COVID-19 in Patients with Inflammatory Arthritis: A Prospective Study on the Effects of Immunomodulatory Therapy on Susceptibility and Clinical Outcomes

Patients with inflammatory arthritis (IA), including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondyloarthritis (SpA), have an inherently heightened susceptibility to infection and are thus considered high risk for developing coronavirus disease 2019 (COVID-19). Furthermore, small molecules and biologics that aim to treat these diseases theoretically render these patients even more immunocompromised. Paradoxically, however, the use of immune pathway-specific cytokine inhibitors has been shown to improve outcomes of patients with COVID-19 through various mechanisms, including inhibition of the virus-triggered cytokine storm and amelioration of the damage resulting from systemic hyperinflammation. Given the novelty of both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the pathogenesis of COVID-19, there is currently limited information that can guide clinicians on the appropriate monitoring and management of IA patients during the current global pandemic. To address this gap, we have established a prospective cohort of immune mediated inflammatory disease (IMID) patients to better understand the incidence and outcomes of COVID-19, namely web-based assessment of autoimmune, immune-mediated, and rheumatic patients during the COVID-19 pandemic (WARCOV). The overarching aim of this study is to determine whether having an IA and/or being on certain drugs with immune pathway-specific inhibition significantly impacts susceptibility to SARS-CoV-2 and, for those who become infected, COVID-19 symptomatology and disease course. Further, it aims to identify other risk factors for COVID-19 within this population, which, in turn, can lead to clinical stratification and closer monitoring and aid in therapeutic decision-making. We hypothesize that patients with IA on anti-cytokine therapy, and specifically tumor necrosis factor inhibitors (TNFis), will have improved COVID-19 outcomes (i.e., lower incidence, lower rates of hospitalization and death).