Background/Purpose: Rheumatoid arthritis (RA) has been associated with severe COVID-19, but few studies have investigated outcomes in RA phenotypes such as interstitial lung disease (RA-ILD), seropositivity, and bone erosions. We aimed to assess COVID-19 outcomes in patients with RA overall, and those with and without RA-ILD, compared to general population comparators.

Methods: A multicenter, retrospective comparative cohort study was conducted at two healthcare systems with hospitals and outpatient centers in 6 states across the US. Consecutive patients with RA meeting 2010 ACR/EULAR criteria and a positive COVID-19 test (index date) from March 1, 2020, through June 6, 2021, were matched 1:5 on age, sex, race, and calendar date to general population comparators without RA. We examined subgroups of RA by phenotypic features: RA-ILD per Bongartz criteria (Bongartz, T. Arthritis Rheum. 2010), serostatus (either rheumatoid factor or cyclic citrullinated peptide antibody), and bone erosions. Severe COVID-19 was a composite of hospitalization or death within 14 days of COVID-19 diagnosis. We used multivariable Cox regression to investigate the association of RA and RA phenotypes with COVID-19 outcomes compared to matched comparators.

Results: We identified 582 patients with RA and 2,875 matched comparators, all with COVID-19. The mean age was 62 years, 72% were female, and 79% were White. Among patients with RA, median RA duration was 8 years, 9% had RA-ILD, 68% were seropositive, 27% had bone erosions. 28% were using glucocorticoids, and 79% were on DMARDs at the time of COVID-19 diagnosis. During a follow-up of 41,411 person-days, there were 126 (22%) severe outcomes observed in the RA patients and 363 (13%) in the comparators (follow-up 226,550 person-days). The corresponding rate was higher among RA patients than comparators (3.0 per 1,000 days [95% CI 2.5-3.6] vs. 1.6 per 1,000 days [95% CI 1.4-1.8], respectively). Overall, RA patients had a 75% higher risk of severe COVID-19 than comparators after adjustment (HR 1.75, 95% CI 1.45-2.10). Among those with RA-ILD, the severe COVID-19 rate was significantly higher than their comparators (10.9 [95% CI 6.7-15.2] vs. 2.5 per 1,000 days [1.8-3.2], respectively). RA-ILD was associated with 2.5-fold higher risk for severe COVID-19 than comparators (multivariable HR 2.50 [95% CI 1.66-3.77], Table). There was a significant interaction between RA/comparator status and presence/absence of ILD for risk of severe COVID-19 (p< 0.046, Figure). The elevated risk for severe COVID-19 was similarly higher for seropositive and erosive RA compared to the general population but these were not effect modifiers of the association of RA with severe outcomes.

Conclusion: RA patients have a higher risk of severe COVID-19, especially those with ILD. Our findings suggest that ILD or its treatment may be a significant contributor to severe COVID-19 outcomes in RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-interstitial-lung-disease-on-covid-19-severity-among-patients-with-rheumatoid-arthritis-a-multicenter-comparative-study/