People with rheumatic diseases faced challenges during the COVID-19 pandemic, including concerns about higher risks of infection. Researchers formed a population-based cohort to investigate whether those with IA, their treatments and shielding status affected the risk of adverse outcomes from COVID-19 for the entire population of Wales.

The challenge

During the COVID-19 pandemic, the lives of individuals with rheumatic diseases, such as rheumatoid arthritis, were greatly affected by concerns about the risk of infection. Having IA means the immune system is compromised and arthritis medication can also suppress the immune system. People with arthritis are also at increased risk of infection in general. The NHS advised high risk individuals to follow shielding practices including social distancing.

The solution

Researchers in Wales, supported by HDR UK and the National Centre for Population Health and Wellbeing Research Centre, undertook a retrospective, population-based cohort study. The study aimed to look at the risk of COVID-19 infection for people with IA and the potential for adverse outcomes.

They linked anonymised health data from the SAIL Databank, including primary and secondary care, Office for National Statistics Mortality and COVID-19 laboratory data, for the population of Wales. Individuals aged 18 years and over, who had tested positive for COVID-19 between March 2020 and May 2021 and had rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis formed the study cases and were compared to the general population who had tested positive for COVID-19.

The impact

The COVID-19 incidence rate was 3.5% in people with IA versus 6% in the general population. This showed that individuals with IA had a lower incidence of COVID-19, which was probably due to shielding. 

IA was not associated with increased mortality following COVID-19 infection; however, being vulnerable (shielded), comorbidities such as diabetes and cancer, and other factors such as smoking and increasing age, were associated with increased risk of dying within 28 days of infection. 

These key risk factors were used to identify individuals with IA at greater risk from COVID-19 and encourage those at risk to shield during high COVID-19 prevalence and highlight the importance of vaccination.

Dr Roxanne Cooksey, first author of the paper published in the journal Rheumatology, said:

“It is well known that people with inflammatory arthritis are at higher risk of infections, but we wanted to know how COVID played into that, particularly if some individuals with arthritis felt they should stop their medication out of concern. This study was novel because of our access to information on shielding from COVID data and being able to link it with primary and secondary care data, as well as death data, to see the impact on the arthritis community versus the general population.

“Our findings have been able to reassure people with inflammatory arthritis about the risk of COVID-19 while identifying those people that particularly need to shield in the community and to encourage vaccination for this group. Advising those most at risk means that the negative effects of shielding, such as social withdrawal due to social distancing could be mitigated to only those at greatest risk of severe COVID. Our next step is to revisit the study using linked data for the following year to explore health outcomes further following infection.”

Read the full paper