Background While rheumatoid arthritis (RA) and its treatments are associated with an increased infection risk, it remains unclear whether these factors impact the risk or severity of COVID‐19. Methods We conducted a matched cohort study using national Veterans Affairs data. Among non‐deceased individuals on January 1, 2020 who received VA care in 2019, we matched RA to non‐RA patients (1:1) on age, sex, and VA site. COVID‐19 and severe COVID‐19 (hospitalization or death) were obtained from a national VA COVID‐19 surveillance database through December 10, 2020. We used multivariable Cox models to compare the risk of COVID‐19 and COVID‐19 hospitalization or death after adjusting for demographics, comorbidities, health behaviors, and county level COVID‐19 incidence rates. Results RA and non‐RA patients (n=33,886 each) were male predominant (84.5%) and had a mean age of 67.8 years. During follow‐up, there were 1,503 COVID‐19 diagnoses, 388 severe COVID‐19 cases, and 228 non‐COVID‐19 related deaths. After multivariable adjustment, RA was associated with a higher risk of COVID‐19 (hazard ratio [HR] 1.25 [95% confidence interval 1.13, 1.39]) and COVID‐19 hospitalization or death (HR 1.35 [1.10, 1.66]). DMARDs and prednisone, but not RA autoantibody seropositivity, as well as black race, Hispanic ethnicity, and several chronic conditions were associated with COVID‐19 and COVID‐19 hospitalization or death. Conclusions Patients with RA are at higher risk for COVID‐19 and COVID‐19 hospitalization or death than non‐RA. With a COVID‐19 risk that approaches other recognized chronic conditions, these findings suggest RA patients should be prioritized for COVID‐19 prevention and management.

ObjectivesTo compare the onset and trajectory of multimorbidity between individuals with and without rheumatoid arthritis (RA).MethodsA matched, retrospective cohort study was completed in a large, US commercial insurance database (MarketScan) from 2006 to 2015. Using validated algorithms, patients with RA (overall and incident) were age-matched and sex-matched to patients without RA. Diagnostic codes for 44 preidentified chronic conditions were selected to determine the presence (≥2 conditions) and burden (count) of multimorbidity. Cross-sectional comparisons were completed using the overall RA cohort and conditional logistic and negative binomial regression models. Trajectories of multimorbidity were assessed within the incident RA subcohort using generalised estimating equations.ResultsThe overall cohort (n=277 782) and incident subcohort (n=61 124) were female predominant (76.5%, 74.1%) with a mean age of 55.6 years and 54.5 years, respectively. The cross-sectional prevalence (OR 2.29, 95% CI 2.25 to 2.34) and burden (ratio of conditions 1.68, 95% CI 1.66 to 1.70) of multimorbidity were significantly higher in RA than non-RA in the overall cohort. Within the incident RA cohort, patients with RA had more chronic conditions than non-RA (β 1.13, 95% CI 1.10 to 1.17), and the rate of accruing chronic conditions was significantly higher in RA compared with non-RA (RA × follow-up year, β 0.21, 95% CI 0.20 to 0.21, p<0.001). Results were similar when including the pre-RA period and in several sensitivity analyses.ConclusionsMultimorbidity is highly prevalent in RA and progresses more rapidly in patients with RA than in patients without RA during and immediately following RA onset. Therefore, multimorbidity should be aggressively identified and targeted early in the RA disease course.

Objectives To determine whether rheumatoid arthritis (RA) and interstitial lung disease (ILD) severity measures are associated with survival in patients with RA-ILD. Methods We studied U.S. veterans with RA-ILD participating in a multicentre, prospective RA cohort study. RA disease activity (28-joint disease activity score [DAS28-ESR]) and functional status (multidimensional health assessment questionnaire [MDHAQ]) were collected longitudinally while pulmonary function tests (forced vital capacity [FVC], diffusion capacity [DLCO]) were obtained from medical records. Vital status and cause of death were determined from the National Death Index and administrative data. Predictors of death were assessed using multivariable Cox regression models adjusting for age, sex, smoking status, ILD duration, comorbidity burden, and medications. Results We followed 227 RA-ILD participants (93% male and mean age of 69 years) over 1,073 person-years. Median survival after RA-ILD diagnosis was 8.5 years. Respiratory diseases (28%) were the leading cause of death, with ILD accounting for 58% of respiratory deaths. Time-varying DAS28-ESR (adjusted hazard ratio [aHR] 1.21 [1.03–1.41]) and MDHAQ (aHR 1.85 [1.29–2.65]) were separately associated with mortality independent of FVC and other confounders. Modeled together, the presence of either uncontrolled disease activity (moderate/high DAS28-ESR) or FVC impairment (&lt;80% predicted) was significantly associated with mortality risk. Those with a combination of moderate/high disease activity and FVC &lt;80% predicted had the highest risk of death (aHR 4.43 [95% CI 1.70–11.55]). Conclusion Both RA and ILD disease severity measures are independent predictors of survival in RA-ILD. These findings demonstrate the prognostic value of monitoring the systemic features of RA-ILD.

Objective To examine temporal trends in all‐cause and cause‐specific mortality in patients with rheumatoid arthritis (RA) in the Veterans Health Administration (VHA). Methods We conducted a matched cohort study in the VHA from January 1, 2000 to December 31, 2017. Incident RA patients were matched up to 1:10 on age, sex, and VHA enrollment year to non‐RA patients, then followed until death or end of study period. Cause of death was obtained from the National Death Index. Multivariable Cox regression models stratified by RA diagnosis years were used to examine trends in RA‐related risk of all‐cause and cause‐specific mortality. Results Among 29,779 incident RA patients (matched to 245,226 non‐RA patients), 9,565 deaths occurred. RA patients were at increased risk of all‐cause (adjusted hazard ratio [HRadj] 1.23 [95% confidence interval (95% CI) 1.20–1.26]), cardiovascular (HRadj 1.19 [95% CI 1.14–1.23]), cancer (HRadj 1.19 [95% CI 1.14–1.24]), respiratory (HRadj 1.46 [95% CI 1.38–1.55]), and infection‐related mortality (HRadj 1.59 [95% CI 1.41–1.80]). Interstitial lung disease was the cause of death most strongly associated with RA (HRadj 3.39 [95% CI 2.88–3.99]). Nearly 70% of excess deaths in RA were attributable to cardiopulmonary disease. All‐cause mortality risk related to RA was lower among those diagnosed during 2012–2017 (HRadj 1.10 [95% CI 1.05–1.15]) compared to 2000–2005 (HRadj 1.31 [95% CI 1.26–1.36]), but still higher than for non‐RA controls (P < 0.001). Cause‐specific mortality trends were similar. Conclusion Excess RA‐related mortality was driven by cardiovascular, cancer, respiratory, and infectious causes, particularly cardiopulmonary diseases. Although our findings support that RA‐related mortality risk is decreasing over time, a mortality gap remains for all‐cause and cause‐specific mortality in RA.