Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19, 2023, Lim et al.

[SNT Gatchaman]

Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19
Sung Ha Lim; Hyun Jeong Ju; Ju Hee Han; Ji Hae Lee; Won-Soo Lee; Jung Min Bae; Solam Lee

Importance
Multiple cases of autoimmune and autoinflammatory diseases after COVID-19 have been reported. However, their incidences and risks have rarely been quantified.

Objective
To investigate the incidences and risks of autoimmune and autoinflammatory connective tissue disorders after COVID-19.

Design, Setting, and Participants
This was a retrospective population-based study conducted between October 8, 2020, and December 31, 2021, that used nationwide data from the Korea Disease Control and Prevention Agency COVID-19 National Health Insurance Service cohort and included individuals who received a diagnosis of COVID-19 via polymerase chain reaction testing and a control group with no evidence of COVID-19 identified from National Health Insurance Service of Korea cohort. Data analysis was conducted from September 2022 to August 2023.

Exposures
Receipt of diagnosis of COVID-19.

Main Outcomes and Measures
The primary outcomes were the incidence and risk of autoimmune and autoinflammatory connective tissue disorders following COVID-19. A total of 32 covariates, including demographics, socioeconomic statuses, lifestyle factors, and comorbidity profiles, were balanced through inverse probability weighting. The incidences and risks of autoimmune and autoinflammatory connective tissue disorders were compared between the groups using multivariable Cox proportional hazard analyses.

Results
A total of 354 527 individuals with COVID-19 (mean [SD] age, 52.24 [15.55] years; 179 041 women [50.50%]) and 6 134 940 controls (mean [SD] age, 52.05 [15.63] years; 3 074 573 women [50.12%]) were included. The risks of alopecia areata (adjusted hazard ratio [aHR], 1.12; 95% CI, 1.05-1.19), alopecia totalis (aHR, 1.74; 95% CI, 1.39-2.17), antineutrophil cytoplasmic antibody–associated vasculitis (aHR, 2.76; 95% CI, 1.64-4.65), Crohn disease (aHR, 1.68; 95% CI, 1.31-2.15), and sarcoidosis (aHR, 1.59; 95% CI, 1.00-2.52) were higher in the COVID-19 group. The risks of alopecia totalis, psoriasis, vitiligo, vasculitis, Crohn disease, ulcerative colitis, rheumatoid arthritis, adult-onset Still disease, Sjögren syndrome, ankylosing spondylitis, and sarcoidosis were associated with the severity of COVID-19.

Conclusions and Relevance
In this retrospective cohort study, COVID-19 was associated with a substantial risk for autoimmune and autoinflammatory connective tissue disorders, indicating that long-term management of patients with COVID-19 should include evaluation for such disorders.


Link | PDF (JAMA Network Open)

 

[Hutan]

I wonder how much of this increased incidence can be accounted for by people actually having these disorders before Covid19. Then, in the aftermath of Covid-19, when a lot of people have symptoms like fatigue and aches as well, the person goes to the doctor and they get some screening, and these conditions are diagnosed.

 

[Wyva]

I wonder how much of this increased incidence can be accounted for by people actually having these disorders before Covid19. Then, in the aftermath of Covid-19, when a lot of people have symptoms like fatigue and aches as well, the person goes to the doctor and they get some screening, and these conditions are diagnosed.

I really really wouldn't be surprised. I didn't share it here I think but a couple of weeks ago I saw an abstract for a conference from pediatricians from Semmelweis University here. And it was about the children they screened at their long covid clinic. Some of these kids did end up with diagnoses of MS and other diseases and it did sound like these just weren't caught before or were attributed to covid because of the timing.

 

[Ash]

I think that COVID-19 is causing flares and aggressive attacks of autoimmune and autoinflammatory connective tissue disorders in people who would have had a slower progression and or milder form of these diseases.

So it’s the COVID making people sick via other pathways.


I also think COVID can trigger the whole process in susceptible individuals. The Covid causing disease that may not have otherwise occurred, or at least not for many years or decades.

Still COVID making people sick.

I do think it’s also true that when you add another condition on top of an existing one, and lose more functionality, especially as a child you might finally get overdue exploration that would reveal more longstanding conditions.

Edit: one more sentence to emphasise that Covid causes sickness.

 

[Midnattsol]

I think that COVID-19 is causing flares and aggressive attacks of autoimmune and autoinflammatory connective tissue disorders in people who would have had a slower progression and or milder form of these diseases.

So it’s the COVID making people sick via other pathways.


I also think COVID can trigger the whole process in susceptible individuals. The Covid causing disease that may not have otherwise occurred, or at least not for many years or decades.

I do think it’s also true that when you add another condition on top of an existing one, and lose more functionality, especially as a child you might finally get overdue exploration that would reveal more longstanding conditions.

I think this with diabetes as well. As diabetics are more likely to become more ill, if one was prediabetic or undiagnosed full-blown diabetic getting a covid infection could be what ends up giving the diagnosis.

I stil don't enjoy the prospects of people developing diabetes type 1 from this virus, there has been an increase in diabetic diagnoses in children the last year. Ok maybe they were predisposed, but delaying illness onset also has value.

 

[Ash]

I think this with diabetes as well. As diabetics are more likely to become more ill, if one was prediabetic or undiagnosed full-blown diabetic getting a covid infection could be what ends up giving the diagnosis.

I stil don't enjoy the prospects of people developing diabetes type 1 from this virus, there has been an increase in diabetic diagnoses in children the last year. Ok maybe they were predisposed, but delaying illness onset also has value.

Yeah, by predisposed I mean for one thing or another, we all are. It’s definitely Covid causing sickness, just as EBV causes sickness. People are all vulnerable. We are vulnerable in the same way being human and infected with a novel and deadly virus is an immediate risk to our organs and our lives. Also ways chronic diseases and long term damage occurs people have different impacts and outcomes. Outcomes of Covid. If you have asthma and have to breath in polluted air because your society pollutes and this causes a fatal asthma attack. You could have lived long and well with asthma without the constant assaults of poisonous air. Same for Covid.