- This nationally representative U.K. cohort study compared the incidence of COVID-19 in 17,268 individuals with rheumatoid arthritis and 1,616,600 without rheumatoid arthritis during the first 7.5 months of the pandemic
- The risk of suspected/confirmed COVID-19 was a significant 19% higher in the rheumatoid arthritis group than in the general population, and the risk of confirmed COVID-19 was a significant 42% higher
- The results were similar whether or not participants with rheumatoid arthritis used a disease-modifying antirheumatic drug
- No association was apparent between osteoarthritis and the risk of COVID-19
- Patients with rheumatoid arthritis should be encouraged to have COVID-19 booster vaccinations and should have priority access to anti–SARS–CoV-2 monoclonal antibody treatments if necessary
Several studies have reported that patients with rheumatic diseases, considered as a whole, are at increased risk of hospitalization for COVID-19 and more severe outcomes. However, the risk of COVID-19 may vary with different rheumatic diseases.
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Yuqing Zhang, DSc, director of Epidemiological and Biostatistical Methods at the Division of Rheumatology, Allergy and Immunology at Massachusetts General Hospital, and colleagues conducted a study to compare rates of COVID-19 in people with and without rheumatoid arthritis (RA). In Arthritis Care & Research (Hoboken) they report increased risk in people with RA.
Using the Health Improvement Network, a nationally representative primary care database in the U.K., the researchers identified 17,268 individuals with RA and 1,616,600 without.
Eligible subjects were 18 to about 90 years old (age ≥40 years for the general population) who had at least one year of continuous enrollment with a general practice before January 29, 2020, when the first COVID-19 case was diagnosed in the U.K. Subjects were followed until the middle of September 2020.
RA Patients vs. General Population
"Confirmed" COVID-19 meant a positive polymerase chain reaction test and "suspected" meant a symptomatic presentation and/or contact with someone who had confirmed COVID-19.
- The rate of suspected/confirmed COVID-19 (primary outcome) was 1.4/1,000 person-months in the RA group and 0.9/1,000 person-months in the non-RA group (adjusted HR [aHR], 1.19; 95% CI, 1.04–1.36)
- The rate of confirmed COVID-19 was 0.3/1,000 vs. 0.1/1,000 in the non-RA group (aHR, 1.42; 95% CI, 1.01–1.95)
The results were similar in a sensitivity analysis where participants with RA were stratified according to use or nonuse of disease-modifying antirheumatic drugs.
Patients With Osteoarthritis
As a negative comparison group, the researchers identified 161,065 individuals with osteoarthritis and 779,300 without. No association was apparent between osteoarthritis and the risk of COVID-19.
Recommendation for Clinicians
The increased susceptibility to respiratory infections in patients with RA might be attributable to:
- Premature aging of the immune system
- Widespread use of glucocorticoid therapy
- Use of other chronic immunosuppressive medications, including non-biologic DMARDs
Patients with RA should be encouraged to have COVID-19 booster vaccinations. They should also have priority access to anti–SARS–CoV-2 monoclonal antibody treatments if necessary.
View all COVID-19 updates
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