Rheumatoid arthritis and COVID-19 outcomes: a systematic review and Meta-analysis

Abstract Objectives This study aimed to conduct a comprehensive systematic literature review and meta-analysis to assess the risk and outcomes of coronavirus disease 2019 (COVID-19) in patients with rheumatoid arthritis. Methods A systematic search was performed across four electronic databases. The quality of the studies was assessed using the Newcastle‒Ottawa quality assessment scale and the Joanna Briggs Institute critical appraisal checklist. Statistical analyses were conducted using STATA 14 software. Results A total of 62 studies were included in the analysis. First, the meta-analysis revealed the following prevalence rates among rheumatoid arthritis patients: COVID-19, 11%; severe COVID-19, 18%; COVID-19-related hospitalization, 29%; admission to the intensive care unit (ICU) due to COVID-19, 10%; and death from COVID-19, 8%. Second, rheumatoid arthritis was associated with an increased risk of COVID-19 infection (OR 1.045(0.969–1.122), p = 0.006), COVID-19-related hospitalization (OR 1.319(1.055–1.584), p = 0.006), admission to the ICU due to COVID-19 (OR 1.498(1.145–1.850), p = 0.002), and death from COVID-19 (OR 1.377(1.168–1.587), p = 0.001). Third, no statistically significant association was found between rheumatoid arthritis and severe COVID-19 (OR 1.354(1.002–1.706), p = 0.135). Conclusions Rheumatoid arthritis patients have a significantly greater risk of COVID-19 infection, hospitalization, ICU admission, and death than individuals without rheumatoid arthritis. However, rheumatoid arthritis did not show a significant association with the risk of severe COVID-19. These findings underscore the need for tailored management strategies and vigilant monitoring of COVID-19 outcomes in rheumatoid arthritis patients. Systematic Review Registration The study has been registered on PROSPERO [ https://www.crd.york.ac.uk/PROSPERO/ ], and the registration number is CRD42024528119.