COVID-19 admissions and mortality in patients with early inflammatory arthritis: Results from a UK national cohort

Maryam A. Adas, Mark D. Russell, Emma Cook, Edward Alveyn, Jennifer Hannah, Sathiyaa Balachandran, Sarah Oyebanjo, Paul Amlani-Hatcher, Joanna Ledingham, Sam Norton, James B. Galloway*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: To describe the risks and predictors of coronavirus disease 2019 (COVID-19) hospitalization and mortality among patients with early inflammatory arthritis (EIA), recruited to the National Early Inflammatory Arthritis Audit (NEIAA). Methods: NEIAA is an observational cohort. We included adults with EIA from Feb 2020 to May 2021. Outcomes of interest were hospitalization and death due to COVID-19, using NHS Digital linkage. Cox proportional hazards were used to calculate hazard ratios for outcomes according to initial treatment strategy, with adjustment for confounders. Results: From 14 127 patients with EIA, there were 143 hospitalizations and 47 deaths due to COVID-19, with incidence rates per 100 person-years of 0.93 (95% CI 0.79, 1.10) for hospitalization and 0.30 (95% CI 0.23, 0.40) for death. Increasing age, male gender, comorbidities and ex-smoking were associated with increased risk of worse COVID-19 outcomes. Higher baseline DAS28 was not associated with COVID-19 admissions [confounder adjusted hazard ratio (aHR) 1.10; 95% CI 0.97, 1.24] or mortality (aHR 1.11; 95% CI 0.90, 1.37). Seropositivity was not associated with either outcome. Higher symptom burden on patient-reported measures predicted worse COVID-19 outcomes. In unadjusted models, CS associated with COVID-19 death (HR 2.29; 95% CI 1.02, 5.13), and SSZ monotherapy associated with COVID-19 admission (HR 1.92; 95% CI 1.04, 3.56). In adjusted models, associations for CS and SSZ were not statistically significant. Conclusion: Patient characteristics have stronger associations with COVID-19 than the initial treatment strategy in patients with EIA. An important limitation is that we have not looked at treatment changes over time.

Original languageEnglish
Pages (from-to)2979-2988
Number of pages10
JournalRheumatology (United Kingdom)
Issue number9
Publication statusPublished - 1 Sept 2023


  • ankylosing spondylitis
  • corticosteroids
  • COVID-19
  • COVID-19 admissions
  • COVID-19 mortality
  • early inflammatory arthritis
  • inflammatory arthritis
  • psoriatic arthritis
  • rheumatoid arthritis


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