritis Patients
September 22, 2022
RA patients have been observed to experience severe COVID-19 at higher rates than those without rheumatoid arthritis. To further understand this association, researchers at the Mayo Clinic investigated severe COVID-19 and RA phenotypes (observable characteristics) such as rheumatoid arthritis-associated interstitial lung disease, seropositive rheumatoid arthritis, and erosive rheumatoid arthritis, to determine if specific manifestations may be responsible for poor COVID-19 outcomes (1).
Researchers ran a retrospective, comparative study with RA patients from 33 hospitals and affiliated outpatient centers at the Mayo Clinic and Mass General Brigham. 582 RA patients were compared against 2875 non-RA patients in a comparison group; each RA patient was matched to five patients without recorded RA of similar sex and age. All patients had a positive history of COVID-19 between March 1, 2020 and June 6, 2021, and a follow-up was conducted for each patient within 90 days of a positive SARS-CoV-2 test.
Among patients with rheumatoid arthritis, 9% had RA and interstitial lung disease, 68% were seropositive (for rheumatoid factor or anti-CCP), and 25% had bone erosions. 163 and 457 patients were taking glucocorticoids and DMARDs, respectively, at the time of SARS-CoV-2 infection. 63% of patients from both cohorts contracted COVID-19 before vaccines were available.
“In adjusted analyses for age, sex, race, and smoking status, patients with rheumatoid arthritis had increased risk of severe COVID-19 compared with patients without rheumatoid arthritis.” This was the same across all phenotype subgroups, especially those with interstitial lung disease. “There was no association when comparing seropositive patients to seronegative patients, or when comparing patients with erosive disease to patients without erosive disease. Patients with rheumatoid arthritis positive for rheumatoid factor or anti-CCP had similarly increased risk of severe COVID-19 compared with patients without rheumatoid arthritis.” Associations overall decreased slightly when factoring BMI and co-morbidities.
Severe COVID-19 (marked by hospitalization or death) occurred in 22% of RA patients versus 13% in the comparison group. When adjusted for age, sex, race, and smoking status, the risk of hospitalization increased in those with RA versus the comparison group. This association did not decrease when factoring BMI and co-morbidities.
“The risk of severe COVID-19 among women with rheumatoid arthritis was two-fold higher than women without rheumatoid arthritis… Men with rheumatoid arthritis had no difference in their risk compared with men without rheumatoid arthritis.”
While exposure to medications such as Rituximab may impact the severity of COVID-19, due to the nature of this study, researchers were unable to draw associations on disease activity and pharmacologic therapies. Future studies are also needed to assess whether the risk of severe COVID-19 persists in RA patients after being vaccinated.