Nearly 30% of patients with autoimmune disease report long COVID after infection
Click Here to Manage Email Alerts
Key takeaways:
- A study found 29.8% of patients with systemic autoimmune diseases reported long COVID 12 or more weeks after SARS-CoV-2 infection.
- Fatigue, brain fog and joint pain were among the most common symptoms.
Among patients with systemic autoimmune disease in a large, real-world cohort, 29.8% reported long COVID, with frequent impacts to quality of life, following infection, according to data published in The Journal of Rheumatology.
“People with autoimmune conditions such as lupus, rheumatoid arthritis and inflammatory bowel disease endure higher rates of severe acute COVID-19 related to chronic medical conditions and immunosuppressive medications,” William A. Werbel, MD, PhD, assistant professor of medicine at Johns Hopkins University, told Healio. “However, clinical manifestations and prevalence of longer-term effects such as post-acute sequelae of COVID-19 (PASC), also known as ‘long COVID,’ are not well established. This limits patient risk counseling and clinician recognition of this important syndrome.”
To learn more about PASC risk in patients with systemic autoimmune conditions, Werbel — along with co-first authors Mayan S. Teles, BS, and Janetta Brundage, MA — conducted a national, prospective, observational cohort study. Between December 2020 and April 2021, the researchers recruited 1,615 adults with systemic autoimmune diseases who had received at least one SARS-CoV-2 vaccine. They then used questionnaires to assess the persistence and severity of symptoms among those reporting SARS-CoV-2 infections.
The cohort included individuals “who generally experienced mild disease in the omicron era,” the researchers wrote. Reported symptoms were divided into five domains, including neurological/psychological, fatigue, cardiopulmonary, gastrointestinal and musculoskeletal. The researchers defined PASC as an instance of one or more symptoms persisting for 12 or more weeks. Overall, 36.5% of participants (n = 590) reported a SARS-CoV-2 infection and were sent PASC questionnaires. There were 442 responses, 299 of which came 12 or more weeks after the initial infection.
Of those 299 patients, 29.8% (n = 89) reported PASC, with 84% reporting an impact on quality of life, according to the researchers. The symptom domain most reported was neurological/psychological, affecting 83.1%.
“The most common symptoms were fatigue, ‘brain fog,’ and joint pain/swelling, yet phenotypes varied widely,” Werbel said. “Some people reported symptoms across all five organ domains, whereas others only reported a single symptom.”
In addition, compared with those who did not report PASC, those who did reported receiving fewer vaccine doses — median (IQR) 2 (2-3) vs. 3 (2-3) — and more reinfections — 16.9% vs. 5.7%.
“Findings that additional vaccinations and avoidance of reinfections may lower PASC risk support recommendations for booster vaccines and observation of non-pharmaceutical interventions to avoid infections in this patient group, when able,” Werbel said.
One “notable” aspect of the data, Werbel said, was the relatively high PASC rate in the setting of mild disease and prior vaccination. The result “may indicate under-recognition in the community of this syndrome for a population that exhibits baseline abnormal immune responses and chronic symptoms,” he said.
Werbel additionally suggested avenues for future research.
“Large-scale prospective studies that include longitudinal surveys of physical and mental wellbeing alongside careful record of autoimmune, condition-specific symptoms would be helpful to untangle the interplay between disease activity and the effects of viral infections, such as SARS-CoV-2,” he said. “It would also be helpful to make use of biomarker data to characterize PASC risks in the setting of SARS-CoV-2 immune response, as well as autoimmune disease-specific activity.”
For more information:
William A. Werbel, MD, PhD, can be reached at wwerbel1@jhmi.edu; X (Twitter): @HIV_TID.
Perspective
Back to Top
The COVID-19 pandemic altered our world in many ways — societally, professionally and personally. Long COVID, or post-acute sequela of COVID-19 (PASC), is of great concern among health care professionals and their patients.
According to the CDC, symptoms may last up to years following infection. However, there is good news. This national prospective study investigates variables that increase the risks for PASC in our patients with autoimmune diseases. Despite its limitations, the data is compelling.
Nearly all patients (98.1%) demonstrated mild COVID infections. The majority (84%) reported a decreased quality of life, which is a common concern for those with rheumatic diseases. The most commonly reported symptoms included fatigue (70.8%), brain fog (68.5%) and joint pain/swelling (76%), which overlap with symptoms of the underlying autoimmune disease itself. There appeared to be no difference in demographic characteristics, immunosuppressive medications or antiviral treatments.
What is highlighted throughout the study is the need for updated boosters, which appear to reduce the risk of PASC. More than half (54%) of those with PASC were either not or only partially vaccinated.
The results of this study make for a compelling argument that we as health care professionals must continue recommending COVID boosters to our patients. We can support our recommendation by citing the risk for PASC linked to all COVID infections, not just those with serious illness. Updated COVID boosters appear to be the most effective PASC prevention tool.
Collapse
Read more about
Click Here to Manage Email Alerts