JAMA Dermatology

<jats:sec id="ab-doi240057-4"><jats:title>Importance</jats:title><jats:p>Autoimmune diseases such as systemic lupus erythematosus (SLE) and psoriasis have been previously associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). Whether similar increased ASCVD risk is seen with cutaneous lupus erythematosus (CLE) remains unclear.</jats:p></jats:sec><jats:sec id="ab-doi240057-5"><jats:title>Objective</jats:title><jats:p>To evaluate the incidence and prevalence of ASCVD among those with CLE, SLE, and psoriasis compared with a disease-free control group.</jats:p></jats:sec><jats:sec id="ab-doi240057-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This retrospective, matched longitudinal cohort study used data from January 2018 to December 2020 in the IBM MarketScan Commercial Claims and Encounters Database. The control population included individuals free of CLE, SLE, and psoriasis, matched 10:1 with the CLE population on age, sex, insurance type, and enrollment duration. Data were analyzed from September 2022 to April 2024.</jats:p></jats:sec><jats:sec id="ab-doi240057-7"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Prevalent ASCVD was defined as coronary artery disease, prior myocardial infarction, or cerebrovascular accident. Incident ASCVD was assessed through the number of hospitalization events through the end of follow-up (up to 3 years) in each group. Multivariable logistic regression and Cox proportional hazards models were performed to compare the prevalence and incidence of ASCVD between exposure groups, adjusting for age, sex, and cardiovascular risk factors.</jats:p></jats:sec><jats:sec id="ab-doi240057-8"><jats:title>Results</jats:title><jats:p>A total of 8138 persons with CLE (median [IQR] age, 49 [40-47] years; 6618 [81%] female), 24 675 with SLE (median [IQR] age, 46 [36-54] years; 22 432 [91%] female), 192 577 persons with psoriasis (median [IQR] age, 48 [36-56] years; 106 631 [55%] female), and 81 380 control individuals (49 [40-57] years; 66 180 [81%] female) were identified. In multivariable analysis, the odds of ASCVD were higher than control for CLE (odds ratio [OR], 1.72 [95% CI, 1.45-2.02]; <jats:italic>P</jats:italic> &amp;amp;lt; .001) and SLE (OR, 2.41 [95% CI, 2.14-2.70]; <jats:italic>P</jats:italic> &amp;amp;lt; .001), but not psoriasis (OR, 1.03 [95% CI, 0.95-1.11]; <jats:italic>P</jats:italic> = .48). At median 3 years follow-up, incidence rates of ASCVD were highest for SLE (24.8 [95% CI, 23.3-26.4] per 1000 person-years), followed by CLE (15.2 [95% CI, 13.1-17.7] per 1000 person-years), psoriasis (14.0 [95% CI, 13.5-14.4] per 1000 person-years), and then controls (10.3 [95% CI, 9.77-10.94] per 1000 person-years). In multivariable Cox proportional regression modeling with the control group as a reference group, the highest risk of incident ASCVD was in those with SLE (hazard ratio [HR], 2.23 [95% CI, 2.05-2.43]; <jats:italic>P</jats:italic> &amp;amp;lt; .001), followed by CLE (HR, 1.32 [95% CI, 1.13-1.55]; <jats:italic>P</jats:italic> &amp;amp;lt; .001), and psoriasis (HR, 1.06 [95% CI, 0.99-1.13]; <jats:italic>P</jats:italic> = .09).</jats:p></jats:sec><jats:sec id="ab-doi240057-9"><jats:title>Conclusions and Relevance</jats:title><jats:p>In this retrospective matched longitudinal cohort study, CLE was associated with an increased risk for ASCVD, similar to the risk in SLE but higher than the risk in psoriasis. The role of comorbidities that augment ASCVD risk like smoking status should be further investigated. Clinicians treating patients with CLE can consider them at increased ASCVD risk and institute appropriate screening tests.</jats:p></jats:sec>

Systemic lupus erythematosus: diagnosis and clinical management.

J Autoimmun

Does treatment of psoriasis reduce the risk of cardiovascular disease?

Drugs

The effect of TNF inhibitors on cardiovascular events in psoriasis and psoriatic arthritis: an updated meta-analysis.

Clin Rev Allergy Immunol

Systemic lupus erythematosus and the risk of cardiovascular disease: results from the nurses’ health study.

Arthritis Rheum

Risk of myocardial infarction and stroke in newly diagnosed systemic lupus erythematosus: a general population-based study.

Arthritis Care Res (Hoboken)

Distinctive cutaneous subsets in the spectrum of lupus erythematosus.

J Am Acad Dermatol

High prevalence of metabolic syndrome in patients with discoid lupus erythematosus: a cross-sectional, case-control study.

J Immunol Res

Risk for cardiovascular disease associated with metabolic syndrome and its components: a 13-year prospective study in the RIVANA cohort.

Cardiovasc Diabetol

Increased cancer risk in patients with cutaneous lupus erythematosus and systemic lupus erythematosus compared with the general population: a Danish nationwide cohort study.

Lupus

Increased risk of cancer among 3663 patients with cutaneous lupus erythematosus: a Swedish nationwide cohort study.

Br J Dermatol

Older black race is a risk factor for metabolic syndrome in cutaneous lupus erythematosus.

Cutaneous lupus erythematosus and the risk of deep venous thrombosis and pulmonary embolism: a Danish nationwide cohort study.

Cutaneous lupus erythematosus and systemic lupus erythematosus are associated with clinically significant cardiovascular risk: a Danish nationwide cohort study.

Risk of subsequent ischemic and hemorrhagic stroke in patients hospitalized for immune-mediated diseases: a nationwide follow-up study from Sweden.

BMC Neurol

Risk of subsequent coronary heart disease in patients hospitalized for immune-mediated diseases: a nationwide follow-up study from Sweden.

PLoS One

Long-term risk of adverse cardiovascular outcomes associated with cutaneous lupus erythematosus: a nationwide cohort study.

Clin Rheumatol

Cutaneous lupus erythematosus is associated with an increased risk of cardiac and vascular diseases: a large-scale, propensity-matched global retrospective cohort study.

EBioMedicine

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

Lancet

The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement.

PLoS Med

A systematic review of validated methods for identifying systemic lupus erythematosus (SLE) using administrative or claims data.

Vaccine

Validity of diagnostic codes and prevalence of psoriasis and psoriatic arthritis in a managed care population, 1996-2009.

Pharmacoepidemiol Drug Saf

British Association of Dermatologists guidelines for the management of people with cutaneous lupus erythematosus 2021.

Use of sodium-glucose cotransporter 2 inhibitors and glucagonlike peptide-1 receptor agonists in patients with diabetes and cardiovascular disease in community practice.

JAMA Cardiol

Risk of myocardial infarction in patients with psoriasis.

JAMA

Cause-specific mortality in patients with severe psoriasis: a population-based cohort study in the U.K.

Risk of cerebrovascular accidents and ischemic heart disease in cutaneous lupus erythematosus: a population-based cohort study.

Assessment and management of the heightened risk for atherosclerotic cardiovascular events in patients with lupus erythematosus or dermatomyositis.

Int J Womens Dermatol

Smoking enhances Toll-like receptor-9 responsiveness and type I interferon production in plasmacytoid dendritic cells in patients with cutaneous lupus erythematosus.

Influence of smoking on the efficacy of antimalarials in cutaneous lupus: a meta-analysis of the literature.

Association of cigarette smoking but not alcohol consumption with cutaneous lupus erythematosus.

Arch Dermatol

Influence of smoking on disease severity and antimalarial therapy in cutaneous lupus erythematosus: analysis of 1002 patients from the EUSCLE database.

Sensitivity of claims-based algorithms to ascertain smoking status more than doubled with meaningful use.

Value Health

Cutaneous lupus erythematosus and cardiovascular disease: current knowledge and insights into pathogenesis.

2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines.

J Am Coll Cardiol

Modular gene analysis reveals distinct molecular signatures for subsets of patients with cutaneous lupus erythematosus.

IFN-a negatively regulates the expression of endothelial nitric oxide synthase and nitric oxide production: implications for systemic lupus erythematosus.

J Immunol

Interferon-a priming promotes lipid uptake and macrophage-derived foam cell formation: a novel link between interferon-a and atherosclerosis in lupus.

Cautions when using race and ethnicity in administrative claims data sets.

JAMA Health Forum

The accuracy of race & ethnicity data in US based healthcare databases: a systematic review.

Am J Surg

Autoimmune diseases such as systemic lupus erythematosus (SLE) and psoriasis have been previously associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). Whether similar increased ASCVD risk is seen with cutaneous lupus erythematosus (CLE) remains unclear.
To evaluate the incidence and prevalence of ASCVD among those with CLE, SLE, and psoriasis compared with a disease-free control group.
This retrospective, matched longitudinal cohort study used data from January 2018 to December 2020 in the IBM MarketScan Commercial Claims and Encounters Database. The control population included individuals free of CLE, SLE, and psoriasis, matched 10:1 with the CLE population on age, sex, insurance type, and enrollment duration. Data were analyzed from September 2022 to April 2024.
Prevalent ASCVD was defined as coronary artery disease, prior myocardial infarction, or cerebrovascular accident. Incident ASCVD was assessed through the number of hospitalization events through the end of follow-up (up to 3 years) in each group. Multivariable logistic regression and Cox proportional hazards models were performed to compare the prevalence and incidence of ASCVD between exposure groups, adjusting for age, sex, and cardiovascular risk factors.
A total of 8138 persons with CLE (median [IQR] age, 49 [40-47] years; 6618 [81%] female), 24 675 with SLE (median [IQR] age, 46 [36-54] years; 22 432 [91%] female), 192 577 persons with psoriasis (median [IQR] age, 48 [36-56] years; 106 631 [55%] female), and 81 380 control individuals (49 [40-57] years; 66 180 [81%] female) were identified. In multivariable analysis, the odds of ASCVD were higher than control for CLE (odds ratio [OR], 1.72 [95% CI, 1.45-2.02]; P < .001) and SLE (OR, 2.41 [95% CI, 2.14-2.70]; P < .001), but not psoriasis (OR, 1.03 [95% CI, 0.95-1.11]; P = .48). At median 3 years follow-up, incidence rates of ASCVD were highest for SLE (24.8 [95% CI, 23.3-26.4] per 1000 person-years), followed by CLE (15.2 [95% CI, 13.1-17.7] per 1000 person-years), psoriasis (14.0 [95% CI, 13.5-14.4] per 1000 person-years), and then controls (10.3 [95% CI, 9.77-10.94] per 1000 person-years). In multivariable Cox proportional regression modeling with the control group as a reference group, the highest risk of incident ASCVD was in those with SLE (hazard ratio [HR], 2.23 [95% CI, 2.05-2.43]; P < .001), followed by CLE (HR, 1.32 [95% CI, 1.13-1.55]; P < .001), and psoriasis (HR, 1.06 [95% CI, 0.99-1.13]; P = .09).
In this retrospective matched longitudinal cohort study, CLE was associated with an increased risk for ASCVD, similar to the risk in SLE but higher than the risk in psoriasis. The role of comorbidities that augment ASCVD risk like smoking status should be further investigated. Clinicians treating patients with CLE can consider them at increased ASCVD risk and institute appropriate screening tests.

Incidence and Prevalence of Atherosclerotic Cardiovascular Disease in Cutaneous Lupus Erythematosus.

Incidence and Prevalence of Atherosclerotic Cardiovascular Disease in Cutaneous Lupus Erythematosus

<jats:sec id="ab-doi240049-4"><jats:title>Importance</jats:title><jats:p>Few studies have investigated the association between COVID-19 and autoimmune and autoinflammatory connective tissue disorders; however, research with long-term observation remains insufficient.</jats:p></jats:sec><jats:sec id="ab-doi240049-5"><jats:title>Objective</jats:title><jats:p>To investigate the long-term risk of autoimmune and autoinflammatory diseases after COVID-19 over an extended observation period.</jats:p></jats:sec><jats:sec id="ab-doi240049-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This retrospective nationwide population-based study investigated the Korea Disease Control and Prevention Agency–COVID-19–National Health Insurance Service (K-COV-N) cohort. Individuals with confirmed COVID-19 from October 8, 2020, to December 31, 2022, and controls identified among individuals who participated in the general health examination in 2018 were included in the analysis.</jats:p></jats:sec><jats:sec id="ab-doi240049-7"><jats:title>Exposures</jats:title><jats:p>Confirmed COVID-19.</jats:p></jats:sec><jats:sec id="ab-doi240049-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Incidence and risk of autoimmune and autoinflammatory connective tissue disorders in patients after COVID-19. Various covariates, such as demographic characteristics, general health data, socioeconomic status, and comorbidity profiles, were balanced using inverse probability weighting.</jats:p></jats:sec><jats:sec id="ab-doi240049-9"><jats:title>Results</jats:title><jats:p>A total of 6 912 427 participants (53.6% male; mean [SD] age, 53.39 [20.13] years) consisting of 3 145 388 with COVID-19 and 3 767 039 controls with an observational period of more than 180 days were included. Alopecia areata (adjusted hazard ratio [AHR], 1.11 [95% CI, 1.07-1.15]), alopecia totalis (AHR, 1.24 [95% CI, 1.09-1.42]), vitiligo (AHR, 1.11 [95% CI, 1.04-1.19]), Behçet disease (AHR, 1.45 [95% CI, 1.20-1.74]), Crohn disease (AHR, 1.35 [95% CI, 1.14-1.60]), ulcerative colitis (AHR, 1.15 [95% CI, 1.04-1.28]), rheumatoid arthritis (AHR, 1.09 [95% CI, 1.06-1.12]), systemic lupus erythematosus (AHR, 1.14 [95% CI, 1.01-1.28]), Sjögren syndrome (AHR, 1.13 [95% CI, 1.03-1.25]), ankylosing spondylitis (AHR, 1.11 [95% CI, 1.02-1.20]), and bullous pemphigoid (AHR, 1.62 [95% CI, 1.07-2.45]) were associated with higher risk in the COVID-19 group. Subgroup analyses revealed that demographic factors, including male and female sex, age younger than 40 years, and age 40 years and older, exhibited diverse associations with the risk of autoimmune and autoinflammatory outcomes. In addition, severe COVID-19 infection requiring intensive care unit admission, the Delta period, and not being vaccinated were associated with higher risk.</jats:p></jats:sec><jats:sec id="ab-doi240049-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>This retrospective cohort study with an extended follow-up period found associations between COVID-19 and the long-term risk of various autoimmune and autoinflammatory connective tissue disorders. Long-term monitoring and care of patients is crucial after COVID-19, considering demographic factors, disease severity, and vaccination status, to mitigate these risks.</jats:p></jats:sec>

Post-acute sequelae of COVID-19: understanding and addressing the burden of multisystem manifestations.

Lancet Respir Med

Global burden of COVID-19: situational analysis and review.

Hum Antibodies

COVID-19-related acute kidney injury: incidence, risk factors and outcomes in a large UK cohort.

BMC Nephrol

COVID-19 and cardiovascular comorbidities.

Exp Clin Endocrinol Diabetes

Tüberk Toraks

COVID-19 and autoimmune diseases.

Curr Opin Rheumatol

SARS-CoV-2, the autoimmune virus.

Autoimmun Rev

Autoimmune and autoinflammatory connective tissue disorders following COVID-19.

JAMA Netw Open

Risk of autoimmune diseases following COVID-19 and the potential protective effect from vaccination: a population-based cohort study.

EClinicalMedicine

Data resource profile: the National Health Information Database of the National Health Insurance Service in South Korea.

Int J Epidemiol

Cohort Profile: The National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea.

All-cause and cause-specific mortality risks associated with alopecia areata: a Korean nationwide population-based study.

JAMA Dermatol

Autoimmune inflammatory rheumatic diseases post–COVID-19 vaccination.

Int Immunopharmacol

Long-term cardiovascular outcomes of COVID-19.

Nat Med

Status and characteristics of the SARS-CoV-2 variant outbreak in the Republic of Korea in January 2021.

Public Health Weekly Report

A review of heart failure in patients with COVID-19.

Heart Fail Clin

Front Epidemiol

The role of cytokines and chemokines in severe acute respiratory syndrome coronavirus 2 infections.

Front Immunol

Patients with COVID-19 exhibit different immunological profiles according to their clinical presentation.

Int J Infect Dis

Characteristics and prognostic factors of disease severity in patients with COVID-19: the Beijing experience.

Prognostic value of interleukin-18 and its association with other inflammatory markers and disease severity in COVID-19.

Cytokine

Autoimmunity, COVID-19 Omicron variant, and olfactory dysfunction: a literature review.

Diagnostics (Basel)

The Omicron (B.1.1.529) SARS-CoV-2 variant of concern does not readily infect Syrian hamsters.

Antiviral Res

Clinical and experimental evidence suggest Omicron variant of SARS-CoV-2 is inherently less pathogenic than delta variant independent of previous immunity.

Eur J Med Res

Risk of autoimmune diseases in patients with COVID-19: a retrospective cohort study.

Vaccine-induced autoimmunity: the role of molecular mimicry and immune crossreaction.

Cell Mol Immunol

Infection and Autoimmunity

A possible role for autoimmunity through molecular mimicry in alphavirus mediated arthritis.

Sci Rep

Untangling COVID-19 and autoimmunity: identification of plausible targets suggests multi organ involvement.

Mol Immunol

SARS-CoV-2–specific immune response and the pathogenesis of COVID-19.

Int J Mol Sci

Molecular mimicry, bystander activation, or viral persistence: infections and autoimmune disease.

Clin Microbiol Rev

Systems immunology analysis reveals the contribution of pulmonary and extrapulmonary tissues to the immunopathogenesis of severe COVID-19 patients.

The type I interferon response in COVID-19: implications for treatment.

Nat Rev Immunol

Systemic lupus erythematosus after coronavirus disease-2019 (COVID-19) infection: case-based review.

Egypt Rheumatol

New onset systemic lupus erythematosus after COVID-19 infection: a case report.

AME Case Rep

New diagnosis of systemic lupus erythematosus after COVID-19 vaccination: a case report and review of literature.

JAAD Case Rep

Axial spondylarthritis following COVID-19 infection.

BMJ Case Rep

Rheumatoid arthritis occurring after coronavirus disease 2019 (COVID-19) infection: case based review.

COVID-19 infection and rheumatoid arthritis: mutual outburst cytokines and remedies.

Curr Med Res Opin

Analysis of the potential relationship between COVID-19 and Behcet’s disease using transcriptome data.

Medicine (Baltimore)

Rheumatologists’ perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets.

New-onset vitiligo following COVID-19 disease.

Skin Health Dis

Vitiligo following COVID-19: a case report and review of pathophysiology.

Vitiligo pathogenesis and emerging treatments.

Dermatol Clin

Virol Immunol J

COVID-19 and oxidative stress.

Biochemistry (Mosc)

New-onset bullous pemphigoid in a COVID-19 patient.

Case Rep Dermatol Med

Bullous pemphigoid outcome is associated with CXCL10-induced matrix metalloproteinase 9 secretion from monocytes and neutrophils but not lymphocytes.

J Allergy Clin Immunol

Three case reports of post immunization and post viral Bullous Pemphigoid: looking for the right trigger.

BMC Pediatr

Few studies have investigated the association between COVID-19 and autoimmune and autoinflammatory connective tissue disorders; however, research with long-term observation remains insufficient.
To investigate the long-term risk of autoimmune and autoinflammatory diseases after COVID-19 over an extended observation period.
This retrospective nationwide population-based study investigated the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service (K-COV-N) cohort. Individuals with confirmed COVID-19 from October 8, 2020, to December 31, 2022, and controls identified among individuals who participated in the general health examination in 2018 were included in the analysis.
Confirmed COVID-19.
Incidence and risk of autoimmune and autoinflammatory connective tissue disorders in patients after COVID-19. Various covariates, such as demographic characteristics, general health data, socioeconomic status, and comorbidity profiles, were balanced using inverse probability weighting.
A total of 6 912 427 participants (53.6% male; mean [SD] age, 53.39 [20.13] years) consisting of 3 145 388 with COVID-19 and 3 767 039 controls with an observational period of more than 180 days were included. Alopecia areata (adjusted hazard ratio [AHR], 1.11 [95% CI, 1.07-1.15]), alopecia totalis (AHR, 1.24 [95% CI, 1.09-1.42]), vitiligo (AHR, 1.11 [95% CI, 1.04-1.19]), Behçet disease (AHR, 1.45 [95% CI, 1.20-1.74]), Crohn disease (AHR, 1.35 [95% CI, 1.14-1.60]), ulcerative colitis (AHR, 1.15 [95% CI, 1.04-1.28]), rheumatoid arthritis (AHR, 1.09 [95% CI, 1.06-1.12]), systemic lupus erythematosus (AHR, 1.14 [95% CI, 1.01-1.28]), Sjögren syndrome (AHR, 1.13 [95% CI, 1.03-1.25]), ankylosing spondylitis (AHR, 1.11 [95% CI, 1.02-1.20]), and bullous pemphigoid (AHR, 1.62 [95% CI, 1.07-2.45]) were associated with higher risk in the COVID-19 group. Subgroup analyses revealed that demographic factors, including male and female sex, age younger than 40 years, and age 40 years and older, exhibited diverse associations with the risk of autoimmune and autoinflammatory outcomes. In addition, severe COVID-19 infection requiring intensive care unit admission, the Delta period, and not being vaccinated were associated with higher risk.
This retrospective cohort study with an extended follow-up period found associations between COVID-19 and the long-term risk of various autoimmune and autoinflammatory connective tissue disorders. Long-term monitoring and care of patients is crucial after COVID-19, considering demographic factors, disease severity, and vaccination status, to mitigate these risks.

Long-Term Risk of Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19.

Long-Term Risk of Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19

Papers