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Perceived Risk of COVID-19 Infection in Patients With Rheumatoid Arthritis

“The COVID-19 pandemic has strongly impacted the lives of patients living with rheumatoid arthritis which has contributed to anxiety, depression, and reduced well-being.”

While perceived risk of COVID-19 varied among patients with rheumatoid arthritis (RA), respondents who perceived a higher risk where more likely to adhere to strict shielding, according to a study published in Rheumatology.1

“The coronavirus disease 2019 (COVID-19) pandemic has strongly impacted the lives of patients living with RA because of concerns and uncertainties regarding their risk for infection and severe outcomes, which have contributed to anxiety, depression, and reduced well-being,” investigators stated.

Participants with RA were surveyed between July 16 and November 8, 2020. Included in the 25-question survey were questions about medication use, COVID-19 diagnosis, perception of COVID-19 risk, and any shielding practices. Investigators further analyzed any association between disease-specific factors or demographics with the perception of risk and shielding measures. Potential participants were selected from the Mass General Brigham (MGB) Research Patient Data Registry (RPDR). Eligible patients had a self-reported diagnosis of RA, a code for inflammatory arthritis (M05-M14), and were being treated with at least 1 disease-modifying antirheumatic drug (DMARD), such as abatacept, interleukin (IL)-6 inhibitors, janus kinase inhibitors (JAKis), methotrexate, or tumor necrosis factor inhibitors (TNFis). Demographics, such as age, sex, and race, as well as disease activity, were collected.

Risk perception was determined using a 5-level scale, with answers ranging from strongly agree to strongly disagree, in regard to the statement: “I am worried that my rheumatic condition or its treatment puts me at a higher risk for COVID-19 or severe complications if I become infected.”

A total of 494 patients with RA were included in the study. The majority of participants were white (91%), female (85%), and nonsmokers (52%). Mean disease activity was 74.6 (19.9). Of these participants, 40% strongly agreed that their rheumatic disease put them at a higher risk for developing COVID-19, 34% (n = 169) agreed, and 26% (n = 130) were either uncertain or disagreed. Younger patients, (odds ratio [OR]: 0.98; 95% confidence interval [CI]:0.96-0.99; P = 0.007), those with a comorbidity (OR: 1.60; 95% CI: 1.09-2.36), and those with recent DMARD use (OR: 1.7;5 95% CI: 1.14-2.68; P = 0.046) were more likely to have a higher perceived risk.

Shielding measures included social distancing, glove or mask use, and quarantine. Most patients were using at least 1 shielding practice at the time of the survey, with 74% quarantining, 96% using masks and/or gloves, and 98% social distancing. Patients with a higher perceived risk were 4 times more likely to utilize all 3 methods.

Free-text responses revealed that the mental health was a common concern for patients with RA, including anxiety, stress, depression, and feelings of uncertainty and fear.

The study was limited as it was originally conduced in mid-2020 and patients’ perceptions of risk may have changed since that time. The demographics (white, female) may limit generalizability; however, the registry included a variety of care facilities with a spectrum of disease severity and DMARDs. It is also important to consider both recall bias and social desirability bias, although patients were told that their answers would not be shared with their rheumatologist.

“The factors associated with COVID-19 risk perception in participants with RA may differ from risk factors reported in observational studies,” investigators concluded. “These findings highlight the importance of patient education campaigns. Additional studies are needed to clarify factors driving risk perception and shielding practices and the impact of these risks and practices on mental health.”


Cook C, Cox H, Fu X, et al. Perceived Risk and Associated Shielding Behaviors in Patients With Rheumatoid Arthritis During the Coronavirus 2019 Pandemic [published online ahead of print, 2021 Sep 8]. ACR Open Rheumatol. 2021;10.1002/acr2.11340. doi:10.1002/acr2.11340