Prevalence and Risk Factors of Postacute Sequelae of COVID-19 in Adults With Systemic Autoimmune Rheumatic Diseases.

Incidence and manifestations of postacute sequelae of coronavirus disease 2019 (PASC) are poorly defined among immunosuppressed populations. We reported, phenotyped, and assessed risk factors for PASC in adults with systemic autoimmune diseases. Persons aged ≥ 18 years with systemic autoimmune diseases were recruited into a national, prospective observational cohort of SARS-CoV-2 vaccination and infection between December 2020 and April 2021. Serial surveys assessed vaccination status, SARS-CoV-2 infection incidence, and disease flares. Participants reporting SARS-CoV-2 infection received a questionnaire assessing symptom duration, severity, and quality of life (QOL) effect; PASC was defined as ≥ 1 symptom persisting for > 12 weeks. PASC syndromes were mapped by overlapping symptom domains. Characteristics were compared between participants who did vs did not report PASC. Among 1615 participants, 590 (36.5%) reported SARS-CoV-2 infection and were sent PASC surveys, 299 (50.7%) of whom responded > 12 weeks following the reported infection. Respondents were 91.6% female, 91.2% White, median (IQR) age was 48 (40-60) years with median (IQR) 3 (2-3) vaccine doses at time of first infection. Common diagnoses included inflammatory arthritis (38.5%) and inflammatory bowel disease (14.4%). Eighty-nine of 299 (29.8%) reported PASC, with the most reported symptom domain being neurological/psychological (83.1%); 84% reported an effect on QOL. Participants with PASC reported lower number of preceding vaccines (median [IQR] 2 [2-3] vs 3 [2-3]; P < 0.001) and more reinfections (16.9% vs 5.7%; P = 0.004). In a large, real-world cohort, 29.8% of persons with systemic autoimmune disease reported PASC, often affecting QOL. Preceding vaccination may reduce PASC, whereas multiple infections may increase risk, supporting ongoing booster vaccine campaigns and efforts to limit breakthrough infections.

Teles MS ，Brundage J ，Chiang TP ，Alejo JL ，Henriquez N ，Wallwork R ，Christopher-Stine L ，Massie A ，Segev DL ，Connolly CM ，Paik JJ ，Werbel WA ... -  《-》

Impact of vaccination on postacute sequelae of SARS CoV-2 infection in patients with rheumatic diseases.

Vaccination decreases the risk of severe COVID-19 but its impact on postacute sequelae of COVID-19 (PASC) is unclear among patients with systemic autoimmune rheumatic diseases (SARDs) who may have blunted vaccine immunogenicity and be vulnerable to PASC. We prospectively enrolled patients with SARD from a large healthcare system who survived acute infection to complete surveys. The symptom-free duration and the odds of PASC (any symptom lasting ≥28 or 90 days) were evaluated using restricted mean survival time and multivariable logistic regression, respectively, among those with and without breakthrough infection (≥14 days after initial vaccine series). Among 280 patients (11% unvaccinated; 48% partially vaccinated; 41% fully vaccinated), the mean age was 53 years, 80% were female and 82% were white. The most common SARDs were inflammatory arthritis (59%) and connective tissue disease (24%). Those with breakthrough infection had more upper respiratory symptoms, and those with non-breakthrough infection had more anosmia, dysgeusia and joint pain. Compared with those with non-breakthrough COVID-19 infection (n=164), those with breakthrough infection (n=116) had significantly more symptom-free days over the follow-up period (+21.4 days, 95% CI 0.95 to 41.91; p=0.04) and lower odds of PASC at 28 and 90 days (adjusted OR, aOR 0.49, 95% CI 0.29 to 0.83 and aOR 0.10, 95% CI 0.04 to 0.22, respectively). Vaccinated patients with SARDs were less likely to experience PASC compared with those not fully vaccinated. While we cannot rule out the possibility that findings may be due to intrinsic differences in PASC risk from different SARS-CoV-2 variants, these findings support the benefits of vaccination for patients with SARDs and suggest that the immune response to acute infection is important in the pathogenesis of PASC in patients with SARDs.

Patel NJ ，Cook C ，Vanni K ，Fu X ，Wang X ，Kawano Y ，Qian G ，Hang B ，Srivatsan S ，Banasiak EP ，Kowalski E ，Bade K ，Zhang Y ，Sparks JA ，Wallace ZS ... -  《-》

Factors Associated With an Electronic Health Record-Based Definition of Postacute Sequelae of COVID-19 in Patients With Systemic Autoimmune Rheumatic Disease.

Many individuals with rheumatic disease are at higher risk for severe acute coronavirus disease 2019 (COVID-19). We aimed to evaluate risk factors for postacute sequelae of COVID-19 (PASC) using an electronic health record (EHR)-based definition. We identified patients with prevalent rheumatic diseases and COVID-19 within the Mass General Brigham healthcare system. PASC was defined by the International Classification of Diseases, 10th revision (ICD-10) codes, relevant labs, vital signs, and medications at least 30 days following the first COVID-19 infection. Patients were followed until the earliest of incident PASC, repeat COVID-19 infection, 1 year of follow-up, death, or February 19, 2023. We used multivariable Cox regression to estimate the association of baseline characteristics with PASC risk. Among 2459 patients (76.37% female, mean age 57.4 years), the most common incident PASC manifestations were cough (14.56%), dyspnea (12.36%), constipation (11.39%), and fatigue (10.70%). Serious manifestations including acute coronary disease (4.43%), thromboembolism (3.09%), hypoxemia (3.09%), stroke (1.75%), and myocarditis (0.12%) were rare. The Delta wave (adjusted hazard ratio [aHR] 0.63, 95% CI 0.49-0.82) and Omicron era (aHR 0.50, 95% CI 0.41-0.62) were associated with lower risk of PASC than the early pandemic period (March 2020-June 2021). Age, obesity, comorbidity burden, race, and hospitalization for acute COVID-19 infection were associated with greater risk of PASC. Glucocorticoid (GC) use (aHR 1.19, 95% CI 1.05-1.34 compared to no use) was associated with greater risk of PASC. Among patients with rheumatic diseases, following their first COVID-19 infection, we found a decreased risk of PASC over calendar time using an EHR-based definition. Aside from GCs, no specific immunomodulatory medications were associated with increased risk, and risk factors were otherwise similar to those seen in the general population.

Patel NJ ，Wang X ，Lin M ，Kowalski EN ，Cook CE ，Vanni KMM ，Guzzo K ，Qian G ，Bade KJ ，Saavedra A ，Venkat R ，Srivatsan S ，Williams ZK ，Hanberg JS ，Kawano Y ，Schiff AE ，Sparks JA ，Wallace ZS ... -  《-》

Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection.

Thaweethai T ，Jolley SE ，Karlson EW ，Levitan EB ，Levy B ，McComsey GA ，McCorkell L ，Nadkarni GN ，Parthasarathy S ，Singh U ，Walker TA ，Selvaggi CA ，Shinnick DJ ，Schulte CCM ，Atchley-Challenner R ，Alba GA ，Alicic R ，Altman N ，Anglin K ，Argueta U ，Ashktorab H ，Baslet G ，Bassett IV ，Bateman L ，Bedi B ，Bhattacharyya S ，Bind MA ，Blomkalns AL ，Bonilla H ，Brim H ，Bush PA ，Castro M ，Chan J ，Charney AW ，Chen P ，Chibnik LB ，Chu HY ，Clifton RG ，Costantine MM ，Cribbs SK ，Davila Nieves SI ，Deeks SG ，Duven A ，Emery IF ，Erdmann N ，Erlandson KM ，Ernst KC ，Farah-Abraham R ，Farner CE ，Feuerriegel EM ，Fleurimont J ，Fonseca V ，Franko N ，Gainer V ，Gander JC ，Gardner EM ，Geng LN ，Gibson KS ，Go M ，Goldman JD ，Grebe H ，Greenway FL ，Habli M ，Hafner J ，Han JE ，Hanson KA ，Heath J ，Hernandez C ，Hess R ，Hodder SL ，Hoffman MK ，Hoover SE ，Huang B ，Hughes BL ，Jagannathan P ，John J ，Jordan MR ，Katz SD ，Kaufman ES ，Kelly JD ，Kelly SW ，Kemp MM ，Kirwan JP ，Klein JD ，Knox KS ，Krishnan JA ，Kumar A ，Laiyemo AO ，Lambert AA ，Lanca M ，Lee-Iannotti JK ，Logarbo BP ，Longo MT ，Luciano CA ，Lutrick K ，Maley JH ，Mallett G ，Marathe JG ，Marconi V ，Marshall GD ，Martin CF ，Matusov Y ，Mehari A ，Mendez-Figueroa H ，Mermelstein R ，Metz TD ，Morse R ，Mosier J ，Mouchati C ，Mullington J ，Murphy SN ，Neuman RB ，Nikolich JZ ，Ofotokun I ，Ojemakinde E ，Palatnik A ，Palomares K ，Parimon T ，Parry S ，Patterson JE ，Patterson TF ，Patzer RE ，Peluso MJ ，Pemu P ，Pettker CM ，Plunkett BA ，Pogreba-Brown K ，Poppas A ，Quigley JG ，Reddy U ，Reece R ，Reeder H ，Reeves WB ，Reiman EM ，Rischard F ，Rosand J ，Rouse DJ ，Ruff A ，Saade G ，Sandoval GJ ，Santana JL ，Schlater SM ，Sciurba FC ，Shepherd F ，Sherif ZA ，Simhan H ，Singer NG ，Skupski DW ，Sowles A ，Sparks JA ，Sukhera FI ，Taylor BS ，Teunis L ，Thomas RJ ，Thorp JM ，Thuluvath P ，Ticotsky A ，Tita AT ，Tuttle KR ，Urdaneta AE ，Valdivieso D ，VanWagoner TM ，Vasey A ，Verduzco-Gutierrez M ，Wallace ZS ，Ward HD ，Warren DE ，Weiner SJ ，Welch S ，Whiteheart SW ，Wiley Z ，Wisnivesky JP ，Yee LM ，Zisis S ，Horwitz LI ，Foulkes AS ，RECOVER Consortium ... -  《-》

Associations of DMARDs with post-acute sequelae of COVID-19 in patients with systemic autoimmune rheumatic diseases: a prospective study.

Venkat RK ，Wang X ，Patel NJ ，Kawano Y ，Schiff A ，Kowalski EN ，Cook CE ，Vanni KMM ，Qian G ，Bade KJ ，Saavedra A ，Srivatsan S ，Williams ZK ，Wallace ZS ，Sparks JA ... -  《-》