COVID-19 may increase risk of autoimmune disease

In a recent study posted on medrex sib*Preprint server, researchers investigated the association between coronavirus disease 2019 (COVID-19) and emerging autoimmune diseases.

Background

Some individuals develop long-lasting, persistent symptoms of COVID after being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This cannot be explained by alternative diagnoses and persists for more than 12 weeks after acute illness. Much of the research (on the long COVID) has focused on symptoms that subside over time. A number of studies have examined a small, selective sample of her COVID-19 patients, and only a few studies have included controls or data on chronic illness.

This evidence is insufficient to assess the burden of COVID-19. Cardiovascular, neurological, respiratory, psychological diseases and other conditions have been studied in the long-term COVID setting, but less is known about autoimmune diseases. To date, information on new-onset autoimmune diseases after SARS-CoV-2 infection is limited. Additionally, similarities between COVID-19 and systemic rheumatic disease can make diagnosis difficult.

About research

In the current study, researchers investigated whether the risk of autoimmune disease is increased after SARS-CoV-2 infection. People infected with SARS-CoV-2 in 2020 and controls were followed up to 30 June 2021 for up to 15 months. Individuals with confirmed SARS-CoV-2 infection by polymerase chain reaction (PCR) were included with COVID-19. cohort. Individuals without laboratory-confirmed COVID-19 diagnosis were excluded.

The team used regular healthcare data from a German health insurance company covering over 39 million people. Data included information on diagnoses, medical procedures, outpatient medical services, and prescriptions. COVID-19 patients were matched exactly with 3 non-COVID-19 controls. After matching, subjects were excluded if they died within her quarter of her COVID-19 diagnosis.

The authors examined 64 potential outcomes from 41 autoimmune diseases based on clinical experience. Data on pre-existing chronic diseases from 2019 health records were used to control for confounders. The incidence of autoimmune disease was estimated and the difference in incidence between COVID-19 and control cohorts was assessed by calculating the incidence ratio.

findings

The team matched 670,301 people with COVID-19 to a control group. After exclusion, 641,407 people with COVID-19 matched his over 1.56 million controls. Most individuals had 3 matched controls, but some patients had 2 or 1 control. In the COVID-19 cohort, her 11.9% of individuals had a pre-existing autoimmune disease prior to her COVID-19.

More than 6,400 developed an autoimmune disease during follow-up. Of those with pre-existing autoimmunity, 1744 developed additional autoimmune disorders. Most subjects were female from the cohort and ranged in age from 18 to 64 years. Approximately 6.4% of individuals were hospitalized during acute COVID-19, and 1.6% required intensive care or a ventilator.

The incidence of autoimmune disease was 15.05 and 10.55 per 1000 person-years in the COVID-19 and control cohorts, respectively. This translates to an excess risk of 4.5 per 1000 person-years from COVID-19. The incidence of autoimmune disease was 1.43. Furthermore, development of autoimmune disease was more frequent in the COVID-19 cohort of individuals with pre-existing autoimmunity.

The most common autoimmune diseases in the COVID-19 cohort were Hashimoto’s thyroiditis, Graves’ disease, psoriasis, rheumatoid arthritis, and Sjögren’s syndrome. Wegner’s disease, Behçet’s syndrome, sarcoidosis, and temporal arteritis were the most common.

The incidence ratios were not significantly different between sexes or age groups. Nevertheless, the absolute incidence of first autoimmune disease was higher in the elderly than in the young. Did.

Conclusion

In summary, the excess risk of developing autoimmunity due to COVID-19 was 4.5 per 1000 person-years in this study. A rare autoimmune disease with vasculitis had the highest incidence. People without pre-existing autoimmunity were 43% more likely to develop an autoimmune disease than controls, and those with pre-existing autoimmunity were 23% more likely to develop another autoimmune disease.

Taken together, COVID-19 was associated with an increased risk of developing autoimmune disease 3–15 months after SARS-CoV-2 infection. Further research is needed to confirm whether SARS-CoV-2 causes autoimmune disease and to identify effective prevention and treatment strategies.

*Important Notices

medRxiv publishes non-peer-reviewed, preliminary scientific reports and should not be considered conclusive, to guide clinical practice/health-related actions, or to be treated as established information .