Higher risk of Long COVID among patients with autoimmune rheumatic diseases and immunomodulatory therapy: a retrospective cohort analysis of national US data.

BACKGROUND: Little is known about the prevalence of and factors associated with Long COVID in patients with autoimmune rheumatic diseases (AIRDs). METHODS: We conducted a retrospective cohort study using data from the National Clinical Cohort Collaborative (N3C). We included adults with a first documented SARS-CoV-2 infection between September 2021 and December 2023, with follow-up through December 2024. Long COVID was defined as ICD-10-CM code U09.9 or a Long COVID clinic visit occurring 28 to 365 days after first infection. We compared patients with AIRD with matched non-AIRD controls using 1:1 nearest-neighbor propensity score matching on age with exact matching on sex, race/ethnicity, SARS-CoV-2 variant-dominant period, and data-contributing organization. We estimated hazard ratios using multivariable Cox regression models. Among people with AIRD, we assessed risk by AIRD type and medication exposure before acute COVID-19. RESULTS: In the matched cohort of 187,106 patients, Long COVID occurred in 2.8% of AIRD patients and 1.5% among non-AIRD patients. In multivariable analyses, AIRD was associated with an increased risk of Long COVID compared with non-AIRD patients (aHR 1.56, 95% CI 1.45-1.67). Among patients with AIRD, higher acute COVID-19 severity, pulmonary disease, obesity, and exposure to rituximab or glucocorticoids were associated with an increased risk of Long COVID. Sjögren's syndrome was associated with a higher risk of Long COVID. CONCLUSION: The higher risk of developing Long COVID among AIRD patients compared with those without AIRD underscores the need to identify potential risk factors for Long COVID in this population to minimize its long-term effects.

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Journal
Arthritis & Rheumatology
Published
2026-10-14
DOI
https://doi.org/10.1002/art.70361
Primary Topic
Long-Term Effects of COVID-19
Type
article
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article

Higher risk of Long COVID among patients with autoimmune rheumatic diseases and immunomodulatory therapy: a retrospective cohort analysis of national US data.

Rena C. Patel, Namrata Singh, Londyn J. Robinson, Kaleb D. Michaud et al.
Arthritis & Rheumatology
Long-Term Effects of COVID-19
article

Higher risk of Long COVID among patients with autoimmune rheumatic diseases and immunomodulatory therapy: a retrospective cohort analysis of national US data.

Rena C. Patel, Namrata Singh, Londyn J. Robinson, Kaleb D. Michaud, Jasvinder A. Singh, Alfred Jerrod Anzalone, Sandra E. Safo, Zachary Butzin-Dozier, Maria I. Danila, Lesley E. Jackson, Holland Stevenson
article en

Abstract

BACKGROUND: Little is known about the prevalence of and factors associated with Long COVID in patients with autoimmune rheumatic diseases (AIRDs). METHODS: We conducted a retrospective cohort study using data from the National Clinical Cohort Collaborative (N3C). We included adults with a first documented SARS-CoV-2 infection between September 2021 and December 2023, with follow-up through December 2024. Long COVID was defined as ICD-10-CM code U09.9 or a Long COVID clinic visit occurring 28 to 365 days after first infection. We compared patients with AIRD with matched non-AIRD controls using 1:1 nearest-neighbor propensity score matching on age with exact matching on sex, race/ethnicity, SARS-CoV-2 variant-dominant period, and data-contributing organization. We estimated hazard ratios using multivariable Cox regression models. Among people with AIRD, we assessed risk by AIRD type and medication exposure before acute COVID-19. RESULTS: In the matched cohort of 187,106 patients, Long COVID occurred in 2.8% of AIRD patients and 1.5% among non-AIRD patients. In multivariable analyses, AIRD was associated with an increased risk of Long COVID compared with non-AIRD patients (aHR 1.56, 95% CI 1.45-1.67). Among patients with AIRD, higher acute COVID-19 severity, pulmonary disease, obesity, and exposure to rituximab or glucocorticoids were associated with an increased risk of Long COVID. Sjögren's syndrome was associated with a higher risk of Long COVID. CONCLUSION: The higher risk of developing Long COVID among AIRD patients compared with those without AIRD underscores the need to identify potential risk factors for Long COVID in this population to minimize its long-term effects.

Arthritis & Rheumatology
Michael E. DeBakey VA Medical Center (US), University of Minnesota (US), Baylor College of Medicine (US), University of Washington (US), University of Alabama at Birmingham (US), Birmingham VA Medical Center (US), Berkeley Public Health Division (US), University of Nebraska Medical Center (US), University of California, Berkeley (US)
Bill and Melinda Gates Foundation, Yale University, Rheumatology Research Foundation, Children's Hospital of Philadelphia, University of Nebraska Medical Center, Vanderbilt University, University of Miami, University of Pennsylvania, Ohio State University, Emory University, Tufts Medical Center, NYU Langone Medical Center, Northwestern University, George Washington University, Wake Forest University, Cincinnati Children's Hospital Medical Center, Vanderbilt Institute for Clinical and Translational Research, University of Chicago, University of Minnesota, Harvard Catalyst, Loyola University Chicago, University of Utah, Tulane University, Johns Hopkins University, Institute for Translational Medicine and Therapeutics, Institute of Clinical and Translational Sciences, Georgetown University, University of Rochester, University of Cincinnati, Dartmouth College, Pennsylvania State University, Carilion Clinic, University of Arkansas for Medical Sciences, Rush University, University of South Carolina, Virginia Commonwealth University, Southern California Clinical and Translational Science Institute, West Virginia University, Montana State University, Rutgers, The State University of New Jersey, MedStar Health Research Institute, Georgetown-Howard Universities Center for Clinical and Translational Science, NorthShore University HealthSystem, Vanderbilt University Medical Center, Georgia Clinical and Translational Science Alliance, Penn State Clinical and Translational Science Institute, Children's National Hospital, Louisiana Clinical and Translational Science Center, Ochsner Health, West Virginia Clinical and Translational Science Institute, Stony Brook University, National Institutes of Health, University of Illinois at Urbana-Champaign, Institute for Clinical and Translational Research, University of Wisconsin, Madison, University of California, Los Angeles, Weill Cornell Medical College, Oregon Clinical and Translational Research Institute, University of California, San Diego, University of Oklahoma Health Sciences Center, University of California, San Francisco, Michigan Institute for Clinical and Health Research, University of Texas Health Science Center at San Antonio, University of California, Irvine, Leonard M. Miller School of Medicine, Center for Clinical and Translational Research, University of Colorado Denver, Center for Clinical and Translational Science, University of Massachusetts, Center for Clinical and Translational Science, Mayo Clinic, Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston, Irving Medical Center, Columbia University, Translational Research Institute, University of Arkansas for Medical Sciences, South Carolina Clinical and Translational Research Institute, Medical University of South Carolina, Clinical and Translational Science Institute, University of Florida, Clinical and Translational Science Center, University of New Mexico, National Institute on Aging, National Institute of General Medical Sciences, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Center for Advancing Translational Sciences, Institute for Integration of Medicine and Science, Colorado Clinical and Translational Sciences Institute, Yale Center for Clinical Investigation, Yale School of Medicine, Institute for Clinical and Translational Science, University of California, Irvine, Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine, Accelerated Innovation Research Initiative Turning Top Science and Ideas into High-Impact Values
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