Caused by COVID? The Risk of Autoimmune Disorders Following COVID Infection

Original Article: Long-Term Risk of Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19

What are the key takeaways of this article?

It is well-known that the COVID-19 pandemic created unparalleled challenges to global health and the healthcare system as a whole. Acute repercussions of COVID-19 infection include acute respiratory distress syndrome, cardiovascular issues, and acute kidney failure. The extended effects are less known, particularly those relating to autoimmune and autoinflammatory diseases. Recent research indicates that COVID-19 may increase the risk of several autoinflammatory diseases such as systemic lupus erythematosus (SLE) and alopecia areata. Unfortunately, most of this research involves short follow-up periods, indicating a need for an extended observational period.

In this retrospective cohort study, Heo et al. analyzed 6.9 million participants in South Korea that were observed for more than 180 days. The COVID group included those with confirmed COVID-19 between October 8, 2020 to December 31, 2022, while the controls were identified among individuals who participated in the general health examination conducted by the Korean government in 2018. The mean follow-up time was 287.6 days for the COVID group and 287.7 days for the control group.

Overall, those in the COVID group were associated with a higher risk of also developing many autoimmune and autoinflammatory diseases. In particular, alopecia areata (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]), and bullous pemphigoid (AHR 1.62 [95% CI 1.07-2.45]) were some dermatological conditions associated with a higher risk in the COVID group. Interestingly, the authors did find some variation depending on the severity of COVID infection and vaccination status of participants. In those with severe infection that required ICU admission, the risk of alopecia areata (AHR 1.21 [95% CI 1.03-1.43]), psoriasis (AHR 1.33 [95% CI 1.11-1.60]), and bullous pemphigoid (AHR 6.82 [95% CI 3.59-12.93]) was significantly higher than in the control group. When stratifying by vaccination status, the authors found that participants who were not vaccinated had a higher risk of developing alopecia areata, alopecia totalis, and psoriasis, whereas vaccinated participants had comparable or lower effect sizes for most outcomes.

Unfortunately, this study population consisted of a single ethnicity which may limit its generalizability. Additionally, there may be a selection bias in the study population regarding individuals who were never tested for COVID-19 or who did not report to a healthcare professional, potentially leading to over- or underestimation of the findings.

In summary, this study did find increased risks of various autoimmune and autoinflammatory connective tissue disorders following COVID-19 infection, many of which would generally be followed by a dermatologist. These findings suggest that counseling on long-term monitoring along with management of certain patients is especially important after COVID-19 infection to mitigate the risks of these conditions. This is especially relevant in the field of dermatology as clinicians may advise patients on certain signs and symptoms that may warrant further physician follow-up.

Publication Date: December 16, 2024

Reference: Heo YW, Jeon JJ, Ha MC, Kim YH, Lee S. Long-Term Risk of Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19. JAMA Dermatol. Published online November 6, 2024. doi:10.1001/jamadermatol.2024.4233

Summary By: Taylor Skinner