Autoimmune Patients Face Higher Long COVID Risk

A large U.S. cohort study links autoimmune rheumatic diseases to a 1.5-fold increased risk of long COVID after SARS-CoV-2 infection.

Updated on Nov. 2, 2026 in Arthritis

An empty infusion recliner beside a sunlit window in a quiet treatment room, with a folded blanket and striped blind shadows on the floor. — A large U.S. cohort study of 187,106 patients found those with autoimmune rheumatic diseases face a 1.5-fold higher risk of long COVID than matched controls. AI Illustration. Upload story photo >

A retrospective cohort study published in Arthritis & Rheumatology found that patients with autoimmune rheumatic diseases had a 1.5-fold increased risk of long COVID compared with matched controls. The analysis drew on National COVID Cohort Collaborative (N3C) data covering 187,106 patients and an equal number of matched controls.

Why it matters

Patients with autoimmune rheumatic diseases already live with immune dysregulation, fatigue, and pain, and many take immune-suppressing medicines, so added long COVID burden compounds those challenges. The findings bear on how clinicians weigh infection risk for this population across the United States.

The analysis compared 187,106 autoimmune rheumatic disease patients with an equal number of matched controls, finding long COVID prevalence of 2.8% versus 1.5%, an adjusted hazard ratio of 1.56 (95% CI 1.45-1.67). The study does not address whether the elevated risk persists beyond the 365-day follow-up window used to define long COVID.

The players

National COVID Cohort Collaborative (N3C)

N3C is a large United States database of electronic health records linking COVID-19 patient data across institutions for research.

The details

Researchers used ICD-10-CM code U09.9 or a clinical visit for long COVID 28 to 365 days after infection to define the condition. Patients exposed to rituximab or glucocorticoids before infection showed higher long COVID risk, and the authors recommend COVID-19 vaccination for individuals with autoimmune conditions.

September 2021: Eligible first documented SARS-CoV-2 infection window opens.
December 2023: Eligible infection window closes.
December 2024: Patient follow-up period ends.

Health Landscape

The study uses the National COVID Cohort Collaborative, a national electronic health record research program, to extend post-pandemic long COVID research into immune-mediated disease populations. It adds evidence to a growing body of work asking how chronic immune conditions shape long-term outcomes after infection.

For people living with autoimmune rheumatic diseases, this research suggests that a COVID-19 infection may carry a higher risk of prolonged symptoms than in the general population. Patients taking immune-suppressing medicines such as rituximab or glucocorticoids should discuss vaccination and infection risk with their clinicians.

The takeaway

Autoimmune rheumatic disease patients face a measurably higher long COVID risk, and the study recommends COVID-19 vaccination for people with autoimmune conditions. Patients should review their medication and vaccination plans with their care team.