Most long COVID patients should see a Rheumatologist

A McMaster University-led study has found that most people infected with the SARS-CoV2 virus recover within 12 months, irrespective of the severity.

However, although 75 per cent had recovered at the 12-month mark after becoming ill with the virus, 25 per cent of patients still had at least one of the three most common symptoms, including coughing, fatigue and breathlessness. Researchers also found that patients with persistent symptoms also had antibodies associated with autoimmune illnesses, as well as raised levels of cytokines, which cause inflammation.

Researchers gleaned the results by surveying 106 people recovering from COVID-19 infections at three, six and 12 months after contracting the disease. All patients surveyed were otherwise healthy and had no pre-existing autoimmune conditions or any other underlying diseases pre-pandemic.

“Generally, one should not worry if they are feeling unwell right after their infection, as the chances of recovering within 12 months is very high, and just because you have typical long COVID symptoms at three months does not mean they will stay forever,” said senior author Manali Mukherjee, an assistant professor of the Department of Medicine.

“However, the study highlights that at 12 months, if you still feel unwell and the symptoms are persisting or worsening, you should definitely seek medical attention.”

Mukherjee said patients with persistent long COVID symptoms should see a rheumatologist, as they specialize in autoimmune disorders and can better assess development of rheumatological complications and the need for an early intervention.

She said that most patients with long COVID are currently assessed by respirologists or infectious disease specialists, who do not specialize in autoimmunity.

Mukherjee said that of the patients who recovered, a reduction in autoantibodies and cytokines was matched by their symptoms improving. Those who had elevated antibody and cytokine levels after one year were those whose symptoms persisted.

“Sometimes, while the body is fighting the virus, the immune system gets so amped up that, in addition to making antibodies that kill the virus, it can produce those that attack the host,” said Mukherjee.

“However, the general tendency of the body after it fights a severe virus like SARS-COV2, is to recover, and its often paced out varying from individual to individual.”

Mukherjee is leading the upcoming COVID-19 Immunity Task Force-funded ‘Autoimmunity in Post-Acute COVID Syndrome’ study and is Hamilton site lead for the Canadian Respiratory Research Network-Long COVID study, both of which are currently recruiting for participants.

Journal Reference:

1. Kiho Son, Rameen Jamil, Abhiroop Chowdhury, Manan Mukherjee, Carmen Venegas, Kate Miyasaki, Kayla Zhang, Zil Patel, Brittany Salter, Agnes Che Yan Yuen, Kevin Soon-Keen Lau, Braeden Cowbrough, Katherine Radford, Chynna Huang, Melanie Kjarsgaard, Anna Dvorkin-Gheva, James Smith, Quan-Zhen Li, Susan Waserman, Christopher J Ryerson, Parameswaran Nair, Terence Ho, Narayanaswamy Balakrishnan, Ishac Nazy, Dawn ME Bowdish, Sarah Svenningsen, Chris Carlsten, Manali Mukherjee. Circulating anti-nuclear autoantibodies in COVID-19 survivors predict long-COVID symptoms. European Respiratory Journal, 2022; 2200970 DOI: 1183/13993003.00970-2022