COVID-19 Pandemic
Risk of Incident Rheumatoid arthritis in Post COVID-19 Infection: A Systematic Review and Meta-analysis of Cohort Studies Amarit Tansawet* Parkin Paramiraksa Metavee Boonsiri Poramin Patthamalai
Objective
Increasing evidence has reported the incident of autoimmune disease including rheumatoid arthritis (RA) following COVID-19 infection. However, the inconsistencies remain among studies. Our study aim to determine the risk of incident RA in post COVID-19 infection.
Methods
A comprehensive search of PubMed, EMBASE, Scopus, Cochrane library, and medRxiv was independently conduct by two reviewers to identify cohort studies reporting the risk of incident RA in patients with post COVID-19 infection, compare to controls who were not diagnosed with COVID-19 throughout the follow-up period. Eligible studies will be further extracted key characteristic. Quality assessments were performed according to the Newcastle-Ottawa Scale (NOS). The PRISMA and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were followed. To ensure the minimize effect of confounder, only the adjusted hazard ratio (aHR) were pooled using the random-effects meta-analysis. Publication bias was assessed by funnel plot.
Results
A total of 5 studies with 5 cohorts (n = 20,113,294 participants) were eligible for inclusion and were pooled in the meta-analysis. A significant association was found between post COVID-19 infection and risk of incident RA (pooled aHR, 2.80; 95% CI, 1.60-4.88). Subgroup analysis by age revealed that no association was found in patient aged < 40 years (pooled aHR, 0.96; 95% CI, 0.21-4.47). Nevertheless, patients age ≥ 40 years were at significantly increased risk of developing RA following COVID-19 infection (pooled aHR, 3.75; 95% CI, 1.83-7.69). No evidence of publication bias was observed. Quality assessments of the included studies were high.
Conclusion
Patients with post-COVID-19 infection have a significant increase risk of incident RA, particulary in the age group of ≥ 40 years. The possible risk of RA needs to be considered when managing patients with post COVID-19 infection, especially in the case with RA risk at baseline.