Long COVID Linked to Significantly Worse Rheumatic Disease Activity

Zachary Wallace, MD, MSc

Credit: Massachusetts General Hospital

COVID-19 has demonstrated a substantial impact on patients with inflammatory arthritis, with those experiencing “long COVID” showing a significantly worse disease activity in addition to worse disability, pain, fatigue, and quality of life. Additionally, even those without long COVID had worse disease control when compared with patients without a history of a prior COVID-19 diagnosis.¹
“People with rheumatoid arthritis (RA), psoriatic arthritis (PsA), juvenile idiopathic arthritis (JIA), and axial spondyloarthritis (axSpA) are at risk for poor acute COVID-19 outcomes because of their disease, comorbidities, and/or treatments,” wrote a team of investigators led by Zachary Wallace, MD, MSc, assistant professor of Medicine at Massachusetts General Hospital. “Less is known about the impact of COVID-19 infection and ‘long COVID’ on post-acute COVID-19 outcomes in this vulnerable population, particularly with regard to rheumatic disease activity, disability, and quality of life.”

To determine the link between COVID-19 and long COVID with quality of life, disability, and disease activity among a cohort of patients with inflammatory arthritis, investigators recruited patients ≥ 28 days after onset of COVID-19. RheumCARD, a prospective cohort study of patients with systemic rheumatic disease both with and without a history of COVID-19 from a large US healthcare system, was used to identify eligible participants.

Patients completed surveys including the Routine Assessment of patient Index Data 3 (RAPID-3), the fatigue symptom inventory (FSI), the short form 12 (SF-12), the short form McGill Pain Questionnaire (SF-MPQ), and the modified health assessment questionnaire (MHAQ). Surveys were filled out between March 2021 and October 2023. Rheumatic disease control was self-reported on a scale of 0 to 10, with 10 defined as being well-controlled, both prior- and post-diagnosis in the COVID-19 cohort or the test in the control cohort. Long COVID was characterized by symptoms of acute COVID-19 for ≥ 28 days. Unadjusted and adjusted models evaluated the association of having or not having COVID-19 with these measures in addition to the association of long COVID with these measures. A subgroup analysis of patients with RA was also performed.

In total, investigators included 276 COVID-19 cases and 59 controls. Among the COVID-19 cases, 39.5% were categorized as having long COVID. Most cases and controls had rheumatoid arthritis (67% and 85%, respectively), most were female (80% and 80%, respectively), and most were White (88% and 93%, respectively). The most commonly prescribed medications were methotrexate and/or tumor necrosis factor (TNF) inhibitors.

Although the SF-12 physical and mental health, FSI, SF-MPQ, RAPID-3, and MHAQ scores were comparable across cases and controls, rheumatic disease control was worse post-COVID-19 infection among patients with a prior COVID-19 diagnosis. After stratifying by long COVID status, worse RAPID-3 (3.7 vs 2.3, P <.01), MHAQ (0.4 vs 0.1, P <.01), SF-12 physical (38.1 vs 47.2, P <.01) and mental health (48.6 vs 53.0, P = .03), FSI (5 vs 4 (P <.01) were observed among patients with and without long COVID. Similarly, SF-MPQ scores for sensory (4.5 vs 3, P <.01), affective (1 vs 1, P = .01), and present pain (2 vs 1, p<0.01), and rheumatic disease control scores (6 vs 7, P = .05) were observed among both groups, respectively.

Perceived rheumatic disease control prior to a COVID-19 diagnosis or testing was comparable among patients with long COVID, those without long COVID, and those without a prior history of COVID-19. Patients without long COVID reported similar outcomes to subjects without a history of COVID-19, with the exception of rheumatic disease control, which was worse in the “without long COVID” group. The RA subgroup analysis and the adjusted age, sex, and race analyses reported similar results.

“These differences may reflect features of ‘long COVID’ and/or exacerbations of the underlying inflammatory arthritis,” investigators concluded. “Additional studies are needed to elucidate the immunologic or other factors driving these differences.”

References

1. ^{Wallace ZS, Lin M, Wang X, Patel N, et al. The Impact of COVID-19 and ‘Long COVID’ on Self-Reported Disease Activity, Disability, and Quality of Life in People with Inflammatory Arthritis. Presented at: EULAR. Vienna, Austria. June 12 – 15, 2024.}