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A large systematic review and meta-analysis found an increased risk of various autoimmune and autoinflammatory connective tissue disorders among patients who had COVID-19 infection.

The analysis appears in . According to the investigators, results indicate that dermatologists should monitor patients over the long term following COVID-19 infection.

First author Yeon-Woo Heo, MD, is a dermatologist and researcher with Yonsei University Wonju College of Medicine in South Korea. Heo's discussion of study findings with the Reading Room has been edited for length and clarity.

What was your main goal for this investigation?

Heo: The question this paper aimed to address was whether, as the impacts of the COVID-19 pandemic gradually fade from public consciousness, dermatologists continue to encounter conditions that are influenced by the pandemic.

Specifically, the study focused on investigating the long-term risk of autoimmune and autoinflammatory connective tissue disorders associated with COVID-19.

How would you summarize your main findings or conclusions?

Heo: This research, with an extended follow-up period, identified a statistically significant association between COVID-19 and an increased risk of several autoimmune and autoinflammatory disorders.

These disorders include: alopecia areata, vitiligo, Behçet disease, Crohn's disease, systemic lupus erythematosus, and others.

The risks were notably higher in individuals with severe COVID-19, including those who required ICU admission, were infected with the Delta variant, or were unvaccinated. This underscores the need for long-term patient monitoring to manage potential sequelae.

Did anything surprise you about this study?

Heo: One of the surprise findings was the significantly higher risk of certain conditions like bullous pemphigoid (adjusted HR 1.62).

Another was a clear stratification of risk based on COVID-19 severity, variant type, and vaccination status.

These nuanced outcomes highlight the multifactorial nature of post-COVID-19 autoimmune risks.

The paper talks about the importance of long-term monitoring and management of patients after COVID-19. Do you have any ideas or advice for clinicians and practices that want to do this more effectively?

Heo: Dermatologists could begin by routinely asking patients about their history of COVID-19 infection during consultations. If a patient reports a history of infection, additional questions regarding the timing of infection, severity of illness, and vaccination status could be incorporated.

This information can guide clinicians to educate patients on recognizing early symptoms of conditions such as vitiligo, rheumatoid arthritis, or Crohn's disease. Based on the presence of symptoms, autoimmune antibody tests could be conducted to facilitate early diagnosis.

Furthermore, utilizing electronic health records to track and identify high-risk individuals for tailored interventions could enhance the effectiveness of long-term monitoring and management.

Given that many autoimmune and autoinflammatory conditions can develop slowly, regular follow-ups and long-term vigilance are essential to ensure timely intervention and optimal patient outcomes.

Is there anything else you believe was important regarding this paper or topic?

Heo: This study underscores the importance of considering the long-term effects of COVID-19 -- particularly its potential to contribute to autoimmune and autoinflammatory conditions. For dermatologists, recognizing the links between post-COVID-19 patients and conditions such as alopecia areata, vitiligo, and bullous pemphigoid is essential. These conditions may serve as early indicators of systemic autoimmune involvement, facilitating timely intervention and management. Additionally, it is important for dermatologists to stay attentive in the post-pandemic era and actively collaborate across specialties to ensure holistic patient care.

Moving forward, we hope this research inspires further investigations and supports the development of optimized care strategies for post-COVID-19 patients in dermatology practices.