- Design
- Retrospective matched cohort, US national data
- Population
- 187,106 adults with first SARS-CoV-2 infection, with and without autoimmune rheumatic disease
- Primary outcome
- Long COVID diagnosis 28–365 days after infection
- Effect
- 2.8% vs 1.5%; aHR 1.56 (95% CI 1.45–1.67)
Using the US National COVID Cohort Collaborative, researchers matched adults with autoimmune rheumatic disease to controls without it, all with a first SARS-CoV-2 infection between late 2021 and 2023. Long COVID was defined by a diagnostic code or a Long COVID clinic visit 28 to 365 days after infection.
Among 187,106 matched patients, Long COVID was recorded in 2.8% with rheumatic disease and 1.5% without (adjusted HR 1.56, 95% CI 1.45–1.67). Within the rheumatic group, more severe acute illness, lung disease, obesity, and prior rituximab or glucocorticoid use were linked to higher risk, as was Sjögren's disease.
Coding-based definitions undercount Long COVID, and patients already in specialist care may be more likely to be diagnosed. The risk factors are familiar ones, and they reinforce existing advice: keep steroid doses as low as possible and keep vaccination up to date in patients on B-cell depletion.
- Ask about persistent symptoms after COVID-19 in patients with autoimmune rheumatic disease.
- Keep glucocorticoid doses as low as disease control allows.
- Review vaccination status in patients on rituximab or other B-cell therapy.
- Consider Sjögren's disease a higher-risk group for prolonged post-COVID symptoms.
Why it matters
It identifies which of our patients are most likely to have symptoms that persist after infection.
Don't overread it
This was observational — it cannot show that rituximab or steroids cause Long COVID.
The statistics, in plain English
An adjusted hazard ratio of 1.56 with a narrow interval is a precise estimate, but the absolute difference is about 1.3 percentage points, and coding-based definitions miss many cases.
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