Rheumatological syndromes with Autoimmune features in post covid setting at 24 months: Reversible, persistent and accelerated traits

<bold>Background:</bold>Rheumatological symptoms and autoimmune conditions were frequently documented in post covid setting. <bold>Methods:</bold>Prospective, observational study conducted during and after all three waves of COVID-19 pandemic and included recovered 1396 cases with rheumatological symptoms with autoimmune feature with rheumatological and autoimmune profile workup such as RA factor, antinuclear antibody, ANA profile (Anti-Centromere Ab, Anti-dsDNA, Anti-La Ab, Anti-Ro Ab, Anti-Scl-70 Ab, Anti-Sm, Anti-U1 RNP) in cases with positive ANA test. Reversible, persistent and progressive ‘traits’ were categorised on basis of clinical symptoms and antibody titer during follow up done at 24 months. Statistical analysis was by using chi-test. <bold>Results:</bold>Reversible, persistent and accelerated traits were documented in 34.24%(478/1396), 50.71%(708/1396) and 15.04%(210/1396) cases respectively. Inflammatory markers during follow-up and markers of antigenic mimicry have shown significant association (p<0.00001). Exaggerated symptoms and persistent versus progressive traits have showed significant association with virus variant in all three waves(p<0.00001) Immune dysregulation as TH1/TH2 normal, supressed and hyperactive shown significant association (p<0.00001) Exaggerated symptoms and persistent versus progressive traits have showed significant association with virus variant in all three waves (p<0.00001). <bold>Conclusion</bold>:Unmasking effect of corona virus related immune dysregulation on Rheumatological syndrome & new onset Rheumatological syndromes after covid-19 is the plausible mechanism. Recurrent coronavirus related events are triggers for worsening or new onset illness needs further research.