Patients with COVID-19 have 43% increased risk for new-onset autoimmune diseases
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Key takeaways:
- Patients with a more severe case of COVID-19 have a greater chance of developing an autoimmune disorder.
- Vasculitis diseases were more common than others.
Patients with COVID-19 demonstrate a 43% increased risk for new-onset autoimmune diseases in the 3 to 15 months following acute infection, according to data published in Clinical Rheumatology.
“To date, different respiratory, cardiovascular, neurological, and mental diseases as well as various symptoms in the context of long/post-COVID have been studied with routine health care data,” Falko Tesch, MSc, of the Dresden University of Technology, in Germany, and colleagues wrote. “The group of autoimmune diseases is less discussed in the literature, although autoantibodies could be found in patients after SARS-CoV-2 infection, e.g., anti-type I IFNs, anti-IFN-, and anti-nuclear antibodies (ANAs).
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“So far there is limited evidence on newly manifested autoimmune diseases after an infection based on several case reports and two recent cohort studies,” they added. “Furthermore, COVID-19 itself shares some similarities with systemic autoimmune rheumatic diseases, which could be a challenge for diagnostics.”
To examine the risk for new-onset autoimmune disease development after acute SARS-CoV-2 infection, Tesch and colleagues conducted a matched cohort study using routine health care data from patients in Germany. The researchers measured the rates of new autoimmune diseases in patients with and without previous SARS-CoV-2 exposure.
The cohort included patients who had received a confirmed COVID-19 diagnosis from a PCR test from Jan. 1, 2020, to June 30, 2021. The control group, meanwhile, was comprised of patients without a confirmed infection. Patients with COVID-19 were matched 1:3 to control participants based on age, biological sex and whether there was a history of autoimmune diseases. The researchers assessed a total of 64 potential health outcomes, including 41 autoimmune diseases. The follow-up period spanned 3 to 15 months after confirmed diagnosis.
The analysis included 641,704 patients with previous COVID-19 infections. According to the researchers, patients with COVID-19 (IR = 15.05; 95% CI, 14.69-15.42) demonstrated a 42.63% higher likelihood of developing autoimmunity following the acute infection phase, compared with the control population (IR = 10.55; 95% CI, 10.25-10.86).
The rate remained relatively consistent regarding common diagnoses, including Hashimoto thyroiditis, rheumatoid arthritis and Sjögren’s syndrome. According to the researchers, the highest IRR was reported for vasculitis diseases. In addition, patients who experienced more severe COVID-19 infection appeared to demonstrate a higher chance of developing a autoimmune disease.
“In this large, matched cohort study, COVID-19 was associated with an increased risk of being newly diagnosed with autoimmune disease 3 to 15 months after SARS-CoV-2 infection,” Tesch and colleagues wrote. “The strength of the association with SARS-CoV-2 infection was most pronounced for autoimmune diseases in the vasculitis group.”
Perspective
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COVID-19, the acute disease caused by the SARS-CoV-2 virus, is sometimes followed by a prolonged phase lasting more than 12 weeks, known as post-acute COVID or long COVID. Recent evidence is currently insufficient to determine the long-term burden of COVID-19 and future challenges to health systems. Additionally, patients often have symptoms that impact respiratory, cardiovascular, neurological, musculoskeletal and psychological health, mimicking syndromes associated with chronic autoimmune and inflammatory diseases.
The investigators used a matched cohort study to compare the rates of newly diagnosed autoimmune disease between individuals with and without documented COVID-19. The most common incident autoimmune diseases with an IR above 1 in 1,000 person-years in the COVID-19 group were Hashimoto thyroiditis, Graves’ disease, psoriasis, rheumatoid arthritis and Sjögren’s syndrome. The highest IRRs were found for Wegener’s disease (granulomatosis with polyangiitis), Behcet’s disease, and temporal arteritis.
Additionally, a higher IRR for a new-onset autoimmune disease was observed in children and adolescents than in adults with or without COVID-19. However, differences between age groups did not reach statistical significance.
This information adds further insight into the diagnosis and management of patients presenting with chronic symptoms following a SARS-CoV-2 infection, and can allow for tailored treatment for those developing new-onset rheumatic disease. Further research may help shed light on possible etiopathogenic links between this and other viral infections, and multiple autoimmune diseases.
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