COVID-19 infection is associated with an increased long-term risk of autoimmune and autoinflammatory connective tissue disorders, particularly in severe cases, during the Delta period, and among unvaccinated individuals. Autoimmune and autoinflammatory connective tissue disorders are a significant health concern, yet their potential link to COVID-19 remains under-researched, especially over extended observation periods. This study aimed to assess the long-term risk of developing these conditions following COVID-19 infection. By investigating a large-scale cohort from South Korea, this research provides valuable insights into how COVID-19, its severity, and vaccination status influence the development of such disorders.
This retrospective cohort study analysed data from 6,912,427 participants in the Korea Disease Control and Prevention Agency COVID-19–National Health Insurance Service (K-COV-N) database, covering confirmed COVID-19 cases between October 2020 and December 2022. The cohort included 3,145,388 individuals with COVID-19 and 3,767,039 controls, with a follow-up period exceeding 180 days. Participants’ demographic and health data were balanced using inverse probability weighting. Findings revealed that COVID-19 infection was associated with increased risks for several autoimmune and autoinflammatory disorders, including alopecia areata (adjusted hazard ratio [AHR], 1.11), rheumatoid arthritis (AHR, 1.09), systemic lupus erythematosus (AHR, 1.14), Behçet disease (AHR, 1.45), Crohn disease (AHR, 1.35), and ulcerative colitis (AHR, 1.15). Higher risks were observed during the Delta variant period, in unvaccinated individuals, and those with severe COVID-19 requiring intensive care. Subgroup analyses identified varying associations by age and sex, with individuals under 40 years and those over 40 years displaying diverse risk profiles.
This study highlights the need for proactive monitoring and long-term care for patients recovering from COVID-19, particularly those with severe disease, exposure during high-risk periods, or who are unvaccinated. Early identification and management of emerging autoimmune and autoinflammatory conditions can mitigate their impact on patient health. Clinicians should integrate risk assessments based on COVID-19 history into routine care and tailor management strategies accordingly. Future research is necessary to elucidate the mechanisms underlying these associations and to refine risk stratification models for improved clinical outcomes.
Abigail Craig, EMJ
Reference
Heo Y-W et al. Long-term risk of autoimmune and autoinflammatory connective tissue disorders following covid-19. JAMA Dermatol. 2024;160(12):1278-87.
