Risk Factors Associated with Coronavirus Disease 2019-Related Hospitalization in Rheumatoid Arthritis Patients

Background: Previous studies have shown that the outcome of coronavirus disease 2019 (COVID-19) in patients with rheumatoid arthritis is influenced by certain comorbidities, diseases, and specific therapeutic modalities. Aim: This study aimed to analyze the impact of disease-modifying antirheumatic drugs, vaccination status, and clinical and demographic characteristics on the hospitalization rate of COVID-19 patients with rheumatoid arthritis. Patients and Methods: Retrospective analysis was obtained by completing a web-based survey, according to the European COVID-19 register. The data included demographic patient characteristics, comorbidities, immunosuppressive and other drugs, and 112 COVID-19 patients with rheumatoid arthritis. These patients were infected with severe acute respiratory syndrome coronavirus 2 from July 16 to November 22, 2021. Results: In patients with rheumatoid arthritis, 21 (18.75%) were hospitalized due to COVID-19 infection. In the group of hospitalized patients, 19 (90.5%) patients required oxygen support therapy, while 6 (28.6%) patients died during hospitalization. The participants were predominantly female (78.6%), with a mean age of 54. Age was associated with a higher hospitalization rate in the univariate analysis. After multiple adjustments, the final regression model showed that hypertension (OR (odd ratio) = 5.994, 95% CI (confidence interval) 1.443-24.901, p = 0.014) and rituximab therapy (OR = 23.969, 95% CI 5.129-112.008, p < 0.001) were the risk factors associated with hospitalization. Vaccination status did not affect the outcome of COVID-19 infection. Conclusions: In rheumatoid arthritis patients with COVID-19 infection, treatment with disease-modifying antirheumatic drugs, except for rituximab, did not increase the risk of hospitalization, while the use of tocilizumab proved to be protective. Independent factors associated with the hospitalization of rheumatoid arthritis patients were age, hypertension, and rituximab therapy. The strongest predictors for hospitalization due to severe acute respiratory syndrome coronavirus 2 infection were the use of rituximab and hypertension. Therapy with rituximab increases the risk of a severe course of infection. Therefore, it should be given with particular caution. Hypertension is a significant risk factor that further increases these patients' hospitalization risk.

Automated summary

This study analyzed the impact of disease-modifying antirheumatic drugs, vaccination status, and clinical and demographic characteristics on the hospitalization rate of COVID-19 patients with rheumatoid arthritis. The results showed that treatment with disease-modifying antirheumatic drugs, except for rituximab, did not increase the risk of hospitalization, while the use of tocilizumab proved to be protective. Age, hypertension, and rituximab therapy were identified as independent factors associated with the hospitalization of rheumatoid arthritis patients.