2022 Update: COVID and Autoimmune Diseases
A lot has happened in the last few years in regard to our understanding of COVID and how it affects autoimmune diseases. Here are some updates from our original post that we now understand about their connections.
COVID-19 Can Stimulate New Autoimmunity
More people that have never had an autoimmune condition have developed autoimmune conditions after a COVID-19 infection. We have seen this in our clinic as well as in scientific reports. Usually people have felt fine prior to infection, and then post-infection, will start to have symptoms of fatigue, joint pain, migraines, muscle weakness, vision changes and cognitive changes (to name a few).
A study published in December 2021 showed that the most common autoimmune diseases that occurred after COVID-19 infection were vasculitis conditions, arthritic conditions, rheumatic autoimmune diseases and myopathies. The most common vasculitis conditions included Kawasaki disease, ANCA-associated vasculitis and IgA vasculitis. Arthritic conditions included rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Rheumatic autoimmune diseases included systemic lupus, scleroderma and sarcoidosis, where myopathies included polymyositis and dermatomyositis.
Symptom onset after infection was somewhere between 10 to 45 days after infection on average. And at least 20% of people that did not have antibodies before infection will have elevation of antibodies after infection.
Autoimmune Diseases Increase Risk of Severe COVID-19
Many studies have come out looking at whether or not those with autoimmune diseases are at higher risk of developing severe COVID-19 complications. Mostly this is due to those with autoimmune diseases being on immunosuppressants. There is some good evidence to suggest that those on immunosuppressants do not have as strong response to vaccinations or to infection. This can lead to poorer immunity to the virus for initial and subsequent infections.
Those with inflammatory arthritis seem to be the most affected. A recent study showed that at least half of those hospitalized for severe COVID-19 at at least one antibody present in their blood stream. Where antibodies are only present in up to 15% of healthy populations. Anti-nuclear antibodies (ANA) and anti-neutrophil cytoplasmic antibodies (ANCA) where the most common antibodies present in severe COVID-19 cases. These antibodies are the ones most associated with vasculitis and rheumatic conditions such as lupus and scleroderma.
Additionally, men with rheumatoid arthritis are more likely to have severe COVID-19 outcomes. Though it’s unclear if this is because of the rheumatoid arthritis being present, or because men are more likely to have comorbidities such as high blood pressure, high cholesterol, diabetes and kidney disease.
Autoimmune Diseases Prolong Symptoms of COVID-19
For those that have autoimmune diseases, but do not get severe COVID-19, the risk of developing prolonged symptoms or long-COVID does appear to be higher.
For those with autoimmune rheumatic diseases (rheumatoid arthritis, lupus, scleroderma…etc) – more than 25% developed COVID-19 symptoms that lasted longer than 1 month. With up to 10% of individuals having symptoms for up to 3 months post infection. And of all of the people that still have symptoms after 3 months of infection, 44% of them had elevated antibodies in their blood.
Those with long-COVID symptoms are also at risk of having elevations of ANA antibodies in their blood up to 12 months after infection. It does appear that these antibodies do start to decline around 3 months after infection, which provides some hope around symptoms improvement within a year post infection.
Conclusion
So far most of the studies that have come out have been related to rheumatologic conditions and arthritis. More studies need to look at other autoimmune diseases such as thyroid conditions, diabetes, multiple sclerosis and inflammatory bowel diseases. We will be sure to keep you up to date as information continues to be updated.
If you have any questions about how your autoimmune disease may be affected by COVID-19 or if you are concerned you have developed an autoimmune disease, you can contact our office today to schedule a free consult with one of our physicians about how we can help you.
