TY - JOUR
T1 - Risk of Autoimmune Rheumatic Diseases following COVID-19
T2 - A Systematic Review and Meta-Analysis
AU - Agouridis, Aris P.
AU - Makris, Anastasios
AU - Ellina, Danae
AU - Vougiouklakis, Georgios
AU - Alexakis, Konstantinos
AU - Toulkeridis, Georgios
AU - Ierodiakonou, Despo
AU - Tsioutis, Constantinos
AU - Spernovasilis, Nikolaos
N1 - Publisher Copyright:
Bentham Science Publishers
PY - 2025
Y1 - 2025
N2 - Introduction: Multiple cases of autoimmune rheumatic diseases following COVID-19 have been reported in the literature. This study aims to systematically determine whether COVID-19 affects the incidence of autoimmune rheumatic diseases. Methods: We searched MEDLINE (PubMed), Global Index Medicus, and Cochrane Library databases up to March 30, 2024, for studies evaluating the incidence of systemic autoimmune diseases following SARS-CoV-2 infection in adult populations. Results: Eight cohort studies with 5,537,742 COVID-19 and 18,433,129 non-COVID-19 patients were included in our pooled analysis. The risk of developing mixed connective tissue disease and Behçet’s disease in COVID-19 patients was increased by 168% (RR: 2.68, 95% CI (1.14 to 6.34), I2=94%) and 101% (RR: 2.01, 95% CI (1.4 to 2.87), I2=6%), respectively, compared to uninfected subjects. A 45% increase in the risk of both rheumatoid arthritis (RR: 1.45, 95% CI (1.02 to 2.06), I2=99%) and psoriasis (RR: 1.45, 95% CI (1.10 to 1.92), I2=98%) after SARS-CoV-2 infection was noted. The risk of dermatopolymyositis was 40% higher (RR: 1.40, 95% CI (1.10 to 1.79), I2=68%) in the COVID-19 group. Non-significant increases in risk were observed in the pooled analysis for ankylosing spondylitis (RR: 1.39, 95% CI (0.94 to 2.05), I2=93%), systemic lupus erythematosus (RR: 1.21, 95% CI (0.70 to 2.07), I2=98%), systemic sclerosis (RR: 1.23, 95% CI (0.73 to 2.04), I2=89%), Sjögren’s syndrome (RR: 1.28, 95% CI (0.91 to 1.80), I2=95%), and polymyalgia rheumatica (RR: 1.45, 95% CI (0.94 to 2.25), I2=94%). Discussion: Since the onset of COVID-19, several cases of new-onset autoimmune rheumatic diseases following SARS-CoV-2 infection have been reported. To the best of our knowledge, this is the first systematic review and meta-analysis assessing the impact of COVID-19 on the risk of developing autoimmune rheumatic diseases. Overall, COVID-19 increases the risk of autoimmune rheumatic diseases, especially during the first year after infection. Conclusion: COVID-19 is associated with an increased risk of several autoimmune rheumatic diseases, including mixed connective tissue disease, Behçet’s disease, rheumatoid arthritis, psoriasis, and dermatopolymyositis. However, our results must be interpreted with caution due to high inter-study heterogeneity.
AB - Introduction: Multiple cases of autoimmune rheumatic diseases following COVID-19 have been reported in the literature. This study aims to systematically determine whether COVID-19 affects the incidence of autoimmune rheumatic diseases. Methods: We searched MEDLINE (PubMed), Global Index Medicus, and Cochrane Library databases up to March 30, 2024, for studies evaluating the incidence of systemic autoimmune diseases following SARS-CoV-2 infection in adult populations. Results: Eight cohort studies with 5,537,742 COVID-19 and 18,433,129 non-COVID-19 patients were included in our pooled analysis. The risk of developing mixed connective tissue disease and Behçet’s disease in COVID-19 patients was increased by 168% (RR: 2.68, 95% CI (1.14 to 6.34), I2=94%) and 101% (RR: 2.01, 95% CI (1.4 to 2.87), I2=6%), respectively, compared to uninfected subjects. A 45% increase in the risk of both rheumatoid arthritis (RR: 1.45, 95% CI (1.02 to 2.06), I2=99%) and psoriasis (RR: 1.45, 95% CI (1.10 to 1.92), I2=98%) after SARS-CoV-2 infection was noted. The risk of dermatopolymyositis was 40% higher (RR: 1.40, 95% CI (1.10 to 1.79), I2=68%) in the COVID-19 group. Non-significant increases in risk were observed in the pooled analysis for ankylosing spondylitis (RR: 1.39, 95% CI (0.94 to 2.05), I2=93%), systemic lupus erythematosus (RR: 1.21, 95% CI (0.70 to 2.07), I2=98%), systemic sclerosis (RR: 1.23, 95% CI (0.73 to 2.04), I2=89%), Sjögren’s syndrome (RR: 1.28, 95% CI (0.91 to 1.80), I2=95%), and polymyalgia rheumatica (RR: 1.45, 95% CI (0.94 to 2.25), I2=94%). Discussion: Since the onset of COVID-19, several cases of new-onset autoimmune rheumatic diseases following SARS-CoV-2 infection have been reported. To the best of our knowledge, this is the first systematic review and meta-analysis assessing the impact of COVID-19 on the risk of developing autoimmune rheumatic diseases. Overall, COVID-19 increases the risk of autoimmune rheumatic diseases, especially during the first year after infection. Conclusion: COVID-19 is associated with an increased risk of several autoimmune rheumatic diseases, including mixed connective tissue disease, Behçet’s disease, rheumatoid arthritis, psoriasis, and dermatopolymyositis. However, our results must be interpreted with caution due to high inter-study heterogeneity.
KW - autoimmune diseases
KW - autoimmunity
KW - behçet’s disease
KW - COVID-19
KW - dermatopolymyositis
KW - mixed connective tissue disease
KW - psoriasis
KW - rheumatoid arthritis
KW - SARS-CoV-2
UR - https://www.scopus.com/pages/publications/105020275287
U2 - 10.2174/0115733971382167250921213314
DO - 10.2174/0115733971382167250921213314
M3 - Review article
C2 - 41047691
AN - SCOPUS:105020275287
SN - 1573-3971
JO - Current Rheumatology Reviews
JF - Current Rheumatology Reviews
ER -