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Ruth Topless and colleagues present a well written and intriguing study that reviews potential increased risk of COVID-19 infection in patients with rheumatoid arthritis (RA) and/or gout. Analyzed data stemmed from the UK Biobank originating from 1991. The total gout population was just over 13,000, and RA population nearly 5,500.

In my initial read of the study, published in , the power of the study seemed grand -- with nearly 500,000 patient data points to speak of. However, the COVID-19, RA, and gout numbers overall are small in comparison. In total, 2,118 individuals had confirmed or suspected COVID-19 infection, of whom nearly 500 died: the remaining survived, with the exception of 59 patients, whose outcomes were unknown and were otherwise excluded from analysis. Of the COVID-19 infection cohort, 117 had gout and 61 had RA. Findings from this study concluded an increased risk of COVID-19 infection and COVID-19 related death in patients with RA, but not gout.

The region of data origin (UK) yields a homogenous population, age of studied patients excluded those under 49 years, and outcomes data are incomplete (specifically the possibility of additional deaths not previously identified). The extent of RA treatments used and their potential impact on these findings remains unclear and warrants further study. COVID-19 infection severity assessment was less than ideal since symptoms were not analyzed in this study. Many unidentified factors may have played a role in concluding the increased risk in the RA population; medications, age, disease severity, and infection severity to name a few.

I take this study with a grain of salt. My patients with RA are likely to be cautioned of their increased risk of COVID-19 infection for multiple reasons. Will it change my practice? No. Yes. These continue to be trying and uncertain times. However, I will continue to encourage treating RA to remission or low disease activity, all while weighing the risks of immunosuppression as it pertains to COVID-19 infection.

Vaneet Kaur Sandhu, MD, is associate professor of medicine in the division of rheumatology at Loma Linda University Health in Loma Linda, California, and Director of Rheumatology Clinical Operations at Riverside University Health System.

Read the study here and an interview with the lead study author here.