Q&A: Rheumatoid Arthritis Linked to More Severe COVID-19 Outcomes

In this Q&A, Rheumatology Network interviewed Bryant England, MD, PhD, to discuss his recent study, “Risk of COVID‐19 in Rheumatoid Arthritis: A National Veterans Affairs Matched Cohort Study in At‐Risk Individuals ,” originally published in Arthritis and Rheumatology.¹ The study finds that patients with rheumatoid arthritis (RA) are not only at a higher risk for contracting COVID-19, they are more likely to have severe outcomes, such as hospitalization and death, when compared with the general population. Based on this evidence, England and his team suggest that patients with RA should be prioritized for COVID-19 prevention and management.

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Rheumatology Network: What made your team decide to investigate the correlation between RA and COVID-19 hospitalization and death?

Bryant England, MD, PhD: After the pandemic took off, we, as clinicians, began considering what this meant for our patients. Recognizing that patients with RA have a higher risk of infection related to RA and the treatments for RA, we became concerned our patients may also be disproportionately affected by COVID-19. Moreover, when we visited with our patients during the pandemic, they consistently asked if they were at higher risk of COVID-19.

RN: Why do you believe RA patients should be prioritized for COVID‐19 prevention and management?

BE: Our study findings were that patients with RA were at higher risk of COVID-19 and COVID-19 disease that resulted in hospitalization or death. Being a population disproportionately affected by COVID-19 and severe COVID-19, we believe our patients with RA need early prevention and management strategies to minimize the negative health outcomes associated with COVID-19.

RN: Why do patients with RA have an inherently increased risk of COVID-19 infection?

BE: Although our study does not determine why patients with RA were at higher risk of COVID-19, it is hypothesized that both RA itself, particularly when RA is very active, and the medications used to treat RA, immunosuppressive therapies, both contribute to the risk of COVID-19 in RA.

RN: How and why does RA increase the severity of COVID-19 symptoms?

BE: While not directly answered in our study, it is likely the same factors, namely immune dysregulation related to active RA and RA therapies, that contribute to COVID-19 risk also lead to a more severe COVID-19 disease course.

RN: Are there any strengths or limitations of the study that you’d like to discuss?

BE: While we found RA therapies, particularly glucocorticoids and biologic disease-modifying antirheumatic drug (DMARDs) to be associated with higher COVID-19 risk, we did not have information on RA disease activity in our study. Thus, we were unable to disentangle whether the disease activity and/or medications were causally related to COVID-19.

RN: Were you surprised by the results of the study?

BE: Based on literature for largely bacterial infections in RA, we expected there to be a higher risk of COVID-19 and more severe COVID-19 disease course in the patients with RA.

RN: Does your team plan on doing any further research on this topic?

BE: There still remains much we do not understand about the factors that drive COVID-19 risk and outcomes, long-term sequelae of COVID-19, and response to vaccines.