Patients with rheumatoid arthritis report ‘many symptoms’ of long COVID prior to infection

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SAN DIEGO — Patients with rheumatoid arthritis who reported having long COVID in the past year demonstrated “many symptoms” of long COVID prior to initial infection, according to data presented at ACR Convergence 2023.

“As you know, long COVID, also known as post-acute syndrome or post-acute sequelae, refers to the development of persistent new symptoms among individuals who have recovered from COVID,” Kaleb Michaud, MD, of the University of Nebraska Medical Center, told attendees.

Michaud suggested that as many as 30% of individuals with COVID-19 may experience post-acute syndromes, while 10% may remain positive for the virus at 6 months. He added that patients with RA may be at an increased risk for long COVID manifestations. “Uncertainty remains whether it was due to a direct response to infection or the natural RA symptom course,” Michaud said.

To analyze whether characteristics and symptoms of long COVID had appeared among patients with RA prior to initial COVID-19 infection, Michaud and colleagues examined data from FORWARD, the National Databank for Rheumatic Diseases. The researchers identified 667 patients with RA and COVID-19, and who responded in the affirmative to a long COVID item on a comprehensive questionnaire about the infection. The questionnaire was made available in July 2022. Patient responses through April 2023 were included in the analysis.

The questionnaire also included data that had been provided by patients 6 months prior to reported COVID-19 infection. Patients also provided information for July 2022 or January 2023 that included information about their long COVID diagnosis.

Due to some concern that this information was too close to COVID-19 diagnosis, Michaud and colleagues gathered additional information from prior to their COVID-19 infection.

“We looked back at a sensitivity analysis 1 year before the COVID infection,” he said. “Then we looked at the sensitivity analysis from a year before the pandemic began.”

The questionnaire also featured a broad cross-section of health information such as socioeconomic status, treatments, symptoms and hospitalizations, along with patient-reported parameters, including HAQ, Fatigue, Pain, Sleep Problem, Health Satisfaction, PHQ-8 (depressive symptoms), GAD2 (anxiety symptoms), WPI, SSS and fibromyalgia 2016 criteria.

Approximately 15% of the cohort had a positive diagnosis of long COVID. Respondents with long COVID tended to be older and were less likely to be white than those who were not positive for long COVID. Other factors associated with the long COVID group were lower socioeconomic status, more comorbidities, worse patient-reported outcomes related to RA and more depression.

According to the researchers, 41% of patients who reported having long COVID also demonstrated fibromyalgia, vs. 13% in the non-long COVID group.

Additionally, long COVID was associated with more severe COVID-19 infections, and greater use of intravenous antibiotics than patients who did not have long COVID — 23% vs. 9%. Hospitalization rates were 18% for patients with long COVID and 5% for patients without long COVID.

“This stands up to some validity,” Michaud said.

Notably, the sensitivity analyses conducted prior to participants’ COVID-19 diagnosis demonstrated that patients reported high scores for pain, depression and other symptoms of long COVID even before the pandemic, according to Michaud.

“These were from 2018 and 2019, as far removed from the pandemic as possible,” he said. “What I wanted to point out is that a lot of the things still hold true as being significant in their odds ratios and P values.”

However, Michaud acknowledged that the depressive symptoms were not as strong in the earlier sensitivity analysis than the later analyses.

“The closer you get to the pandemic, the depressive symptoms become more significant,” he said.

Beyond depression, Michaud stressed that patient responses were comparable at multiple time points.

“Persons with RA who reported long COVID in the past year had many symptoms of long COVID prior to the development of COVID infection,” he said. “A long COVID diagnosis may reflect preexisting illness, which may not be possible to separate.”

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