Covid raises risk of new-onset of alopaecia, vitiligo, arthritis

South Korean researchers have identified a significantly higher risk of multiple new-onset autoimmune and auto-inflammatory connective tissue disorders after Covid-19 infection.

The study, published in JAMA Network Open, showed that the risks of alopaecia totalis (total hair loss), psoriasis (skin disease), vitiligo (depigmented skin patches), vasculitis (inflammation of blood vessels), Crohn's disease and ulcerative colitis (types of inflammatory bowel disease), rheumatoid arthritis, adult-onset Still disease (a rare type of arthritis), Sjogren's syndrome (immune disorder causing dry mouth and eyes), ankylosing spondylitis and sarcoidosis (growth of tiny collections of inflammatory cells in body) were associated with higher Covid-19 severity. 

However, vaccination was found to lower the risk, said the team from the Yonsei University, Wonju College of Medicine in South Korea. 

'The findings suggest that autoimmune and auto-inflammatory connective tissue disorders may manifest as post Covid-19 sequelae, highlighting the potential long-term health ramifications associated with Covid-19,' the researchers said in the paper. 

'Long-term management should include evaluating the development of such disorders in patients who had Covid-19,' they added. 

The large cohort study included 354,527 individuals who had had Covid and 6,134,940 controls. It identified a significant elevation in the risk of multiple incident autoimmune and auto-inflammatory disorders subsequent to Covid. 

The risks of alopaecia areata (adjusted hazard ratio [aHR] was 1.12), alopaecia totalis (aHR of 1.74), anti-neutrophil cytoplasmic antibody-associated vasculitis (aHR 2.76), Crohn's disease (aHR 1.68) and sarcoidosis (aHR 1.59) were higher in the Covid-19 group. 

The diseases' link with Covid suggests the existence of a common pathway, which may involve excessive cytokine storms leading to prolonged autoimmune responses that trigger the specific underlying pathophysiology of each disease. 

The researchers said that due to the potential involvement of SARS-CoV-2 infection in cardiopulmonary failure, extensive evaluation of cardiovascular and respiratory outcomes following Covid-19 infection has been conducted. 

Although similarities between Covid-19 and several autoimmune diseases have been suggested, a comprehensive evaluation of autoimmune or inflammatory diseases as post-acute Covid-19 sequelae has not yet been established. 

'Taken together, surveillance for the new development of autoimmune and auto-inflammatory diseases for the myriad of Covid-19 survivors globally is suggested,' the researchers said.