Analysis of the course of immune-mediated inflammatory rheumatic diseases after COVID-19: flare frequency and prognostic determinants

Even after the end of the COVID-19 pandemic, the SARS-CoV-2 virus continues to circulate in the population and influence the course of immune-mediated inflammatory rheumatic diseases (IMIRDs). Previous COVID-19 infection may be associated with increased IMIRD activity; however, data on the long-term post-infectious impact of COVID-19 on rheumatic disease progression remain limited. Objective : To assess dynamics of IMIRDs course in patients with a history of COVID-19, based on individual disease activity indices measured at 3, 6, and 12 months after infection. Material and Methods . A retrospective-prospective cohort study included 100 patients with IMIRDs (rheumatoid arthritis [RA], systemic lupus erythematosus, systemic sclerosis, and ankylosing spondylitis) who had experienced COVID-19. Disease activity was assessed using validated indices: DAS28, SLEDAI-2K, modified Valentini index, and ASDAS. Data were analyzed using nonparametric statistical methods and performance analysis (ROC-analysis). Results and discussion . At 3 months post-COVID-19, high or very high disease activity was noted in 51% of patients; at 12 months, activity decreased to 38.8%. Persistent high disease activity was observed in 18% of patients throughout the follow-up period, most commonly in RA patients. Risk factors for experiencing ≥2 disease flares included a history of COVID-19-associated pneumonia (odds ratio [OR] 7.1; 95% confidence interval [CI] 1.6–32.2; p=0.011) and comorbid pathology (OR 6.7; 95% CI 1.3–34.9; p=0.024). The prognostic model demonstrated high diagnostic accuracy: sensitivity 89.4%, specificity 82.5%. Conclusions . Previous COVID-19 infection is associated with a high frequency of IMIRD flares, particularly during the early post-infection months. Development of a risk stratification model may optimize patient management in the post-COVID period.