Long term autoimmune, autoinflammatory disease risk significantly higher after COVID-19
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Key takeaways:
- Chances of developing various autoimmune diseases were significantly higher in people who had COVID-19.
- Risks were particularly high in severe cases, unvaccinated people and during the delta wave.
SARS-CoV-2 infection, especially a severe case or without vaccination, significantly increases the long-term risk for developing autoimmune and autoinflammatory connective tissue diseases, according to data published in JAMA Dermatology.
“COVID-19 is associated with autoimmune diseases, as SARS-CoV-2 potentially interferes with self-tolerance mechanisms in the body and triggers autoimmune responses through cross-reactivity, potentially resulting in the onset of autoimmune diseases,” Yeon-Woo Heo, MD, of the department of dermatology at Yonsei University Wonju College of Medicine, in South Korea, and colleagues wrote.
“Nevertheless, most [studies so far] involved a short follow-up period and were inadequate for assessing the development of autoimmune diseases that generally have indolent onset and slow development, thereby underscoring the need for long-term risk assessment,” they added.
To examine the long term risks for autoimmune and autoinflammatory diseases post SARS-CoV-2 infection, Heo and colleagues analyzed the incidence of autoimmune disease following more than 3 million COVID-19 cases in South Korea through December 2022. Their retrospective, nationwide, population-based study combined comprehensive population data from South Korea’s National Health Insurance Service with data from the Korea Disease Control and Prevention Agency’s registry of COVID-19 cases.
The study included a total of 6,912,427 participants (mean age, 53.39 years; 46.4% women), 3,145,388 of whom had COVID-19 while 3,767,039 with no COVID-19 history acted as the control arm. The average follow-up period was 287 days, which the researchers described as “considerably longer” than previous studies, and participants had to have at least 180 days of observation for entry.
The researchers assessed risks for various diseases using multivariable Cox proportional hazards models, with the two groups’ demographics, comorbidities and other covariates balanced using inverse probability of treatment weighting.
According to the results, the COVID-19 group demonstrated elevated risks for the following diseases, compared with the control group:
- bullous pemphigoid (adjusted HR = 1.62; 95% CI, 1.07-2.45);
- Behçet’s disease (adjusted HR = 1.45; 95% CI, 1.2-1.74);
- Crohn’s disease (adjusted HR = 1.35; 95% CI, 1.14-1.6);
- alopecia totalis (adjusted HR = 1.24; 95% CI, 1.09-1.42);
- ulcerative colitis (adjusted HR = 1.15; 95% CI, 1.04-1.28);
- systemic lupus erythematosus (adjusted HR = 1.14; 95% CI, 1.01-1.28);
- Sjögren’s disease (adjusted HR = 1.13; 95% CI, 1.03-1.25);
- ankylosing spondylitis (adjusted HR = 1.11; 95% CI, 1.02-1.2);
- alopecia areata (adjusted HR = 1.11; 95% CI, 1.07-1.15);
- vitiligo (adjusted HR = 1.11; 95% CI, 1.04-1.19); and
- rheumatoid arthritis (adjusted HR = 1.09; 95% CI, 1.06-1.12).
Furthermore, risks for many of these diseases were significantly higher among those who demonstrated COVID-19 and required ICU admission, as well as those who were not vaccinated. Many risks were also significantly higher when the delta variant was dominant, before January 2022, according to the researchers.
“This cohort study comprehensively examined the long-term risks of autoimmune and autoinflammatory connective tissue disorders in patients with COVID-19, underscoring the potential sequelae following COVID-19 and the need for continued vigilance and research on the autoimmune consequences of COVID-19,” Heo and colleagues wrote. “Understanding the specific vulnerabilities and disease patterns among different subgroups is crucial for mitigating the long-term impact of the pandemic on global health.”
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