Study: COVID-19 May Lead to Long-Term Elevated Risk of Autoimmune Disorders

In a retrospective cohort study based on the Korea Disease Control and Prevention Agency–COVID-19–National Health Insurance Service (K-COV-N) cohort, researchers found long-term associations between COVID-19 and an elevated risk of autoimmune and autoinflammatory connective tissue disorders. Individuals with a confirmed COVID-19 diagnosis exhibited increased incidences of various disorders, including alopecia areata, alopecia totalis, vitiligo, Behçet disease, Crohn disease, ulcerative colitis, rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrome, ankylosing spondylitis, and bullous pemphigoid, compared to control participants without COVID-19.

This study addresses a gap in understanding the chronic sequelae of COVID-19, particularly regarding autoimmune and autoinflammatory diseases. Although COVID-19's acute effects have been well-documented, the risk of developing longer-term autoimmune and autoinflammatory conditions post-infection remains underexplored

This study included individuals with confirmed COVID-19 between October 8, 2020 and December 31, 2022, matched with control participants from a 2018 general health examination cohort. A total of 6,912,427 participants were analyzed, with 3,145,388 individuals having COVID-19 and 3,767,039 controls.

The findings revealed that COVID-19 was associated with increased risks of specific autoimmune and autoinflammatory disorders. Alopecia areata showed an adjusted hazard ratio (AHR) of 1.11 (95% CI, 1.07-1.15), alopecia totalis had an AHR of 1.24 (95% CI, 1.09-1.42), and vitiligo presented an AHR of 1.11 (95% CI, 1.04-1.19). Additionally, conditions like Crohn disease and Behçet disease exhibited substantial associations with AHRs of 1.35 (95% CI, 1.14-1.60) and 1.45 (95% CI, 1.20-1.74), respectively. The study also identified a heightened risk of rheumatoid arthritis (AHR = 1.09; 95% CI, 1.06-1.12), systemic lupus erythematosus (AHR = 1.14; 95% CI, 1.01-1.28), and bullous pemphigoid (AHR = 1.62; 95% CI, 1.07-2.45). Severe COVID-19 requiring ICU admission, infections during the Delta variant period, and lack of vaccination were additional factors linked to higher autoimmune and autoinflammatory risk.

The study’s limitations include its retrospective design and reliance on observational data.

“This retrospective cohort study with an extended follow-up period found associations between COVID-19 and the long-term risk of various autoimmune and autoinflammatory connective tissue disorders,” the study authors concluded. “Long-term monitoring and care of patients is crucial after COVID-19, considering demographic factors, disease severity, and vaccination status, to mitigate these risks.”

Reference

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 6, 2024. doi:10.1001/jamadermatol.2024.4233