COVID-19 Latest: New Zealand And Australian Study Shows That Rheumatoid Arthritis May Increase Risk Of COVID-19 Mortality
: A new study by scientists from the University of Otago-New Zealand, University of Auckland-New Zealand and University of Queensland, Brisbane-Australia have found that individuals with rheumatoid arthritis (RA) may be at an increased risk of death if they develop COVID-19 after becoming infected with SARS-CoV-2.
The study team used data from the UK Biobank. Multivariate-adjusted logistic regression was employed in the following analyses. Analysis A: to test for association between gout or RA and COVID-19 diagnosis in a population-based cohort (n=473,139). Analysis B: to test for association between gout or RA and death from COVID-19 in a case-control cohort of people who died or survived with COVID-19 (n=2,073). Analysis C: to test for association with gout or RA and death from COVID-19 in a population-based cohort (n=473,139)
Study results showed that neither RA nor gout associated with COVID-19 diagnosis in analysis A, nor did RA or gout associate with risk of death in the COVID-19-diagnosed group in analysis B. However RA associated with risk of death from COVID-19 using the population-based cohort in analysis C independent of comorbidities and other measured risk factors (OR=1.8 [95% CI 1.2 ; 2.7]). Gout was not associated with death from COVID-19 in the same population-based analysis (OR=1.2 [95% CI 0.9 ; 1.7]).
The study showed that RA and gout are not risk factors for COVID-19-diagnosis. However RA, but not gout, is a risk factor for death from COVID-19.
The study findings were published on a preprint server and are pending peer review. https://www.medrxiv.org/content/10.1101/2020.11.06.20227405v1
The study team used data from the UK Biobank to assess whether the two most common inflammatory arthropathies ie gout and rheumatoid arthritis are risk factors for being diagnosed with or dying from the disease.
Initially in a population-based analysis of more than 470,000 people, neither condition was associated with an increased risk of being diagnosed with COVID-19.
Alarmingly however, rheumatoid arthritis, but not gout, was associated with an increased risk of death from the disease, after adjustment for comorbidities and other risk factors.
Corresponding author Dr Tony Merriman from the University of Otago-New Zealand told Thailand Medical News, “We found an increased risk of death from RA [rheumatoid arthritis], and this needs to be further explored in large datasets where a range of other factors can be investigated (e.g., RA therapies).”
Typically gout is caused by an overreactive innate immune response to monosodium urate crystals in the joints; a response that is driven by auto-inflammatory interleukin-1β (IL-1β).
In theory this could lead to an increased immune response to infection with SARS-CoV-2 – the agent that causes COVID-19.
Additionally, high serum levels of the pro-inflammatory factors IL-6, IL-8 and tumor necrosis factor-α (TNF-α) have been associated with poor outcomes in COVID-19. Since individuals with gout have higher circulating levels of these cytokines, they may also be
at risk of these poor outcomes, say the research team.
Furthermore gout is also strongly associated with cardiometabolic comorbidities such as heart disease, type 2 diabetes, and kidney disease, all of which are known risk factors for COVID-19-related death.
Rheumatoid arthritis is a T-cell and B-cell mediated autoimmune disease that, again, targets the joints.
The clinical condition is characterized by high circulating levels of TNF-α and IL-6, and, like gout, could potentially lead to an increased immune response to SARS-CoV-2. Rheumatoid arthritis is also associated with a greater risk of cardiovascular disease.
To date however, there is a paucity of data available on COVID-19 outcomes among individuals with these common inflammatory arthropathies.
Dr Merriman added, “Information on the risk of death from COVID-19 for people with gout and rheumatoid arthritis is scarce.”
The study team set out to investigate whether gout and arthritis are associated with an increased risk of COVID-19 diagnosis or COVID-19-related death.
The study team used UK Biobank data, including information on hospital diagnoses from 1991 up to June 30th, 2020; SARS-CoV-2 tests carried out between March 16th and August 24th, 2020, and death records up to August 14th, 2020.
For the study all associations were analyzed using multivariate-adjusted logistic regression to control for age, sex, ethnicity, Townsend deprivation index, BMI, smoking status and 14 comorbidities.
Study analysis A tested for associations between gout or rheumatoid arthritis and COVID-19 diagnosis in a population-based cohort of 473,139 individuals.
The analysis B tested for associations between each of the conditions and death among a case-control cohort of 2,073 individuals who had been diagnosed with COVID-19.
Whereas analysis C also used the population-based cohort to test for associations between each of the conditions and death from COVID-19.
Interestingly no association was identified between gout or rheumatoid arthritis and COVID-19 diagnosis in the population-based cohort, and neither condition was associated with death among the diagnosed individuals.
Significantly, rheumatoid arthritis was associated with a 1.8-fold increased risk of death in the population-based cohort. Gout, on the other hand, was not associated with any increased risk of death in this cohort.
The study team however said that the findings need to be checked using larger datasets
The team said, “In a population-based analysis there is an increased risk of death by COVID-19 for people with rheumatoid arthritis independent of comorbidities, but not gout.”
The team says it is important that the findings presented here are replicated in larger administrative datasets.
Dr Merriman added, “These datasets would allow for more stratification and use of additional models to fully explore factors including medications that might influence the observed association with RA rheumatoid arthritis.”
The study team concluded, “If our association were replicated, investigation of the reasons for the relationship between RA and death from COVID-19 would improve understanding and potentially improve clinical management of COVID-19.”
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