UK Biobank Study Finds Elevated Risk of Death From COVID-19 in Those With RA

Information on the risk of death from COVID-19 in individuals with rheumatoid arthritis (RA) or gout is limited; a recent study from the United Kingdom sought to examine whether gout and RA are risk factors for COVID-19 diagnosis or death.

Researchers used data from for UK Biobank, which contains the records of about half a million participants; recruitment began in 2006 with planned follow-up for at least 30 years. The analysis included those who had a positive SARS-CoV2 test result and/or an International Classification of Diseases, Tenth Revision code for confirmed COVID-19 or probable COVID-19 as well as a variety of methods to determine RA or gout: self-reported gout, hospital codes for gout, self-reported RA, hospital codes for RA, and hospital records of either illness.

They created and analyzed 3 case-controlled datasets:

• Analysis A tested for association with COVID‐19 diagnosis in a population‐based cohort, consisting of 2118 case patients and 471,021 controls
• Analysis B tested for association with death from COVID‐19 in people with COVID‐19, consisting of 457 people diagnosed with COVID‐19 who died and 1602 people diagnosed with COVID‐19 who survived
• Analysis C tested for association with death related to COVID‐19 in a population‐based cohort, consisting of 457 people diagnosed with COVID‐19 who died and 472,682 others, including 1616 people diagnosed with COVID‐19 not known to have died

Multivariable-adjusted analysis showed that RA, but not gout, was associated with COVID‐19 diagnosis in analysis A.

Neither RA nor gout was associated with risk of death in the group diagnosed with COVID‐19 in analysis B.

However, in analysis C, RA was associated with risk of death related to COVID‐19, independent of comorbidities and other measured risk factors (OR, 1.9; 95% CI, 1.2–3.0). Gout was not associated with death related to COVID‐19 in the same UK Biobank analysis (OR 1.2; 95% CI, 0.8–1.7).

The study had a number of limitations, which the researchers hope could be overcome in future, larger studies. For one thing, the influence of RA therapies was not known. In addition UK Biobank registrants are middle-aged, white Europeans and so can't be generalized to other ethnic groups or in individuals younger than 50. There is also no information on recovery status, so it is possible that the cohort in analysis B may have had unidentified COVID-19 deaths later.

Reference

Topless RK, Phipps-Green A, Leask M, et al. Gout, rheumatoid arthritis, and the risk of death related to coronavirus disease 2019: An analysis of the UK Biobank. ACR Open Rheumatol. Published online April 15, 2021. doi: 10.1002/acr2.11252.