A yearlong study led by a UNMC and Veterans Affairs researcher found that rheumatoid arthritis was associated with a 25% higher risk of COVID-19 and 35% higher risk of COVID-19 hospitalization or death.
Researchers used a national VA health care database comparing 33,886 patients with rheumatoid arthritis to 33,886 patients without it for the study.
The large, national study accounted for many factors that influence COVID-19 risk, including age, sex, race, comorbidities and geography.
"RA patients are known to be predisposed to infection, but prior literature was largely for bacterial infections," said Bryant England, MD, PhD, assistant professor in the UNMC Department of Internal Medicine Division of Rheumatology & Immunology and the VA Nebraska-Western Iowa Health Care System. "During the pandemic, both providers and patients consistently have been asking whether RA may predispose patients to COVID-19 -- a viral infection -- and a more severe COVID-19 disease course."
Dr. England said the team's findings showed RA patients with greater levels of immunosuppressive therapies such as biologic disease-modifying antirheumatic drugs and prednisone, had the highest risk of COVID-19 and severe COVID-19.
"This does not mean that the medications cause COVID-19 and patients should not pre-emptively discontinue their use," he said. "Rather, they should work with their rheumatologist to determine the optimal treatment regimen that balances the benefits of controlling their RA with the potential risks of these therapies."
He said factors that may be associated with use of these medications, such as more severe RA, also may be contributing to the COVID-19 risk.
"RA represents a population at high risk for COVID-19 and a severe COVID-19 disease course. Thus, we need to prioritize delivering preventive and therapeutic strategies to these patients in order to minimize negative health outcomes. To date, the list of 'high-risk' conditions has not included most patients receiving immunosuppressive therapies.
"While future studies are needed outside of RA, our findings suggest that policy makers should consider broadening the 'high-risk' group to include patients taking immunosuppressive therapies for reasons other than post-transplant," Dr. England said.
Other UNMC authors were Punyasha Roul, Yangyuna Yang, PhD, Andre Kalil, MD, Kaleb Michaud, PhD, Geoffrey Thiele, PhD, and Ted Mikuls, MD.