Autoimmune/Inflammatory Tissue Disorders Associated With COVID-19 Infection

New research has found that people were at higher risk of a number of autoimmune and autoinflammatory connective tissue disorders after COVID-19 infection.¹

These findings are from a cohort study conducted by Yeon-Woo Heo, MD, Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea, and colleagues. The study included 6,912,427 participants from the Korea Disease Control and Prevention Agency–COVID-19–National Health Insurance Service (K-COV-N) cohort, 3,145,388 with COVID-19 and 3,767,039 controls, who were followed for over 180 days.¹

“COVID-19, which by its very name suggests a disease of the past, is officially here to stay. Although enormous scientific progress has been made to effectively combat this disease, the long-term sequelae of the COVID-19 pandemic will persist for years to come. Future SARS-CoV2 variants could portend even greater risk for the development of autoimmune disease, and we should all remain vigilant to the complex interplay between infection and autoimmune disease as SARS-CoV-2 continues to mutate,” Lisa M. Arkin, MD, Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, and colleagues wrote in a related editorial.² “Heo et al. have shed epidemiologic light on a phenomenon well supported by translational science, and this makes it a welcome addition to the literature”

The study participants had a mean age of 53.29 years (standard deviation, 20.13) and 53.6% were male. Heo and colleagues found that post-COVID infection, participants had an adjusted hazard ratio (AHR) of 1.11 for alopecia areata (95% CI, 1.07-1.15), an AHR of 1.24 for alopecia totalis (95% CI, 1.09-1.42), an AHR of 1.11 of vitiligo (95% CI, 1.04-1.19), an AHR of 1.45 of Behçet disease (95% CI, 1.20-1.74), an AHR of 1.35 of Crohn disease (95% CI, 1.14-1.60), and AHR of 1.15 of ulcerative colitis (95% CI, 1.04-1.74), an AHE of 1.09 of rheumatoid arthritis (95% CI, 1.06-1.12), an AHR of 1.14 of systemic lupus erythematosus (95% CI, 1.01-1.28), an AHR of 1.13 of Sjögren syndrome (95% CI, 1.03-1.25), an AHR of 1.11 of ankylosing spondylitis (95% CI, 1.02-1.20), and an AHR of 1.62 of bulbous pemphigoid (95% CI, 1.07-2.45).¹

Associations were diverse across demographic factors including sex and age. The investigators also found that severe COVID-19 infection requiring intensive care unit admission, the Delta period, and not being vaccinated were factors associated with higher risk of autoimmune and autoinflammatory outcomes.

In their editorial, Arkin and colleagues emphasized the rarity of autoimmune and autoinflammatory disease incidence even after COVID-19 infection, cautioning against unnecessary testing for these diseases in the absence of new physical symptoms.

“However, it is unknown whether individuals with preexisting autoimmune conditions are at greater risk of disease flare or the development of additional autoimmune diseases following COVID-19 infection” Arknin and colleauges wrote.² “These data would help to frame an evidence-based approach for patients with autoimmune disorders who develop COVID-19 infection, including the role for antiviral treatments.”

REFERENCES

1. Heo Y, Jeon JJ, Ha MC, Kim YH, Lee S. Long-Term Risk of Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19. JAMA Dermatol. Published online November 06, 2024. doi:10.1001/jamadermatol.2024.4233

2. Arkin LM, Barbieri JS, Cowen EW. COVID-19 as a Risk Factor For Autoimmune Skin Disease. JAMA Dermatol. Published online November 06, 2024. doi:10.1001/jamadermatol.2024.4222