Among patients with inflammatory arthritis receiving biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs), those with overweight or obesity face an increased risk of COVID-19 infection, according to a study from Singapore.
Being overweight or obese (BMI ≥23 kg/m2) was associated with a 63-percent higher risk of earlier COVID-19 infection compared with having normal BMI or being underweight (hazard ratio [HR], 1.63, 95 percent confidence interval [CI], 1.05–2.53; p=0.029). [Int J Rheum Dis 2026;29:e70682]
“This association remained significant after adjusting for gender, race, comorbidities, clinical diagnosis, and class of b/tsDMARD used. In contrast, other demographic and clinical variables, including immunomodulatory therapy type and common comorbidities such as hypertension and diabetes, were not significantly associated with infection risk,” the authors noted.
“Our findings underscore the clinical importance of considering BMI as a modifiable risk factor in the management of inflammatory patients, particularly during periods of heightened infectious risk,” they added.
To improve infection susceptibility in this population and improve their overall health outcomes, holistic care approaches are needed, according to the authors. These include routine assessment of weight and incorporation of individualized weight management strategies through dietary counselling, exercise interventions, and, when appropriate, pharmacologic support.
“Additionally, clinicians may consider enhanced monitoring for infections in inflammatory arthritis patients with overweight and obesity, especially those receiving TNF or JAK inhibitors, and prioritize vaccination strategies in this subgroup,” they said.
Study overview
The study included a real-world cohort of 561 patients (median age 49 years, 60.1 percent female, 69 percent Chinese). Of these, 36.9 percent had rheumatoid arthritis, 26.6 percent had psoriatic arthritis, and 33.9 percent had spondyloarthritides. Most of them (63.8 percent) were on TNF inhibitors.
COVID-19 infection occurred in a quarter of the population (25 percent). Compared with those who did not, patients who contracted the infection had higher BMI (27 vs 25 kg/m2; p=0.005).
Severe COVID-19 infection occurred in five patients, all of whom were male and four had underlying comorbidities. These patients were receiving b/tsDMARDs including golimumab, tofacitinib, adalimumab biosimilar, and infliximab biosimilar.
“Despite initial concerns regarding COVID-19 infection severity in immunosuppressed populations, most infections in this cohort were mild, with few hospitalizations and no reported deaths,” the authors noted. “[This highlights] the relative safety of continuing immunosuppressive therapy in this population when appropriately monitored.”
In the future, studies should explore the role of obesity-related immune dysregulation such as chronic inflammation, altered adipokine signalling, and immunosenescence and immunosuppressive therapies in shaping viral susceptibility among inflammatory arthritis patients, they said.