Breakthrough SARS-CoV-2 infection and disease flares in patients with rheumatoid arthritis: Result from COVAD e-survey study

Published Date: 01st January 2024

Publication Authors: Nune. A

Background
Existing studies have shown that disease activity of patients with rheumatoid arthritis (RA) may surge after COVID-19. However, factors associated with disease flares remain unknown. This study aimed to identify factors associated with breakthrough infection (BI) and disease flares in patients with RA following COVID-19.

Methods
We selected patients with RA from an online e-survey data from the COVID-19 vaccination in autoimmune diseases (COVAD) study. Demographic data, patient-reported outcomes, comorbidities and pharmacologic treatment were extracted from the database. Disease flare-ups were derived from the e-survey database. Factors associated with disease flare-ups were determined by multivariate logistic regression analysis.

Results
In total, 1928 patients with RA were extracted from the COVAD database. Older age, Caucasian ethnicity, comorbidities with chronic kidney disease and asthma were associated with COVID-19 breakthrough infection. Moreover, younger age (odds ratio (OR): 0.98, 95% CI: 0.96-0.99, p < 0.001), ethnicity other than Asian, past history of tuberculosis (OR: 3.80, 95% CI: 1.12-12.94, p = 0.033), treatment with methotrexate (OR: 2.55, 95% CI: 1.56- 4.17, p < 0.001), poor global physical health (OR: 1.07, 95% CI: 1.00 -1.15, p = 0.044) and mental health (OR: 0.91, 95% CI: 0.87 -0.95, p < 0.001) were independent factors associated disease flares in patients with RA.

Conclusion
Our study highlights important socio-demographic, clinical characteristics and mental health to be associated with flares in patients with RA. This finding may help determine relevant strategies to proactively manage RA patients at risk of flares.

Chen, Y; Nune, A et al. (2024). Breakthrough SARS-CoV-2 infection and disease flares in patients with rheumatoid arthritis: Result from COVAD e-survey study. International Journal of Rheumatic Diseases. 27(S1), pp.114-116. [Online]. Available at: https://dx.doi.org/10.1111/1756-185X.14982 [Accessed 20 February 2026]