Abstract：
COVID-19 has been suggested as a possible trigger of disease flares in patients with rheumatoid arthritis (RA). However, factors associated with disease flares remain unknown. This study aimed to identify factors associated with breakthrough infection (BIs) and disease flares in patients with RA following COVID-19. We analysed data from RA patients who participated in the COVID-19 vaccination in autoimmune diseases (COVAD) study. Demographic data, patient-reported outcomes, comorbidities, pharmacologic treatment and details regarding disease flares were extracted from the COVAD database. Factors associated with disease flare-ups were determined by multivariate logistic regression analysis. The analysis comprised 1928 patients with RA who participated in the COVAD study. Younger age, Caucasian ethnicity, comorbidities with obstructive chronic pulmonary disease and asthma were associated with COVID-19 breakthrough infection. Moreover, younger age (odds ratio (OR): 0.98, 95% CI 0.96-0.99, p < 0.001), ethnicity other than Asian, past history of tuberculosis (OR: 3.80, 95% CI 1.12-12.94, p = 0.033), treatment with methotrexate (OR: 2.55, 95% CI: 1.56-4.17, p < 0.001), poor global physical health (OR: 1.07, 95% CI 1.00-1.15, p = 0.044) and mental health (OR: 0.91, 95% CI 0.87-0.95, p < 0.001) were independent factors associated disease flares in patients with RA. Our study highlights the impact of socio-demographic factors, clinical characteristics and mental health on disease flares in patients with RA. These insights may help determine relevant strategies to proactively manage RA patients at risk of flares.
摘要：
COVID-19已被认为是类风湿关节炎（RA）患者疾病发作的可能触发因素。然而,与疾病耀斑相关的因素仍然未知。这项研究旨在确定与COVID-19后RA患者的突破性感染（BIs）和疾病发作相关的因素。我们分析了参加COVID-19自身免疫性疾病（COVAD）研究的RA患者的数据。人口统计数据,患者报告的结果，合并症,我们从COVAD数据库中提取了药物治疗和疾病耀斑的细节.通过多变量逻辑回归分析确定与疾病发作相关的因素。分析包括参加COVAD研究的1928名RA患者。年龄更小,白种人,阻塞性慢性肺疾病和哮喘的合并症与COVID-19突破性感染相关。此外，年龄较小（比值比（OR）：0.98，95%CI0.96-0.99，p<0.001），亚洲以外的种族，既往结核病史(OR:3.80,95%CI1.12-12.94,p=0.033),甲氨蝶呤治疗（OR：2.55，95％CI：1.56-4.17，p<0.001），全球体质健康不良(OR:1.07,95%CI1.00-1.15,p=0.044)和心理健康(OR:0.91,95%CI0.87-0.95,p<0.001)是RA患者疾病发作的独立相关因素。我们的研究强调了社会人口因素的影响，RA患者疾病发作的临床特征及心理健康状况。这些见解可能有助于确定相关策略，以主动管理存在耀斑风险的RA患者。
