Breakthrough SARS-Cov-2 Infection and Disease Flares in Patients with Rheumatoid Arthritis: Result from COVAD E-Survey Study

Yi-Ming Chen¹, Jun-Pen Chen², Chi-Wei Tseng², CARLOS ENRIQUE TORO GUTIERREZ³, Elena Nikiphorou⁴, Ai Lyn Tan⁵, Arvind Nune⁶, Esha Kadam⁷, Masataka Kuwana⁸, Jessica Day⁹, Sreoshy Saha¹⁰, Tsvetelina Velikova¹¹, James Lilleker¹², CARLO VINICIO CABALLERO¹³, Parikshit Sen¹⁴, Hector Chinoy¹⁵, Rohit Aggarwal¹⁶, Vikas Agarwal¹⁷ and Latika Gupta¹⁸, ¹Taichung Veterans General Hospital, Taichung, Taiwan, ²Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan, ³Centro de Estudios de Reumatología y Dermatología SAS, Cali, Colombia, ⁴King's College London, London, United Kingdom, ⁵University of Leeds, Leeds, United Kingdom, ⁶Southport & Ormskirk NHS Foundation Trust, Liverpool, United Kingdom, ⁷Seth Gordhandhas Sunderdas Medical College and King Edwards Memorial Hospital, Mumbai, India, ⁸Nippon Medical School Graduate School of Medicine, Tokyo, Japan, ⁹Walter and Eliza Hall Institute, Melbourne, Australia, ¹⁰Mymensingh Medical College, Faridpur, Bangladesh, ¹¹Medical Faculty, Sofia University St. Kliment Ohridski, Sofia, Bulgaria, ¹²Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK. Orcid ID: 0000-0002-9230-4137., Manchester, United Kingdom, ¹³REUMACARIBE IPS, Barranquilla, Colombia, ¹⁴Maulana Azad Medical College, 2-Bahadurshah Zafar Marg, New Delhi, Delhi-110002, India., Dalhi, India, ¹⁵The University of Manchester, Sale, United Kingdom, ¹⁶University of Pittsburgh, Pittsburgh, PA, ¹⁷Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India, ¹⁸Royal Wolverhampton Trust, Wolverhampton/University of Manchester, United Kingdom

Meeting: ACR Convergence 2023

Keywords: Arthritis, Infectious, COVID-19, rheumatoid arthritis

Session Information

Date: Sunday, November 12, 2023

Title: (0196–0228) Infection-related Rheumatic Disease Poster

Session Type: Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Existing studies have shown that disease activity of patients with rheumatoid arthritis (RA) may surge after COVID-19 infection. However, factors associated with disease flares remain unknown. This study aimed to identify factors associated with breakthrough infection and disease flares in patients with RA following COVID-19 infection.

Methods: We selected patients with RA from an online e-survey data from the COVAD study. Demographic data, patient reported outcomes, comorbidities and pharmacologic treatments were extracted from the database. Disease flare-up was derived from the e-survey database. Factors associated with disease flare-up were determined by multivariable logistic regression analysis.

Results: In total, 1928 patients with RA were extracted from the COVAD database. Older age, Caucasian ethnicity, comorbidities with chronic kidney disease and asthma, were associated with COVID-19 breakthrough infection. Moreover, younger age (odds ratio, OR: 0.98, 95% CI: 0.96 – 0.99, p< 0.001), ethnicity other than Asian, tuberculosis (OR: 3.80, 95% CI: 1.12 – 12.94, p=0.033), treatment with methotrexate (OR: 2.55, 95% CI: 1.56 – 4.17, p< 0.001), poor global physical health (OR: 1.07, 95% CI: 1.00 –1.15, p=0.044) and mental health (OR: 0.91, 95% CI: 0.87 –0.95, p< 0.001) were independent factors associated with disease flares in patients with RA.

Conclusion: Our study highlights the necessity for rheumatologists to recognize potential predictors of RA flare-up following COVID-19 infection. Proactive strategies are recommended for managing high-risk RA patients.

Table 1. Factors associated with breakthrough COVID_19 infection in patients with RA
By Chi-square test or ANOVA test. *p<0.05, **p<0.01
#infliximab, adalimumab, certolizumab, golimumab, etanercept
+tofacitinib, baricitinib, upadacitinib

Table 2. Factors associated with disease flare in patients with RA after COVID_19 infection.
By Logistic regression. *p<0.05, **p<0.01.
#infliximab, adalimumab, certolizumab, golimumab, etanercept
+tofacitinib, baricitinib, upadacitinib

Disclosures: Y. Chen: None; J. Chen: None; C. Tseng: None; C. TORO GUTIERREZ: AbbVie/Abbott, 6, Boehringer-Ingelheim, 6, Janssen, 6; E. Nikiphorou: AbbVie/Abbott, 6, Celltrion, 6, Eli Lilly, 6, fresenius, 6, Galapagos, 6, Gilead, 1, 6, Pfizer, 6, Sanofi, 6; A. Tan: Abbvie, 1, 6, Gilead, 6, Janssen, 6, Lilly, 6, Novartis, 6, Pfizer, 6, UCB, 6; A. Nune: None; E. Kadam: None; M. Kuwana: AbbVie/Abbott, 6, Asahi-Kasei, 5, 6, Astellas, 6, AstraZeneca, 2, Boehringer-Ingelheim, 2, 5, 6, Chugai, 2, 5, 6, Corbus, 2, Eisai, 6, GlaxoSmithKlein(GSK), 2, Horizon, 2, Janssen, 6, Kissei, 2, MBL, 2, 5, Mitsubishi Tanabe, 2, 5, 6, Mochida, 2, 6, Nippon Shinyaku, 6, Ono, 5, 6; J. Day: CSL limited, 5; S. Saha: None; T. Velikova: AstraZeneca, 6, Pfizer, 6; J. Lilleker: None; C. CABALLERO: None; P. Sen: None; H. Chinoy: AstraZeneca, 1, Biogen, 2, Eli Lilly, 5, GlaxoSmithKlein(GSK), 6, Novartis, 2, Orphazyme, 2, Pfizer, 1, UCB, 6; R. Aggarwal: Actigraph, 2, Alexion, 2, ANI Pharmaceuticals, 2, Argenx, 2, AstraZeneca, 2, Boehringer-Ingelheim, 2, 5, Bristol-Myers Squibb(BMS), 2, 5, CabalettaBio, 2, Capella Bioscience, 2, Corbus, 2, CSL Behring, 2, EMD Serono, 2, 5, Galapagos, 2, Horizon Therapeutics, 2, I-Cell, 2, Janssen, 2, 5, Kezar, 2, Kyverna, 2, Mallinckrodt, 5, Merck, 2, Octapharma, 2, Pfizer, 2, 5, Q32, 5, Roivant, 2, Sanofi, 2, Teva, 2; V. Agarwal: None; L. Gupta: None.

To cite this abstract in AMA style:

Chen Y, Chen J, Tseng C, TORO GUTIERREZ C, Nikiphorou E, Tan A, Nune A, Kadam E, Kuwana M, Day J, Saha S, Velikova T, Lilleker J, CABALLERO C, Sen P, Chinoy H, Aggarwal R, Agarwal V, Gupta L. Breakthrough SARS-Cov-2 Infection and Disease Flares in Patients with Rheumatoid Arthritis: Result from COVAD E-Survey Study [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/breakthrough-sars-cov-2-infection-and-disease-flares-in-patients-with-rheumatoid-arthritis-result-from-covad-e-survey-study/. Accessed .

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