Is post-COVID syndrome an autoimmune disease?

ABSTRACT

Introduction

Post-COVID syndrome (PCS) is recognized as a new entity in the context of SARS-CoV-2 infection. Though its pathogenesis is not completely understood, persistent inflammation from acute illness and the development of autoimmunity play a critical role in its development.

Areas covered

The mechanisms involved in the emergence of PCS, their similarities with post-viral and post-care syndromes, its inclusion in the spectrum of autoimmunity and possible targets for its treatment.

Expert opinion

An autoimmune phenomenon plays a major role in most causative theories explaining PCS. There is a need for both PCS definition and classification criteria (including severity scores). Longitudinal and controlled studies are necessary to better understand this new entity, and to find what additional factors participate into its development. With the high prevalence of COVID-19 cases worldwide, together with the current evidence on latent autoimmunity in PCS, we may observe an increase of autoimmune diseases (ADs) in the coming years. Vaccination’s effect on the development of PCS and ADs will also receive attention in the future. Health and social care services need to develop a new framework to deal with PCS.

KEYWORDS:

• Post-COVID syndrome
• post-COVID
• long COVID
• post-acute COVID-19
• COVID-19
• autoimmunity
• autoantibodies
• latent autoimmunity

Article highlights

• Post-COVID syndrome (PCS) is a heterogeneous condition characterized by persistent inflammation and autoimmunity.

• PCS shares similarities with other post-infectious conditions but may last longer (> 6 months).

• The overlap between post-care syndromes and PCS may hinder differential diagnosis while suggesting clinical subphenotypes of PCS.

• In addition to an autoimmune-mediated mechanism, endotheliopathy, coagulopathy, autonomic, endocrine, neurological dysfunction, and viral persistence may contribute to PCS.

• Based on population data and new health and social care frameworks, personalized medicine should be considered to deal with PCS.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.