Symptom Duration After COVID-19 Onset Studied in Autoimmune Rheumatic Diseases

sick man taking temperature
sick man taking temperature
Researchers assessed the prevalence of prolonged COVID-19 symptom duration among patients with systemic autoimmune rheumatic diseases.

Prolonged COVID-19 symptom duration was assessed in patients with systemic autoimmune rheumatic diseases (SARDs), in a study published in RMD Open. While the majority of patients with SARDs had complete symptom resolution by day 15 after COVID-19 onset, some reported symptoms that persisted for at least 28 days, with 1 in 10 experiencing symptoms for at least 90 days.

Researchers analyzed data from the COVID-19 Global Rheumatology Alliance Vaccine Survey to study prolonged COVID-19 symptom duration among patients with SARDs. The survey was disseminated to adult patients with SARDs around the world, and responses submitted between April and October 2021 were included in the analysis.

Eligible respondents had test-confirmed COVID-19 at some point prior to the survey. Participants were asked to report COVID-19 severity and symptom duration in addition to sociodemographic and clinical data. Prolonged symptom duration was defined as those lasting at least 28 days. Data of patients with symptoms lasting at least 90 days were also collected.

Logistic regression was used to identify correlates of prolonged symptom duration in those infected with COVID-19. Models were adjusted for age as a continuous variable.

A total of 11,415 patients from 102 countries completed the survey, among whom 497 reported a test-confirmed diagnosis of COVID-19. After excluding patients without a known symptom duration, the study cohort included 441 patients. Mean age was 48.2±12.6 years; 83.7% were women; and most of the respondents lived in the Americas (63.2%) or Europe (30.5%). The most common SARD diagnoses were rheumatoid arthritis (39.5%), lupus (15.6%), inflammatory myositis (11.6%), and Sjögren syndrome (11.6%). Most patients (82.0%) reported taking at least 1 disease-modifying antirheumatic drug (DMARD) at the time of the survey. The most common comorbidities were hypertension (26.5%), obesity (23.1%), and lung disease (18.1%).

The median COVID-19 symptom duration was 15 days (IQR, 7-25 days). A total of 107 (24.2%) patients had prolonged symptoms lasting 28 days or more. In addition, 42 (9.8%) patients reported symptoms persisting for 90 days or more.

Compared with patients with a symptom duration of less than 28 days, those with symptoms of 28 days or greater were more likely to report that COVID-19 impeded their daily activities (age-adjusted odds ratio [aOR], 4.02; 95% CI, 2.31-7.31) during the acute phase. Hospitalization for COVID-19 was also associated with significantly increased odds of prolonged symptoms (OR, 6.49; 95% CI, 3.03-14.1). Patients with COVID-19 onset between January and July 2021 had lower odds of prolonged symptom duration compared with those with an onset in June 2020 or earlier (aOR 0.42; 95% CI, 0.21-0.81). Additional correlates of prolonged symptoms included a greater number of comorbidities (aOR, 1.11 per comorbidity; 95% CI, 1.02-1.21) and a diagnosis of osteoarthritis (aOR, 2.11, 95% CI 1.01-4.27).

Results from the study indicated that approximately 1 in 4 patients with SARDs may experience persistent COVID-19 symptoms in the month following onset. In addition, 1 in 10 patients reported a symptom duration of 3 months or longer.

Study limitations included the absence of a control group, the cross-sectional design, and the use of self-report data rather than information from medical records.

“Future studies are needed to investigate the possible relationships between immunomodulating medications, SARD type/flare, vaccine doses and novel viral variants with prolonged COVID-19 symptoms and other postacute sequelae of COVID-19 among people with SARDs,” the researchers noted.

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


DiIorio M, Kennedy K, Liew JW, et al. Prolonged COVID-19 symptom duration in people with systemic autoimmune rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey. RMD Open. 2022;8(2):e002587. doi:10.1136/rmdopen-2022-002587