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. 2024 Feb 8:15:1337406.
doi: 10.3389/fimmu.2024.1337406. eCollection 2024.

New-onset autoimmune disease after COVID-19

Corrilynn O Hileman #  1   2 , Shahdi K Malakooti #  1   2 , Nirav Patil  3 , Nora G Singer  1   2 , Grace A McComsey  1   3
Affiliations

New-onset autoimmune disease after COVID-19

Corrilynn O Hileman et al. Front Immunol. .

Abstract

Introduction: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may trigger autoimmune disease (AD) through initial innate immune activation with subsequent aberrations in adaptive immune cells leading to AD. While there are multiple reports of incident AD diagnosed after COVID-19, the risk in the context of key circulating strains is unknown.

Methods: TriNetX, a global, federated, health research network providing access to electronic medical records across 74 healthcare organizations, was utilized to define an adult cohort between January 1, 2020, and March 3, 2023. Exposure was defined as COVID-19 diagnosis (ICD-10 code or positive laboratory test). Age- and sex-propensity score-matched controls never had COVID-19 diagnosed. Outcomes were assessed 1 month to 1 year after the index date. Patients with AD prior to or within 1 month after the index date were excluded from the primary analysis. Incidence and risk ratios of each AD were assessed.

Results: A total of 3,908,592 patients were included. Of 24 AD patients assessed, adjusted risk ratios for eight AD patients who had COVID-19 were higher compared to those who had no COVID-19. Cutaneous vasculitis (adjusted hazard ratio (aHR): 1.82; 95% CI 1.55-2.13), polyarteritis nodosa (aHR: 1.76; 95% CI 1.15-2.70), and hypersensitivity angiitis (aHR: 1.64; 95% CI 1.12-2.38) had the highest risk ratios. Overall, psoriasis (0.15%), rheumatoid arthritis (0.14%), and type 1 diabetes (0.13%) had the highest incidence during the study period, and of these, psoriasis and diabetes were more likely after COVID-19. The risk of any AD was lower if COVID-19 was diagnosed when Omicron variants were the predominant circulating strains. A positive antinuclear antibody was more likely and predictive of AD after COVID-19.

Discussion: SARS-CoV-2 may be a potential trigger for some AD, but the risk for AD may decrease with time given the apparent lower risk after infection with Omicron variants.

Keywords: COVID-19; antinuclear antibodies; autoantibodies; autoimmune diseases; risk factors.

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Conflict of interest statement

CH has served as consultant for Theratechnologies and Gilead and has received research grant support from Gilead. GM has served as consultant for Gilead, Merck, Theratechnologies, Janssen, GSK/ViiV, and has received research grants from Gilead, Merck, Janssen and Theratechnologies. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Adjusted risk ratio for autoimmune disease within 1 year after COVID-19 diagnosis vs. no COVID-19 diagnosis.
Figure 2
Figure 2
(A) Adjusted risk ratio for autoimmune disease post-COVID-19 during Omicron vs. pre-Delta variant timeframes. (B) Adjusted risk ratio for autoimmune disease post-COVID-19 during Omicron vs. Delta variant timeframes.
See this image and copyright information in PMC

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