The effect of COVID-19 infection on the clinical course, outcome and activity of rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory disease of unknown cause characterized by polyarthritis and extra-articular symptoms. Rheumatoid arthritis has been investigated in patients suffering from COVID-19 infection in several studies. The aim of this study was to investigate the role of COVID-19 infection in the intensity of rheumatoid arthritis.

In this retrospective cohort study, the medical files of 104 rheumatoid arthritis patients with COVID-19 infection were reviewed. Patients were evaluated in terms of rheumatoid arthritis disease activity in the first two weeks of COVID-19 infection based on DAS28 criteria and compared with their disease activity index before COVID-19 infection. Anti-CCP test was used to differentiate the activity of rheumatoid arthritis from the symptoms of viral infection.

The mean age of the patients was 53.3±13.6 years and 84 (80.8%) were women. The mean duration of rheumatoid arthritis in the patients was 95.09±84.05 months. The severity of the COVID-19 disease was severe-critical in 19.3% of patients. The disease activity of 76.5% of the patients did not differ before and after exposing to COVID-19, and only in 14 (13.5%) patients the disease activity intensified after contracting COVID-19. All patients with intensified disease activity had positive Anti-CCP, which was significantly lower in the other two groups. Also, the percentage of mortality in patients whose disease activity was intensified was significantly higher than the other two groups. In terms of outcome, the mean length of hospitalization in patients was 7.3±3.5 days and 10 patients (9.6%) died.

The findings of the present study show that infection with COVID-19 does not have a significant effect on the intensity of rheumatoid arthritis disease, however, it is necessary to conduct more studies in this field.