Abstract: Comment
Post-COVID-19 condition in patients with autoimmune
rheumatic diseases: the COVID-19 Vaccination in Autoimmune
Diseases (COVAD) study
As COVID-19 gradually becomes endemic in many
parts of the world, a silent epidemic of post-COVID-19
condition is emerging. Post-COVID-19 condition
comprises a constellation of long-term sequelae defined
as the persistence or new appearance of symptoms
3 months after a SARS-CoV-2 infection.1 Patients with
autoimmune rheumatic diseases and other autoimmune
diseases are at increased risk for developing severe
COVID-19,2 and might also be at higher risk of developing
more severe long-term COVID-19 sequelae compared
with the general population.3 However, post-COVID-19
condition is poorly understood in these patients, and
the knowledge of specific risk factors for post-COVID-19
condition and of its effects on mental and physical
function is scarce and remains an unmet need.
With data from the second COVID-19 Vaccination
in Autoimmune Diseases (COVAD) international,
multicentre electronic patient survey, which involved
157 collaborators from 106 countries,4 we analysed
the prevalence and predictors of post-COVID-19
condition, the association between the condition
and disease flares, and its on physical and mental
function in patients with rheumatic and non-rheumatic
autoimmune diseases compared with healthy controls.
We circulated a validated patient questionnaire via
collaborating centres, patient support groups, and
social media platforms to collect data on demographics,
type of autoimmune disease, treatment history,
comorbidities, SARS-CoV-2 infection history and
COVID-19 disease course, COVID-19 vaccination
history, disease flares, current symptom status, and
patient reported outcomes (including fatigue visual
analogue scale, pain visual analogue scale, PROMIS10a
global mental and physical function, and quality of life;
appendix pp 1–2). Post-COVID-19 condition was defined
as the persistence of any symptom beyond 3 months
after SARS-CoV-2 infection, per the WHO definition.
Participants provided informed consent to participate
and ethical approval was obtained from the Institutional
Ethics Committee of the Sanjay Gandhi Postgraduate
Institute of Medical Sciences (Lucknow, India).
www.thelancet.com/rheumatology Vol 5 May 2023
Questionnaires were submitted by 12 358 individuals
between Jan 31 and May 21, 2022. Questionnaires with
incomplete entries (4692 [38·0%]) were excluded.
Of the 7666 (62·0%) individuals who submitted
complete questionnaires, 2640 (34·4%) reported
having a positive SARS-CoV-2 test. 1677 (63·5%) of
these 2640 respondents completed the survey more
Univariate
OR (95% CI)
See Online for appendix
Multivariable*
p value
OR (95% CI)
p value
Demographics
Age
··
0·013
1·0 (0·9–1·0)
0·48
Female sex
2·0 (0·9–4·4)
0·050
2·1 (0·8–4·9)
0·089
Country by HDI
··
0·051
0·8 (0·7–1·1)
0·20
White
1·7 (1·1–2·8)
0·018
1·3 (0·6–2·4)
0·41
Mixed ethnicity
0·9 (0·9–0·9)
0·028
··
0·99
Asian ethnicity
0·5 (0·2–1·4)
0·26
··
··
Hispanic ethnicity
0·9 (0·5–1·9)
0·99
··
··
African American ethnicity
0·9 (0·3–2·0)
0·80
··
··
Disease duration
··
0·43
··
··
Any comorbidities
3·3 (1·90–5·5)
<0·0001
2·0 (1·1–3·6)
0·026
AID comorbidity
2·3 (1·4–3·9)
0·0006
1·4 (0·7–2·5)
0·25
Asthma
2·6 (1·5–4·7)
<0·0001
1·3 (0·6–2·6)
0·41
Chronic kidney disease
2·0 (0·8–4·7)
0·10
··
··
Chronic liver disease†
11·6 (2·5–52·8)
<0·0001
··
··
Chronic obstructive..
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