LONG COVID has been found to be more common among people with autoimmune rheumatic diseases (AIRD) than among matched controls, according to a large US analysis, which has also linked specific treatments and clinical factors to a higher risk of developing the condition.
Long COVID has remained a significant concern since the pandemic, and patients with AIRD, including those receiving immunomodulatory therapy, have become a group of particular interest. Before this study, little was known about the prevalence of Long COVID in people with autoimmune rheumatic diseases or about the factors associated with it.
Researchers conducted a retrospective cohort study using data from the National Clinical Cohort Collaborative (N3C). Adults with a first documented SARS-CoV-2 infection (September 2021–December 2023) were included, with follow-up through December 2024.
Long COVID was defined using the International Classification of Diseases, 10th Revision, Clinical Modification code U09.9, or a Long COVID clinic visit occurring 28–365 days after first infection.
Patients with AIRD were compared with matched controls without AIRD using 1:1 nearest-neighbour propensity score matching on age, with exact matching on sex, race/ethnicity, SARS-CoV-2 variant-dominant period and data-contributing organisation.
In the matched cohort of 187,106 patients, Long COVID occurred in 2.8% of patients with AIRD and 1.5% of patients without AIRD.
In multivariable analyses, AIRD was associated with an increased risk of Long COVID compared with non-AIRD status (adjusted hazard ratio: 1.56; 95% CI: 1.45–1.67).
Among patients with AIRD, higher acute COVID-19 severity, pulmonary disease, obesity, and exposure to rituximab or glucocorticoids were associated with an increased risk of Long COVID.
Sjögren’s syndrome was also associated with a higher risk of Long COVID.
The higher risk of Long COVID among patients with autoimmune rheumatic diseases has highlighted the need to identify potential risk factors in this population to minimise long-term effects. Clinicians should remain alert to Long COVID in patients with higher-risk features, while further research is needed to confirm these associations.
Reference
Singh N et al. Higher risk of Long COVID among patients with autoimmune rheumatic diseases and immunomodulatory therapy: a retrospective cohort analysis of national US data. Arthritis & Rheumatology. 2026;DOI:10.1002/art.70361.
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