Long COVID-19 in autoimmune and rheumatic diseases: data from COVID-19 vaccination in autoimmune diseases study

ABSTRACT

Background/Aim: Long COVID-19 is one of the post-infection challenging issues. We aimed to assess the prevalence and characteristics of this syndrome in patients with autoimmune and rheumatic diseases (AIRDs) through a multicentre international e-surveys (The COVID-19 Vaccination in Autoimmune Diseases) COVAD study. Method(s) The COVAD group comprised of collaborators from 109 countries. An online survey platform was conducted in Jan-July 2022 to capture self-reported COVID-19 infection and vaccination data in patients with AIRDs and healthy controls (HCs). Long COVID-19 was defined as per WHO definitions as persistence of symptoms beyond 3 months of COVID-19 infection. Descriptive statistics and multivariable regression adjusted for age, gender, ethnicity, and disease modifying anti-rheumatic drugs (DMARDs) were employed. Result(s) Among the 7666 complete survey respondents, 1677 who had taken the survey >90 days of last COVID-19 infection were analyzed. Among them, a total of 8.1% (n = 136) had long COVID-19 syndrome and the median age was 46 (34-55) years, with Male Female ratio of 16.3. The prevalence of long COVID-19 was significantly higher in patients with AIRDs compared to HCs (OR 2 [1.3-2.9], P < 0.001). Respondents with long COVID-19 had worse PROMIS 10a quality of life global physical and mental health score, as well as fatigue and pain VAS compared to those without post-COVID- 19 (all P < 0.001). Among patients with AIRDs, those with long COVID-19 reported to have higher flares of AIRDs following COVID-19 infection (OR 4.3, P < 0.01). On multivariable regression analysis, the characteristics of patients with long COVID-19 were female gender, Caucasian ethnicity and presence of comorbid insomnia. Presence of fatigue, muscle aches, dyspnoea and loss of taste during previous COVID-19 infection were the significant predictors of long COVID-19. Among patients with AIRDs, comorbidities (OR 2.0;95% CI 1.08-3.6, P = 0.026), and advanced treatment (OR 1.9;95% CI 1.08-3.3, P = 0.024), or intensive care (OR 3.8;95% CI 1.01-14.4, P = 0.047) for severe COVID-19 were risk factors for long COVID-19. The use of rituximab, iv immunoglobulins (IVIG), mycophenolate mofetil and anti-TNF agents use also predicted long COVID-19. Conclusion(s) Patients with AIRDs are at higher risk of long-COVID- 19 syndrome. Associated comorbid conditions and advanced treatment or intensive care for severe COVID-19 confer a higher risk.