Analysis of the course of immune-mediated inflammatory rheumatic diseases after COVID-19: flare frequency and prognostic determinants

Abisheva S.T. Lila A.M. Rutskaya-Moroshan K.S.
2025 Ima-Press Publishing House

Sovremennaya Revmatologiya
2025 #19 Issue 4 25 - 31 pp.

Even after the end of the COVID-19 pandemic, the SARS-CoV-2 virus continues to circulate in the population and influence the course of im-mune-mediated inflammatory rheumatic diseases (IMIRDs). Previous COVID-19 infection may be associated with increased IMIRD activity; however, data on the long-term post-infectious impact of COVID-19 on rheumatic disease progression remain limited. Objective: To assess dynamics of IMIRDs course in patients with a history of COVID-19, based on individual disease activity indices measured at 3, 6, and 12 months after infection. Material and Methods. A retrospective-prospective cohort study included 100 patients with IMIRDs (rheumatoid arthritis [RA], systemic lupus erythematosus, systemic sclerosis, and ankylosing spondylitis) who had experienced COVID-19. Disease activity was assessed using validated indices: DAS28, SLEDAI-2K, modified Valentini index, and ASDAS. Data were analyzed using nonparametric statistical methods and perfor-mance analysis (ROC-analysis). Results and discussion. At 3 months post-COVID-19, high or very high disease activity was noted in 51% of patients; at 12 months, activity decreased to 38.8%. Persistent high disease activity was observed in 18% of patients throughout the follow-up period, most commonly in RA patients. Risk factors for experiencing ≥2 disease flares included a history of COVID-19-associated pneumonia (odds ratio [OR] 7.1; 95% confidence in-terval [CI] 1.6–32.2; p=0.011) and comorbid pathology (OR 6.7; 95% CI 1.3–34.9; p=0.024). The prognostic model demonstrated high diag-nostic accuracy: sensitivity 89.4%, specificity 82.5%. Conclusions. Previous COVID-19 infection is associated with a high frequency of IMIRD flares, particularly during the early post-infection months. Development of a risk stratification model may optimize patient management in the post-COVID period.

COVID-19 , disease activity indices , immune-mediated inflammatory rheumatic diseases , post-COVID period , risk factors

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Astana Medical University, 49A, Beibitshilik Street, Astana, 010000, Kazakhstan
V.A. Nasonova Research Institute of Rheumatology, 34A, Kashirskoe Shosse, Moscow, 115522, Russian Federation
Russian Medical Academy of Continuing Professional Education, Ministry of Health of the Russia, 2/1, Barrikadnaya Street, Build. 1, Moscow, 125993, Russian Federation

Astana Medical University
V.A. Nasonova Research Institute of Rheumatology
Russian Medical Academy of Continuing Professional Education

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