Risk of COVID‐19 in Rheumatoid Arthritis: A National Veterans Affairs Matched Cohort Study in At‐Risk Individuals

England, Bryant R.; Roul, Punyasha; Yang, Yangyuna; Kalil, Andre C.; Michaud, Kaleb; Thiele, Geoffrey M.; Sauer, Brian C.; Baker, Joshua F.; Mikuls, Ted R.

BACKGROUND: While rheumatoid arthritis (RA) and its treatments are associated with an increased infection risk, it remains unclear whether these factors impact the risk or severity of COVID‐19. METHODS: We conducted a matched cohort study using national Veterans Affairs data. Among non‐deceased individuals on January 1, 2020 who received VA care in 2019, we matched RA to non‐RA patients (1:1) on age, sex, and VA site. COVID‐19 and severe COVID‐19 (hospitalization or death) were obtained from a national VA COVID‐19 surveillance database through December 10, 2020. We used multivariable Cox models to compare the risk of COVID‐19 and COVID‐19 hospitalization or death after adjusting for demographics, comorbidities, health behaviors, and county level COVID‐19 incidence rates. RESULTS: RA and non‐RA patients (n=33,886 each) were male predominant (84.5%) and had a mean age of 67.8 years. During follow‐up, there were 1,503 COVID‐19 diagnoses, 388 severe COVID‐19 cases, and 228 non‐COVID‐19 related deaths. After multivariable adjustment, RA was associated with a higher risk of COVID‐19 (hazard ratio [HR] 1.25 [95% confidence interval 1.13, 1.39]) and COVID‐19 hospitalization or death (HR 1.35 [1.10, 1.66]). DMARDs and prednisone, but not RA autoantibody seropositivity, as well as black race, Hispanic ethnicity, and several chronic conditions were associated with COVID‐19 and COVID‐19 hospitalization or death. CONCLUSIONS: Patients with RA are at higher risk for COVID‐19 and COVID‐19 hospitalization or death than non‐RA. With a COVID‐19 risk that approaches other recognized chronic conditions, these findings suggest RA patients should be prioritized for COVID‐19 prevention and management.