LESS THAN EXPECTED IMPACT of RHEUMATOID ARTHRITIS and AXIAL SPONDYLOARTHRITIS DISEASE on COVID SEVERITY

ABSTRACT

Background: Throughout the pandemic, there has been ongoing concern that people with autoimmune diseases such as rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) will have more severe COVID-19 disease due to immune dysfunction associated with autoimmune diseases and their treatment. Objectives: We aimed to compare the severity of COVID-19 in patients with RA versus axSpA and characterize the predictors of COVID-19 severity during the pre-Omicron pandemic phases. Methods: The IMPACT (IMPact of infammatory Arthritis on COVID Outcomes STudy) study is a monthly survey of two established northern Alberta, Canada prospective cohorts of RA and axSpA patients from November 2020-2021 who answered Redcap surveys through de-identifed email link surveying patient demographics, disease characteristics, COVID-19 symptoms, treatment of RA and axSpA, health care utilization, vaccination status and vaccine adverse events. Descriptive and univariate analyses (dependent variable = severe COVID-19) were performed followed by multivariate analyses of all signifcant and clinically relevant independent variables from the univariate analysis. Infection severity was defned as any patient with COVID-19 symptoms who visited a doctor, ER or required hospital admission. Results: 773 of 2167 (36%) patients (RA n=574, axSpA n=197) registered in both cohorts answered at least one baseline survey, 28 (4%) reporting positive COVID-19 tests (24 positive once). Of 442 reporting COVID-19 symptoms during the survey, 11 (3%) were admitted for a mean of 4 days, 2 requiring ICU or blood clot treatment and 1 requiring advanced therapy. 116 (26%) visited a physician for Covid symptoms. Univariate analysis showed that the use of steroids, NSAIDs and increased disease activity were associated with having less severe infection but these associations were not signifcant in the multivariate analysis (Table 1). There were no signifcant impacts of RA vs axSpA, age, gender, treatment, disease activity, or smoking. Conclusion: Possible disease related risk factors for increased COVID-19 severity in RA and axSpA patients preceding the onset of the Omicron variant including use of steroids or DMARDs were not associated with severe infection. These fndings are consistent with other international studies whereby other non-rheumatic disease comorbidities played a greater role in infection severity.