Hospitalization, Critical Illness, and Mortality Outcomes of COVID‐19 in Patients With Rheumatoid Arthritis

OBJECTIVE: To investigate the clinical outcomes of patients with rheumatoid arthritis (RA) with COVID‐19. METHODS: This retrospective study consisted of 361 patients with RA+ and 45,954 patients with RA− (March 2020 to August 2022) who tested positive for SARS‐CoV‐2 by polymerase‐chain‐reaction in the Montefiore Health System, which serves a large low‐income, minority‐predominant population in the Bronx and was an epicenter of the initial pandemic and subsequent surges. Primary outcomes were hospitalization, critical illness, and all‐cause mortality associated with SARS‐CoV‐2 infection. Comparisons were made with and without adjustment for covariates, as well as with 1083 matched controls of patients with RA− and COVID‐19. RESULTS: Patients with RA+ and COVID‐19 were older (62.2 ± 23.5 vs. 45.5 ± 26.3; P < 0.001), were more likely females (83.1% vs. 55.8%; P < 0.001), were Black (35.5% vs. 30.3%; P < 0.05), and had higher rates of comorbidities (P < 0.05), hospitalization (52.4% vs. 32.5%; P < 0.005), critical illness (10.5% vs. 6.9%; P < 0.05), and mortality (11.1% vs. 6.2%; P < 0.01) compared with patients with RA− and COVID‐19. Patients with RA+ with COVID‐19 had higher odds of critical illness (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI]: 1.09‐1.93; P = 0.008) but no differences in hospitalization (aOR = 1.18 [95% CI: 0.93‐1.49]; P = 0.16) and mortality (aOR = 1.34 [95% CI: 0.92‐1.89]; P = 0.10) after adjusting for covariates. Odds ratio analysis identified age, hospitalization status, female sex, chronic kidney disease, chronic obstructive pulmonary disease, and Black race to be significant risk factors for COVID‐19‐related mortality. Pre‐COVID‐19 steroid and biologic therapy to treat RA were not significantly associated with worse outcomes (P > 0.05). Outcomes were not different between patients with RA+ and propensity‐matched RA− controls (P > 0.05). CONCLUSION: Our findings suggest that risk factors for adverse COVID‐19 outcomes were not attributed to RA per se but rather age and preexisting medical conditions of patients with RA.