Patients with rheumatoid arthritis (RA) are at an increased risk of acquiring infections owing to immunologic dysfunction and use of potent immunomodulatory medications; however, few data are available on their risk of Coronavirus Disease 2019 (COVID-19). We estimated the rate of COVID-19 among RA participants and compared with that among the general population.
Using The Health Improvement Network we identified RA patients before February 2020 and followed them to September 2020. We calculated the rate of COVID-19 among participants with RA and compared with that among the general population using Cox proportional hazard model adjusting for potential confounders using overlap weighting of exposure score. We repeated the same analysis among participants with osteoarthritis, a non-autoimmune rheumatic disease, as a negative control exposure.
We identified 225 cases of suspected/confirmed COVID-19 among 17,268 RA patients, and 14,234 cases among 1,616,600 participants in the general population (1.4 versus 0.9/1000 person-months), with adjusted hazard ratio (HR) being 1.19 (95%CI: 1.04-1.36). Confirmed COVID-19 cases developed in 46 RA participants and 2,249 in the general population (0.3 versus 0.1/1000 person-months), with adjusted HR being 1.42 (95%CI: 1.01-1.95). No statistically significant difference was observed for suspected/confirmed (HR=1.00, 95%CI: 0.93-1.07) or confirmed (HR=1.08, 95%CI: 0.92-1.27) COVID-19 rate between osteoarthritis participants and the general population.
RA, but not osteoarthritis, was associated with an increased risk of COVID-19. Our findings provide timely evidence to support recommendations that booster vaccines and priority access to anti-SARS-CoV-2 monoclonal antibody treatments should be encouraged for RA patients.