SARD Patients May Exhibit Higher and Prolonged Persistence of COVID-19 Viral Antigens: Study
USA: Researchers have found in a new study that post-acute COVID-19 syndrome appears more prevalent in individuals with systemic autoimmune rheumatic diseases (SARDs). This secondary analysis of two cohort studies found that patients with SARDs had significantly higher persistence of SARS-CoV-2 viral antigens at 3 and 6 months post-infection compared to the general population.
The findings suggest that immunosuppressive therapies commonly used in SARDs may contribute to the prolonged circulation of viral antigens, potentially explaining the increased risk of long COVID in this group.
The study published in Arthritis & Rheumatology by Naomi J. Patel and colleagues highlights prolonged persistence of SARS-CoV-2 antigens in patients with systemic autoimmune rheumatic diseases (SARDs), offering insights into their post-COVID recovery.
The researchers conducted a retrospective cohort analysis comparing SARD patients from the RheumCARD cohort with individuals without SARDs from the RECOVER-Adult cohort. They assessed the presence of SARS-CoV-2 antigens—spike, S1, and nucleocapsid—at 3 and 6 months post-infection using an ultra-sensitive single-molecule array assay capable of detecting very low antigen levels.
The analysis included 210 participants with SARDs and 348 individuals from the general population.
The researchers reported the following findings:
- A clear difference in SARS-CoV-2 antigen persistence was observed between the two groups.
- Over one-third of individuals with SARDs (36.7%) showed detectable viral antigens during follow-up.
- In comparison, only 18.9% of individuals without SARDs had detectable antigen levels, indicating a statistically significant gap.
- Individuals with SARDs demonstrated substantially higher odds of persistent antigen presence.
- At 3 months post-infection, patients with SARDs had a greater likelihood of nucleocapsid antigen positivity.
- They also showed higher overall antigen positivity at 3 months, even after adjusting for age, sex, vaccination status, infection year, and treatment.
- This pattern continued at 6 months post-infection.
- At 6 months, individuals with SARDs still had significantly higher odds of nucleocapsid antigen detection compared to those without SARDs.
These associations were not explained by differences in demographics, viral variants, vaccination status, or treatments, pointing toward immune dysregulation or immunosuppressive therapy as possible drivers of delayed antigen clearance.
The findings have key clinical implications for understanding long COVID. Persistent viral antigens may sustain immune activation, leading to prolonged symptoms in patients with SARDs. This underscores the need for closer monitoring, tailored management, and further research into therapies that can help eliminate residual viral components.
Overall, the study reinforces evidence that individuals with autoimmune rheumatic diseases may experience a prolonged post-COVID course, highlighting the importance of personalized care strategies.
Reference:
Patel, N. J., Swank, Z., Wang, J., Wang, X., Negron, M., Getachew, L. S., Hansen, L. L., Qian, G., Saavedra, A. A., Mueller, K. T., Davis, N. A., Vanni, M. M., Savage, S., Lam, J. S., Wallace, Z. S., Walt, D. R., & Sparks, J. A. Differences in SARS-CoV-2 antigen persistence in individuals with systemic autoimmune rheumatic diseases compared to the general population: A RECOVER-Adult Cohort Study. Arthritis & Rheumatology. https://doi.org/10.1002/art.70205
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