A recent population-based study published in JAMA Dermatology has revealed an increased long-term risk of autoimmune and autoinflammatory connective tissue disorders among individuals who have recovered from COVID-19, particularly for those who experienced severe cases, were unvaccinated, or contracted the Delta variant. Conducted by researchers in the Republic of Korea, the study leverages a comprehensive dataset from the National Health Insurance Service (NHIS) and the Korea Disease Control and Prevention Agency’s COVID-19 registry to explore COVID-19’s potential to trigger autoimmune responses.
The study investigated over 6.9 million individuals, of whom 3.1 million had COVID-19 and 3.7 million served as controls. Each participant was monitored for a minimum of 180 days. COVID-19 diagnoses were confirmed by PCR or rapid antigen testing, and autoimmune outcomes were tracked through at least three recorded medical visits using the ICD-10 diagnostic codes. The findings indicated a significant increase in the risk of several autoimmune diseases among COVID-19 survivors. Individuals with COVID-19 showed adjusted hazard ratios (AHRs) of 1.11 for alopecia areata, 1.35 for Crohn’s disease, and 1.14 for systemic lupus erythematosus (SLE). The results also suggested that COVID-19 severity correlates with risk: patients who required intensive care had markedly higher rates of certain autoimmune conditions, such as sarcoidosis and bullous pemphigoid.
The study also examined the demographic factors that influenced these risks. Men were more likely to develop autoimmune conditions like alopecia areata, vitiligo, and rheumatoid arthritis, whereas women had heightened risks of conditions like alopecia totalis and bullous pemphigoid. Younger participants (under 40 years of age) were more prone to autoimmune diseases such as primary cicatricial alopecia and ulcerative colitis, while older participants (over 40 years of age) were at greater risk for Sjögren syndrome, SLE, and ankylosing spondylitis. The findings imply age and sex-specific susceptibility to post-COVID autoimmune conditions, potentially guiding tailored health monitoring for these populations.
An interesting aspect of the study is the role of COVID-19 variants and vaccination status in autoimmune disease risk. The Delta variant posed a higher risk for autoimmune disorders compared to Omicron. Unvaccinated individuals were more vulnerable to autoimmune conditions like rheumatoid arthritis, SLE, and Crohn’s disease, suggesting vaccination may offer some protective effects. Notably, vaccinated individuals exhibited lower autoimmune risks, underscoring the importance of COVID-19 vaccination in mitigating long-term health effects. For verification, the researchers performed sensitivity analyses with a pre-pandemic historical control group, confirming similar trends. Additionally, they examined positive control outcomes, like heart failure, and found consistent associations with COVID-19.
Chang et. al in a retrospective cohort study found that COVID-19 infection is associated with a significantly increased risk of developing various autoimmune diseases. After matching COVID-19 patients with controls on demographics and other health-related factors, the study observed notably higher adjusted hazard ratios for conditions such as rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, Sjögren’s syndrome, and mixed connective tissue disease, among others.
The present study findings underscore COVID-19’s potential to elevate autoimmune disease risks, particularly in severe and unvaccinated cases, highlighting the importance of vigilance and long-term observation to fully understand these effects. Identifying risk patterns in specific subgroups will be crucial as populations continue to recover, providing insights into the pandemic’s lasting impacts on global health. The findings emphasize the need for vaccination, timely care for severe cases, and targeted health monitoring, marking a significant step in understanding COVID-19’s influence on autoimmune health and the need for ongoing research and awareness.
References
- Heo YW, Jeon JJ, Ha MC, Kim YH, Lee S. Long-Term Risk of Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19. JAMA Dermatology [Internet]. 2024 Nov 6 [cited 2024 Nov 12]; Available from: https://doi.org/10.1001/jamadermatol.2024.4233
- Chang R, Yen-Ting Chen T, Wang SI, Hung YM, Chen HY, Wei CCJ. Risk of autoimmune diseases in patients with COVID-19: A retrospective cohort study. EClinicalMedicine. 2023 Feb;56:101783.