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Differences in SARS-CoV-2 Antigen Persistence in Individuals With Systemic Autoimmune Rheumatic Diseases Compared to

Naomi J Patel^1,2,3, Zoe Swank^3,4,5, Jiaqi Wang²

¹Division of Rheumatology, Inflammation, and Immunity, Mass General Brigham, Boston, Massachusetts.

Arthritis & Rheumatology (Hoboken, N.J.)

|April 27, 2026

Abstract

Objective:

Individuals with systemic autoimmune rheumatic diseases (SARDs) are at risk for worse acute and post-acute COVID-19 outcomes, though whether individuals with SARDs have longer persistence of viral antigens after COVID-19 has not been studied.

Methods:

This retrospective cohort study evaluated post-COVID-19 differences in SARS-CoV-2 antigen (spike, spike protein that contains the receptor-binding domain, and nucleocapsid) positivity between individuals with SARDs (COVID-19 and Rheumatic Diseases [RheumCARD]) and without SARDs (Researching COVID to Enhance Recovery [RECOVER]-Adult). SARS-CoV-2 antigens were measured in collected samples using a validated ultrasensitive single molecule array. This digital enzyme-linked immunosorbent assay used antibody-coated magnetic beads to capture antigen molecules, which were loaded into microwell arrays and detected through enzymatic cleavage of a fluorescent substrate. We used logistic regression to estimate unadjusted and adjusted (for age, sex, infection year, vaccination status, and COVID-19 treatment) odds ratios for SARS-CoV-2 antigen positivity at months 3 and 6 following COVID-19.

Results:

Among 210 individuals with SARDs in RheumCARD and 348 individuals without SARDs in RECOVER-Adult, any SARS-CoV-2 antigen positivity was more common in those with SARDs (36.7% in RheumCARD vs 18.9% in RECOVER-Adult; P < 0.001). Those with SARDs had higher odds of nucleocapsid antigen positivity (adjusted odds ratio [aOR] 3.73, 95% confidence interval [CI] 1.28-10.85) or any antigen positivity (aOR 2.89, 95% CI 1.43-5.85) three months after COVID-19 infection and higher odds of nucleocapsid antigen positivity (aOR 6.62, 95% CI 1.09-40.30) six months after COVID-19 infection.

Conclusion:

Individuals with SARDs were more likely to have SARS-CoV-2 antigen positivity at months 3 and 6 following COVID-19 infection compared with individuals without SARDs, not explained by demographics, variant, vaccination, or treatment.

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