People with rheumatoid arthritis (RA) are at a higher risk for infections, including COVID-19, the novel coronavirus that has caused the current worldwide pandemic. COVID-19 is a highly infectious virus that spreads through airborne respiratory droplets.
Anyone can get COVID-19, but because people with RA are more susceptible to infections, their risk for COVID-19 might be higher. People with RA who develop COVID-19 might also be at higher risk for severe symptoms and complications.
Keep reading to learn about how COVID-19 might affect people with RA, including risk factors, symptoms to look out for, when to see your healthcare provider, and more.
Verywell / Jessica Olah
Added Infection Risk
Having RA increases your risk for any type of infection. According to a study reported in 2019 in the journal RMD Open, people with RA have an elevated risk for serious infections compared to people with non-inflammatory arthritis or musculoskeletal conditions. And this risk applies to all types of infection, including viral, bacterial, and respiratory.
People with RA are more vulnerable to infections when their RA is more active and during flare-ups. Having RA also means you are more likely to end up in the hospital if you develop an infection. This risk is related to a suppressed immune system and the use of RA therapies that add further strain on your immune system.
A study reported in 2019 in the Journal of Advanced Research looked at nearly 5,600 people with RA over 11 years. Of this group, 289, or 4.2%, were hospitalized for infections, many of which were upper and lower respiratory infections.
COVID-19 can trigger both upper respiratory infections and lower respiratory infections. Upper respiratory infections affect the sinuses, nose, and throat, while lower respiratory infections affect the windpipe and lungs. Many coronaviruses like COVID-19 cause respiratory infections.
According to the University of Texas Southwestern Medical Center, a moderate upper respiratory infection can progress into a serious lower respiratory infection, which could lead to a person with COVID-19 needing ventilator support to breathe.
People with RA may have other conditions called comorbidities, which are defined as the presence of two or more medical conditions in a person. Some of these comorbidities might make it harder to fight off infections like COVID-19. Such conditions might include heart disease, diabetes, and lung diseases like chronic obstructive pulmonary disease.
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Is There An Overestimated Risk?
Despite the elevated risk for infection, people with RA and other rheumatic conditions (i.e., arthritis) are not contracting COVID-19 at higher rates, contrary to what researchers previously feared would happen.
A study reported at the 2020 American College of Rheumatology (ACR) Convergence conference found that people with rheumatic diseases were less likely to become infected with COVID-19. Here, researchers examined COVID-19 rates of infection in people with rheumatic conditions using biologic drug therapies and people with rheumatic diseases not using biologic therapies.
What they found was that despite an increased infection risk, this group was contracting COVID-19 at a rate lower than others in the general problem. Researchers don’t know why this is the case, but they suspect that people with rheumatic diseases are strictly observing social distancing practices and other protective approaches to reduce their risk for COVID-19.
How COVID-19 Might Affect People With RA
One of the concerns healthcare providers have when it comes to people with RA contracting COVID-19 is that their immune systems might be too compromised to fight the virus.
This risk might be even higher if you are an older adult, have other medical conditions, if your RA is severe and unmanaged, or if you have previously been hospitalized for a respiratory infection. These risk factors also increase the potential for more severe complications of COVID-19. In addition, if your RA is affecting organs or systems other than the joints, particularly the lungs, this could predict worse outcomes with COVID.
Hospitalizations and Death
There has been mixed research on whether people with rheumatic conditions who contract COVID-19 might become more seriously ill.
A study reported in November 2020 at the ACR Convergence found people with autoimmune diseases like RA who develop COVID-19 are more likely to be hospitalized. This group was also more likely to be admitted to an intensive care unit and end up on a ventilator. They are also more likely to develop kidney problems and heart failure associated with COVID-19.
In late 2020, researchers from New Zealand and Australia conducted a study that found people with RA had an increased risk of death from COVID-19. That risk mainly came from having a weakened immune system related to the use of immunosuppressive drug therapies. The researchers did not have any other explanation for the higher death risk, and noted further research on treatment for people with RA who develop COVID-19 was needed.
Other studies contradict the findings on COVID-19 severity and mortality in people with autoimmune and rheumatic diseases. A review from researchers out of the University of Texas presented at the 2020 ACR meeting found a high number of people with rheumatic diseases who contracted COVID-19 had mild symptoms, and very few died. The review was based on only eight studies, however, and the researchers felt they needed larger studies to look at treatment and disease severity.
Comorbid Conditions
Many studies that were presented at the 2020 ACR Convergence found having a rheumatic disease and another condition could lead to serious COVID-19 complications.
The previously mentioned comorbidity study found that people with RA had higher rates of high blood pressure, chronic kidney disease, asthma, and heart failure before developing COVID-19. Researchers suggested the higher prevalence of these conditions might explain why people with rheumatic diseases had an increased risk of complications.
Corticosteroid Use
Early on in the pandemic, rheumatologists were warning about the risks associated with COVID-19 and corticosteroid use. If your healthcare provider has prescribed corticosteroids, it is likely to treat out of control RA symptoms or an RA flare-up. These drugs shut down your immune system responses, which makes you vulnerable to infections like COVID-19.
If you develop COVID-19 while using a corticosteroid, your risk for complications and death might be higher than for those who are not using these therapies. A metanalysis reported in 2020 in the journal The Lancet concluded that the overall mortality rate for COVID-19 was higher among patients who were using corticosteroids to treat other health conditions.
More recent studies, however, have looked at the viability of corticosteroids for treating COVID-19 and their potential for reducing the duration and severity of the disease.
A study reported in December 2020 evaluated the effectiveness of the corticosteroid drug dexamethasone for managing COVID-19. Here, researchers found a reduced 28-day mortality risk in people with COVID-19 who needed oxygen therapy or mechanical ventilation.
This study led researchers to reconsider their previous position on corticosteroids as they relate to COVID-19. However, the researchers did add that further study was needed to confirm specific benefits and risks connected to corticosteroids and COVID-19.
If you have been prescribed a corticosteroid to help you manage RA symptoms and you are worried about your risk for COVID-19, reach out to your healthcare provider. They are in the best position to determine your risk for COVID-19 and how corticosteroid therapy might affect you.
Symptoms to Look Out For
The symptoms of COVID-19 are the same with or without RA. The most common symptoms are fever, cough, fatigue, sore throat, and shortness of breath. If you contract COVID-19 and develop symptoms, you will notice these two to 14 days after exposure to the virus.
More severe symptoms of COVID-19 might include a high fever, severe cough, and shortness of breath. These symptoms could mean pneumonia or acute respiratory distress syndrome (ARDS). However, immunosuppressive drugs, including steroids, can sometimes suppress fever, so this is not a reliable symptom in people taking these medications.
Pneumonia is an infection in which one or both of the lungs become inflamed and filled with fluid, leading to breathing difficulties. Pneumonia caused by COVID-19 often affects both lungs.
If pneumonia becomes severe, it can lead to ARDS, a type of lung failure. ARDS can be fatal, and people who develop it need to be on a ventilator. If they survive ARDS and recover from COVID-19, there may be lasting lung damage and scarring. Another serious complication of COVID-19 is sepsis, which can cause serious damage to the lungs and other organs.
Additional symptoms of COVID-19 to watch for include headache, chills, loss of appetite, confusion, loss of taste and/or smell, and gastrointestinal symptoms like nausea, vomiting, and diarrhea. Joint and muscle aches (myalgia) are also possible, but true muscle weakness and joint inflammation are much rarer.
What To Do If You Develop Symptoms
If you develop symptoms of COVID-19, call your primary care healthcare provider or rheumatologist. They will explain what you should do, which will depend on the symptoms you have.
Do not go to the hospital. If you have COVID-19, you can spread it to others. Ask for a telemedicine visit so you can stay home and avoid exposing others. If your healthcare provider thinks you have COVID-19, they will let you know where to go for a COVID-19 test.
If you test positive for COVID-19, your healthcare provider will discuss and prescribe treatments you will need to manage symptoms. You should stay home and self-isolate away from family members. If possible, use a separate bathroom.
You might be contacted by a public health professional about contact tracing. This person will assist in locating and notifying people you may have been in contact with after you were exposed to the virus.
If you need to leave your home to pick up medications or for a healthcare provider's visit, make sure you wear a mask and keep your distance from other people.
You should watch out for dangerous complications of COVID-19. Call 911 if you experience the following symptoms:
- Problems with breathing
- Chest pain or pressure
- Confusion
- Intractable vomiting or diarrhea, which can lead to severe dehydration
- An inability to stay awake
- Blue lips or a blue face
Make sure you tell the 911 operator that you have RA and suspect COVID-19 or have tested positive.
Treatment
COVID-19 has no cure at present, however there are several vaccines available.
Pfizer-BioNTech's COVID-19 vaccine received the FDA's first emergency use authorization (EUA) on December 11, 2020. The Moderna vaccine was granted EUA the following week. The first single-dose COVID-19 vaccine from Johnson & Johnson was granted EUA status on February 27, 2021.
On August 23, 2021, the FDA approved the Pfizer-BioNTech COVID-19 vaccine for individuals ages 16 and older. Five months later, Moderna's vaccine was granted full approval for use in adults 18 and older. The FDA later expanded the EUA for the Pfizer and Moderna vaccines to include adolescents and children as young as 6 months of age.
On July 13, 2022, the FDA authorized the Novavax COVID-19 Vaccine for emergency use in individuals ages 18 and older.
If you have mild symptoms, you can recover at home. Your healthcare provider might recommend prescription medications like Paxlovid (nirmatrelvir and ritonavir) and over-the-counter (OTC) cough and pain relievers. They will also advise you to keep yourself hydrated and get plenty of rest.
With severe symptoms, you might need to stay in the hospital. Your healthcare provider will design a treatment plan for you based on your symptoms, age, and overall health. This might include oxygen supplementation or putting you on a ventilator, a machine that can breathe for you.
Other therapies that might be included in your hospital treatment plan include antibiotics like Zithromax (azithromycin), antiviral drugs including Veklury (remdesivir), and steroids, including dexamethasone.
COVID-19 Prognosis With RA
Your outlook and recovery with COVID-19 when you have RA will be different than someone else’s recovery and outlook. According to a 2020 review, recovery will depend on your age and any other health conditions you might have in addition to RA.
According to the review, people who are older, have comorbidities, or have a high degree of immunosuppression are more likely to have a poor outlook. The worst outcomes are connected to people with coronary heart disease or cerebrovascular disease.
COVID-19 in people with severe RA might be associated with heart and lung complications, which can also lead to a poorer outcome.
A Word From Verywell
Researchers still don’t have a lot of information about the effects of COVID-19 on people with rheumatoid arthritis. But, in general, because you have RA, your risk is higher for infections, including COVID-19. The best way to manage your outlook and recovery is by keeping your RA and any other health conditions managed in case you contract COVID-19.
Make sure you are taking your RA medications as prescribed and that you have an adequate supply of them, or access to refills, if you have to quarantine. Do not stop taking any of your RA medications or medications for another health condition unless your healthcare provider tells you to.
Vaccinations, including boosters, are the most effective way to protect yourself against COVID-19. You should also do what you can to limit your exposure to the coronavirus by wearing a mask, practicing social distancing, and washing your hands often. These general prevention tips are important for everyone and are the best tools to reduce your risk for infection and the spread of COVID-19.
The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.