Patients with prior COVID-19 at higher risk for new-onset autoimmune inflammatory disease
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Key takeaways:
- Risk for autoimmune inflammatory rheumatic disease increased with severity of COVID-19 cases.
- Vaccine doses lowered the risk, except among those who had more severe COVID-19.
Patients with a history of COVID-19 demonstrate a higher risk for new-onset autoimmune inflammatory rheumatic diseases, with greater infection severity linked to greater risk, according to data published in the Annals of Internal Medicine.
“Emerging data suggest a higher risk for autoimmune inflammatory rheumatic diseases among patients with a history of COVID-19,” Min Seo Kim, MD, of the Broad Institute of MIT and Harvard, and colleagues wrote. “However, these findings are based entirely on comparisons between groups infected with SARS-CoV-2 and those that are not, which might be biased by differences in health-seeking behavior and inherent risk factors within the groups. In addition, studies have not explored the effect of vaccination and other modifiable factors on prevention of long-term COVID-19 complications.”
To develop a clearer picture of the risk for autoimmune inflammatory rheumatic diseases among patients with prior COVID-19, Kim and colleagues conducted a longitudinal study using a nationwide cohort from South Korea and a claims-based cohort from Japan. The South Korean cohort included 10,027,506 individuals aged 20 years or older, while the Japanese cohort featured 12,218,680.
Using an exposure-driven propensity score matching process, the researchers matched patients who had COVID-19 between Jan. 1, 2020, and Dec. 31, 2021, to four randomly selected uninfected individuals from the general population, as well as to one patient with influenza. Each group’s risk for all-cause incident autoimmune inflammatory rheumatic disease was determined using Cox regression analysis. Incident autoimmune inflammatory rheumatic disease was defined as at least two claims beyond the first 30 days after infection with SARS-CoV-2.
Compared with either uninfected or influenza-infected control patients, those infected with SARS-CoV-2 demonstrated a “significantly higher” risk for autoimmune inflammatory rheumatic diseases in both the South Korean and Japanese cohorts, according to the researchers. In the South Korean cohort, risk increased among those with mild (HR = 1.22; 95% CI, 1.15-1.29) and moderate-to-severe (HR = 1.42; 95% CI, 1.27-1.59) cases of COVID-19.
Meanwhile, the risk for autoimmune inflammatory rheumatic disease decreased as patients received additional COVID-19 vaccine doses (one dose HR = 0.59; 95% CI, 0.49-0.71; two or more doses HR = 0.42; 95% CI, 0.34-0.52), regardless of vaccine type. However, this was only true among those who had mild, but not moderate-to-severe, COVID-19, the researchers wrote.
“This population-based cohort study shows that the increased risk for incident [autoimmune inflammatory rheumatic disease (AIRD)] extends up to 12 months after SARS-CoV-2 infection,” Kim and colleagues wrote. “Care strategies for patients who survive COVID-19 should pay close attention to manifestations of AIRD, particularly after severe COVID-19.”
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Kim MS, et al. Ann Intern Med. 2024;doi:10.7326/M23-1831.
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