Initial Treatment Strategy Not Linked to COVID-19 Hospitalization in Inflammatory Arthritis

In early inflammatory arthritis (IA), patient characteristics compared with initial treatment strategy are strongly associated with severe COVID-19 outcomes, including hospitalization and mortality, according to study results published in Rheumatology.

Researchers in the UK collected data from the National Early Inflammatory Arthritis Audit (NEIAA) to assess the risks and predictors of COVID-19 hospitalization and mortality.

The study population (N=14,007) included patients with IA aged a median of 57 years; 61.9% were women; 85.5% were White; and 19.5% had 2 or more comorbidities. The most common types of arthritis among patients were rheumatoid arthritis (RA), followed by psoriatic arthritis (PsA), and undifferentiated arthritis.

During the first 3 months after IA diagnosis, most of the patients received corticosteroids (70%) and the most common disease-modifying antirheumatic drug (DMARD) was methotrexate monotherapy (44%). One-fifths of the study population (21%) did not receive DMARDs during the first 3 months after diagnosis.

A total of 143 patients were hospitalized for COVID-19, 47 of whom died. The incidence rate (IR) of COVID-19 hospitalization was 0.93 per 100 person-years (py). Stratified by type of arthritis, the IR for COVID-19 admissions was highest for other arthritis (IR, 1.18 per 100 py), followed by undifferentiated arthritis (IR, 1.03 per 100 py), RA (IR, 0.98 per 100 py), axial spondyloarthritis (IR, 0.66 per 100 py), and PsA (IR, 0.56 per 100 py). The IR for COVID-19 mortality was 0.30 per 100 py, and as with admissions, the IR was highest for other arthritis diagnoses (IR, 0.84 per 100 py).

Compared with the general population, patients with IA did not have a significantly different COVID-19 standardized mortality ratio.

In the unadjusted analyses, sulfasalazine monotherapy was associated with COVID-19 admission (hazard ratio [HR], 1.92; 95% CI, 1.04-3.56; P =.03), and steroids were associated with COVID-19 mortality (HR, 2.29; 95% CI, 1.02-5.13; P =.04). However, both associations were attenuated after adjusting for age, sex, comorbidities, and IA severity.

Predictors for hospital admission that remained significant in the adjusted analysis included Health Assessment Questionnaire (HAQ) score (adjusted HR [aHR], 2.49), former smoking status (aHR, 1.62), age per 1-year increase (aHR, 1.02), the Musculoskeletal Health Questionnaire (MSK-HQ) score (aHR, 0.96), deprivation per decile (aHR, 0.92), and the female sex (aHR, 0.69). Predictors for COVID-19 mortality were diabetes (aHR, 3.66), HAQ score (aHR, 2.61), hypertension (aHR, 1.99), and age per 1-year increase (aHR, 1.07).

Study limitations included the low incidence rates of COVID-19 hospitalization and mortality and the inability to assess treatment changes over time.

The study authors concluded, “Risk factors for severe COVID-19 did not differ to the known predictors in the general population. Importantly, the initial treatment strategy did not appear to associate with COVID-19 hospitalization or mortality.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Rheumatology Advisor