Post-COVID-19 shifts in granulomatosis with polyangiitis: epidemiology, clinical features, and predictors in Iran

Granulomatosis with polyangiitis (GPA) is a rare anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis characterized by necrotizing granulomatous inflammation and small- to medium-vessel vasculitis. The COVID-19 pandemic has raised interest in its potential to trigger autoimmune diseases like GPA. This retrospective study investigates changes in GPA frequency, clinical features, and serological patterns before and after the COVID-19 pandemic.

This retrospective study analyzed 72 patients with GPA at one of the most referral hospitals (2016-2024), divided into pre-COVID (n = 27) and post-COVID (n = 45). Demographic, clinical, radiological, and laboratory data were collected. Pre- and post-COVID groups were compared using t-tests and chi-square tests. Firth's logistic regression identified predictors of post-COVID GPA, adjusting for age, sex, ANCA subtype, and clinical features.

A total of 72 patients with GPA were analyzed, including 27 diagnosed pre-COVID-19 and 45 post-COVID-19. The post-COVID-19 cohort was significantly younger (mean age 37.75 ± 10.38 vs. 50.66 ± 12.76 years, P < 0.001) and showed increased prevalence of pulmonary ground-glass opacities (64.4 vs. 25.9%, P = 0.003), cutaneous manifestations (75.6 vs. 25.9%, P = 0.004), and ophthalmic involvement (44.4 vs. 11.1%, P = 0.007). Firth's logistic regression identified younger age [odds ratio (OR) = 0.89, 95% confidence interval (CI): 0.82-0.97, P = 0.008], male sex (OR = 1.94, 95% CI: 1.02-3.99, P = 0.044), pulmonary ground-glass opacities (OR = 5.71, 95% CI: 1.84-18.27, P = 0.002), and ophthalmic complications (OR = 3.27, 95% CI: 1.02-10.48, P = 0.047) as predictors of post-COVID-19 GPA. No association was found between COVID-19 vaccination and GPA onset or relapse (P = 0.429).

This study reveals a higher frequency of GPA and a younger age at onset post-COVID-19. Predictors of post-COVID-19 GPA included younger age, male sex, and pulmonary involvement. SARS-CoV-2 may trigger autoimmune activation, but no link with vaccination was found. GPA clinical features remained consistent, warranting ongoing monitoring and research into COVID-19's autoimmune effects.