Risk for COVID-19 hospitalization, death 35% higher in patients with RA
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A study of patients who received care at Veterans Affairs centers found that rheumatoid arthritis is linked to a 25% higher risk for COVID-19, and a 35% increased risk for related hospitalization and death, according to data.
“With the rapid development of effective vaccines for COVID-19, individuals with select chronic conditions that predispose to a more severe COVID-19 disease course have been prioritized for vaccine administration,” Bryant R. England, MD, PhD, of the Veterans Affairs Nebraska-Western Iowa Health Care System, and the University of Nebraska Medical Center, in Omaha, and colleagues wrote in Arthritis & Rheumatology.
“High-risk chronic conditions and behaviors specified in these recommendations include cancer, chronic kidney disease, cardiovascular disease, prior solid organ transplantation, obesity, sickle cell disease, smoking, type 2 diabetes mellitus, and pregnancy,” they added. “RA and other rheumatic diseases that require immunosuppressive therapies for management have not been prioritized. Few observational studies have evaluated whether rheumatic diseases and related immunosuppressive therapies are associated with COVID-19 outcomes.”
To compare the risk for COVID-19 — including severe and fatal disease — between patients with RA and those without in an at-risk population, England and colleagues conducted a retrospective, matched cohort study using national data from the Veterans Health Administration. The researchers identified 33,886 patients with RA who had received care at a VA center and were not deceased as of Jan. 1, 2020. These patients were then matched based on age, sex and VA center site to an equal number of individuals without RA who received VA care during 2019.
Data on COVID-19, as well as severe COVID-19 — defined as those involving hospitalization or death — were obtained from a national VA COVID-19 surveillance database through the end of the follow-up period on Dec. 10, 2020. The researchers used multivariable Cox models to compare the risk for COVID-19 and COVID-19 hospitalization or death after adjusting for demographics, comorbidities, health behaviors and county level incidence rates.
According to the researchers, there were 1,503 COVID-19 diagnoses, 388 cases of severe COVID-19, and 228 deaths unrelated to COVID-19 during the follow-up period. After multivariable adjustment, RA was associated with a higher risk for COVID-19 (HR = 1.25; 95% CI, 1.13-1.39), as well as related hospitalization or death (HR = 1.35, 95% CI, 1.1-1.66). Patients taking disease-modifying antirheumatic drugs and prednisone — but not RA autoantibody seropositivity — those with several chronic conditions, and those who were Black or Hispanic also demonstrated an increased risk for COVID-19 and COVID-19 hospitalization or death.
“We found that RA patients were at 25% higher risk of COVID-19 and 35% higher risk of COVID-19 hospitalization or death,” England told Healio Rheumatology. “These risks were similar to those for other recognized high risk conditions including heart failure, diabetes mellitus and chronic lung diseases. We also observed that RA patients receiving more immunosuppressive therapies, for example biologic DMARDs and glucocorticoids, had the highest COVID-19 risk.”
“Our findings illustrate that RA is a high-risk population we need to be very intentional about preventing COVID-19,” he added. “This means getting our patients vaccinated, considering booster vaccines, determining how RA and RA-related therapies may impact vaccine efficacy, and considering additional public health prevention strategies (eg, masks, social distancing) if there is concern vaccine responses may be impaired.”
Perspective
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While we have known that there is an associated risk of increased infections for patients with RA as well as with many of the treatments used to treat RA, what we didn’t know at the onset of this pandemic was how these factors would impact our patients’ risk for COVID-19 as well as the severity of the virus. Fortunately, as more data is being published, we are beginning to learn that our patients with RA are at a higher risk for not only developing COVID-19, but are also more likely to have complications requiring hospitalization.
I felt the frustration of so many of our patients when the vaccine was rolled out and prioritized to patients with certain “chronic conditions” that did not include rheumatologic diseases. The study conducted by England and colleagues emphasized the fact that RA was consistent with the risk of other chronic conditions that did receive priority vaccination status. My hope is that with the results of this study, and others, vaccine prioritization going forward will include those patients with rheumatologic conditions.
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