Risk of Autoimmune Rheumatic Diseases following COVID-19: A Systematic Review and Meta-Analysis

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.

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.

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%).

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.

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.