Rheumatic disease was linked to more long COVID, especially with rituximab or steroids

Design

Retrospective matched cohort (US N3C national data)

Population

187,106 adults with and without autoimmune rheumatic disease after first SARS-CoV-2 infection

Primary outcome

Coded long COVID or long COVID clinic visit 28–365 days after infection

Effect

2.8% vs 1.5%; aHR 1.56 (95% CI 1.45–1.67)

Using a large US national electronic health record collaboration, researchers matched 187,106 adults with and without autoimmune rheumatic disease who had a first SARS-CoV-2 infection between late 2021 and 2023, and followed them for coded long COVID or a long COVID clinic visit.

Long COVID was recorded in 2.8% of those with rheumatic disease and 1.5% of controls, a 56% higher adjusted risk. Within the rheumatic disease group, more severe acute COVID, lung disease, obesity, and exposure to rituximab or glucocorticoids were linked to higher risk, as was Sjögren's syndrome.

Coding-based definitions undercount long COVID and may be applied differently to people already in regular specialist contact, so both absolute rates and the comparison should be read cautiously.

The practical messages are familiar: vaccination, early antiviral assessment for those on high-risk therapy, and attention to persisting symptoms after infection rather than attributing all fatigue to the underlying disease.

• Keep COVID-19 vaccination up to date in patients on immunomodulatory therapy.
• Assess eligibility for early antiviral treatment when patients on rituximab or steroids are infected.
• Ask about persisting symptoms in the months after COVID-19.
• Do not attribute all post-infection fatigue to the rheumatic disease without assessment.

Why it matters

It identifies which patients in rheumatology clinics most need follow-up after a COVID-19 infection.

Don't overread it

Observational and code-based; it cannot show that the drugs cause long COVID.

The statistics, in plain English

An adjusted hazard ratio of 1.56 means about half as much again the rate of recorded long COVID. Absolute numbers are small, 2.8% against 1.5%, and both likely undercount true long COVID.

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