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

  1. Ching-Yi Chuo
  2. Vince Yau
  3. Sriraman Madhavan
  4. Larry Tsai
  5. Jenny Chia

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Abstract

Introduction

Coronavirus 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.

Aim

The 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.

Methods

RA 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.

Results

We 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.

Conclusion

We didn’t 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.

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      SciScore for 10.1101/2021.07.09.21260106: (What is this?)

      Please note, not all rigor criteria are appropriate for all manuscripts.

      Table 1: Rigor

      Ethicsnot detected.
      Sex as a biological variablenot detected.
      Randomizationnot detected.
      Blindingnot detected.
      Power Analysisnot detected.

      Table 2: Resources

      No key resources detected.

      Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

      Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

      Results from TrialIdentifier: No clinical trial numbers were referenced.

      Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

      Results from JetFighter: We did not find any issues relating to colormaps.

      Results from rtransparent:
      • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
      • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
      • No protocol registration statement was detected.

      Results from scite Reference Check: We found no unreliable references.

      About SciScore

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    2. Version published to 10.1101/2021.07.09.21260106v1 on medRxiv