Risk of Severe COVID-19 Outcomes Among Patients with Rheumatoid Arthritis in the United States

IntroductionCoronavirus disease 2019 (COVID-19) has infected over 22 million individuals worldwide. It remains unclear whether patients with COVID-19 and Rheumatoid Arthritis (RA) experience worse clinical outcomes compared to similar patients with COVID-19 without RA. AimThe aim of this study is to provide insights on how COVID-19 impacted patients with RA given the nature of the disease and medication used. MethodsRA cases were identified via International Classification of Diseases (ICD) codes and COVID-19 cases by laboratory results in the U.S. based TriNetX network. Patients with COVID-19 and RA were propensity-score matched based on demographics with patients with COVID-19 without RA at a 1:3 ratio. A hospitalized sub-population was defined by procedure codes. ResultsWe identified 1,014 COVID-19 patients with RA and 3,042 non-RA matches selected from 137,757 patients. The odds of hospitalization (non-RA:23%, RA:24.6%, OR:1.08, 95% CI: 0.88 to 1.33) or mortality (non-RA:5.4%, RA:6%, OR:0.93, 95% CI: 0.65 to 1.34) were not significantly different. The hospitalized sub-population included 249 patients with COVID-19 and RA and 745 non-RA matches selected from 21,435 patients. The risk of intensive care unit (ICU) admission (non-RA:18.8%, RA:18.1%, OR:0.94, 95% CI: 0.60 to 1.45), and inpatient mortality (non-RA:14.4%, RA:14.5%, OR:0.86, 95% CI: 0.53 to 1.40) were not significantly different. ConclusionWe didnt find evidence suggesting patients with COVID-19 and RA are more likely to have severe outcomes than patients with COVID-19 without RA. Key Messages- Patients with Rheumatoid Arthritis (RA) tend to be older, and often have co-morbidities which could put them at greater risk of severe COVID-19 outcomes. - This study is one of the largest studies of COVID-19 infected RA populations to date. We did not find increased risk of hospitalization, ICU admission, or mortality among RA patients vs. matched non-RA patients. - Patients previously exposed to anti-coagulants experienced higher risks of hospitalization and overall mortality. Extra attention is needed for treating such patients.