Long-Term Risk of Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19, 2024, Heo et al.

Long-Term Risk of Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19
Yeon-Woo Heo; Jae Joon Jeon; Min Chul Ha; You Hyun Kim; Solam Lee

IMPORTANCE
Few studies have investigated the association between COVID-19 and autoimmune and autoinflammatory connective tissue disorders; however, research with long-term observation remains insufficient.

OBJECTIVES
To investigate the long-term risk of autoimmune and autoinflammatory diseases after COVID-19 over an extended observation period.

DESIGN, SETTING AND PARTICIPANTS
This retrospective nationwide population-based study investigated the Korea Disease Control and Prevention Agency–COVID-19–National Health Insurance Service (K-COV-N) cohort. Individuals with confirmed COVID-19 from October 8, 2020, to December 31, 2022, and controls identified among individuals who participated in the general health examination in 2018 were included in the analysis.

EXPOSURES
Confirmed COVID-19.

MAIN OUTCOMES AND MEASURES
Incidence and risk of autoimmune and autoinflammatory connective tissue disorders in patients after COVID-19. Various covariates, such as demographic characteristics, general health data, socioeconomic status, and comorbidity profiles, were balanced using inverse probability weighting.

RESULTS
A total of 6 912 427 participants (53.6% male; mean [SD] age, 53.39 [20.13] years) consisting of 3 145 388 with COVID-19 and 3 767 039 controls with an observational period of more than 180 days were included. Alopecia areata (adjusted hazard ratio [AHR], 1.11 [95% CI, 1.07-1.15]), alopecia totalis (AHR, 1.24 [95% CI, 1.09-1.42]), vitiligo (AHR, 1.11 [95% CI, 1.04-1.19]), Behcet disease (AHR, 1.45 [95% CI, 1.20-1.74]), Crohn disease (AHR, 1.35 [95% CI, 1.14-1.60]), ulcerative colitis (AHR, 1.15 [95% CI, 1.04-1.28]), rheumatoid arthritis (AHR, 1.09 [95% CI, 1.06-1.12]), systemic lupus erythematosus (AHR, 1.14 [95% CI, 1.01-1.28]), Sjogren syndrome (AHR, 1.13 [95% CI, 1.03-1.25]), ankylosing spondylitis (AHR, 1.11 [95% CI, 1.02-1.20]), and bullous pemphigoid (AHR, 1.62 [95% CI, 1.07-2.45]) were associated with higher risk in the COVID-19 group. Subgroup analyses revealed that demographic factors, including male and female sex, age younger than 40 years, and age 40 years and older, exhibited diverse associations with the risk of autoimmune and autoinflammatory outcomes. In addition, severe COVID-19 infection requiring intensive care unit admission, the Delta period, and not being vaccinated were associated with higher risk.

CONCLUSIONS AND RELEVANCE
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. Long-term monitoring and care of patients is crucial after COVID-19, considering demographic factors, disease severity, and vaccination status, to mitigate these risks.


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I doubt this is meaningful. There are likely to be confounding factors. The conditions listed are in several cases completely unrelated but the risk ratios are all rather in the same range.

 

I am not sure why this would be a 'group effect' since a number of these conditions involve completely unrelated processes but it would be nice to see some negatives for equally unrelated illnesses that do not have the 'auto-' tag.

I am not sure about the relation of Behcets to infection. The problem with Behcets is that in Western countries the diagnosis is more often than not likely wrong since the condition is rare and diagnosed on a syndrome of features. In Turkey and Japan the diagnosis is probably usually right because it is common there (relating to HLA status).

I think there will be all sorts of ascertainment issues in a retrospective study of diagnoses.