Patients with autoimmune inflammatory rheumatic diseases (AIRDs) have a significantly higher risk of developing Long COVID after SARS-CoV-2 infection than patients without AIRDs, according to results of a study published in Arthritis & Rheumatology.
These risks are particularly elevated among patients receiving rituximab or systemic glucocorticoid therapy.
In a retrospective cohort study, investigators used electronic health records from the National Clinical Cohort Collaborative (N3C) to evaluate the association between preexisting AIRDs and Long COVID. The study included adults with documented SARS-CoV-2 infection between September 2021 and December 2023, with follow-up through December 2024.
The study cohort included 93,553 patients with AIRDs and 93,553 without AIRDs (median age, 61 years; 76% women). Long COVID was identified through diagnostic codes or specialized clinic visits occurring 28 to 365 days after infection.
These findings highlight the need for targeted monitoring and further investigations and prevention strategies for Long COVID in patients with autoimmune diseases.
Long COVID occurred in 2.8% of patients with AIRDs compared with 1.5% of those without AIRDs. After adjustment, AIRDs were associated with a significantly increased risk of Long COVID (adjusted hazard ratio [aHR], 1.56). Results remained consistent after excluding patients with fibromyalgia (aHR, 1.53).
Among patients with AIRDs, Sjögren syndrome was associated with a higher risk of Long COVID compared with rheumatoid arthritis (aHR, 1.23), whereas systemic sclerosis was associated with a lower risk (aHR, 0.73). In disease-specific analyses comparing patients with individual AIRDs against matched controls without AIRDs, elevated risks were observed with Sjögren syndrome (aHR, 1.88), vasculitis (aHR, 1.79), and systemic lupus erythematosus (aHR, 1.60).
Medication exposure was also associated with Long COVID risk. Patients receiving rituximab had a 68% higher adjusted risk (aHR, 1.68), while systemic glucocorticoid exposure was associated with a 30% higher risk (aHR, 1.30). Conversely, conventional synthetic disease-modifying antirheumatic drugs were associated with a modestly reduced risk (aHR, 0.86).
Patients with AIRDs also demonstrated increased risks of postacute organ system abnormalities, particularly musculoskeletal (aHR, 1.64; 95% CI, 1.62–1.67) and immune system abnormalities (aHR, 1.60; 95% CI, 1.56–1.63).
Study limitations included reliance on diagnostic codes that may underestimate Long COVID prevalence, potential residual confounding from incompletely captured disease activity and other clinical factors, and possible misclassification of AIRD diagnoses and medication exposures.
