Gout, rheumatoid arthritis and the risk of death from COVID-19: an analysis of the UK Biobank

Abstract

ObjectiveTo assess whether gout and / or rheumatoid arthritis (RA) are risk factors for coronavirus disease 19 (COVID-19) diagnosis. To assess whether gout and / or RA are risk factors for death from COVID-19.MethodsWe used data from the UK Biobank. Multivariate-adjusted logistic regression was employed in the following analyses. Analysis A: to test for association between gout or RA and COVID-19 diagnosis in a population-based cohort (n=473,139). Analysis B: to test for association between gout or RA and death from COVID-19 in a case-control cohort of people who died or survived with COVID-19 (n=2,073). Analysis C: to test for association with gout or RA and death from COVID-19 in a population-based cohort (n=473,139)ResultsNeither RA nor gout associated with COVID-19 diagnosis in analysis A, nor did RA or gout associate with risk of death in the COVID-19-diagnosed group in analysis B. However RA associated with risk of death from COVID-19 using the population-based cohort in analysis C independent of comorbidities and other measured risk factors (OR=1.8 [95% CI 1.2 ; 2.7]). Gout was not associated with death from COVID-19 in the same population-based analysis (OR=1.2 [95% CI 0.9 ; 1.7]).ConclusionsRA and gout are not risk factors for COVID-19-diagnosis. However RA, but not gout, is a risk factor for death from COVID-19 in a population-based analysis using the UK Biobank. These findings require replication in larger data sets that also allow inclusion of a wider range of factors.Key messagesWhat is already known?Information on the risk of death from COVID-19 for people with gout and rheumatoid arthritis is scarce.What does this study add?In a population-based analysis there is an increased risk of death by COVID-19 for people with rheumatoid arthritis independent of co-morbidities, but not gout.The findings need to be replicated in other datasets where the influence of therapies for RA can be tested.How might this impact on clinical practice?Improved clinical management and treatment for RA patients with COVID-19.

American College of Rheumatology Guidance for COVID‐19 Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: Version 3

“…Despite these important methodologic caveats and acknowledged limitations in the evidence base, AIIRD patients were rated as having worse outcomes (e.g., need for intensive care unit [ICU] treatment, mechanical ventilation, persistent infection, death) following COVID‐19 compared to patients of similar age and sex without such conditions (23–27,34). In terms of the policy implications of this reasoning, the task force agreed that in general, AIIRD patients should be prioritized to be allocated to receive vaccination before the nonprioritized general population of similar age and sex (35).…”

“…Among these individuals, the risk for incident viral infections (e.g., herpes zoster) was rated as being higher than for the general population (20)(21)(22). There was also agreement that AIIRD patients are likely to be at increased risk for hospitalized SARS-CoV-2 infection (23)(24)(25)(26)(27) and that age, race/ethnicity (especially for underrepresented minorities), and sex were important risk factors that needed to be considered (28)(29)(30)(31) in evaluating risk at the individual patient level.…”

American College of Rheumatology Guidance for COVID‐19 Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: Version 2

“…Despite these important methodologic caveats and acknowledged limitations in the evidence base, AIIRD patients were rated as having worse outcomes (e.g., need for intensive care unit [ICU] treatment, mechanical ventilation, persistent infection, death) following COVID‐19 compared to patients of similar age and sex without such conditions ( 23 , 24 , 25 , 26 , 27 , 34 ). In terms of the policy implications of this reasoning, the task force agreed that in general, AIIRD patients should be prioritized to be allocated to receive vaccination before the nonprioritized general population of similar age and sex ( 35 ).…”

American College of Rheumatology Guidance for COVID‐19 Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: Version 1

“…Among these individuals, the risk for incident viral infections (e.g., herpes zoster) was rated as being higher than for the general population (20)(21)(22). There was also agreement that AIIRD patients are likely to be at increased risk for hospitalized SARS-CoV-2 infection (23)(24)(25)(26)(27) and that age, race/ethnicity (especially for underrepresented minorities), and sex were important risk factors that needed to be considered (28)(29)(30)(31) in evaluating risk at the individual patient level. Multimorbidity was felt to likewise play an important role in the risk for developing COVID-19.…”