Can COVID-19 Infection Raise Your Risk for Developing Autoimmune Diseases?

Even though the COVID-19 pandemic has officially been declared over, the virus that causes COVID continues to affect people around the globe. Thankfully, with COVID vaccines and natural immunity, most people will simply deal with an annoying cold and move on. But some people aren’t so fortunate. 

COVID can cause long-term effects known as long COVID. And researchers are still learning about the links between COVID and autoimmune diseases. 

An autoimmune disease — like lupus or rheumatoid arthritis — is a type of health condition where your immune system attacks your own body. During the COVID pandemic, a pattern emerged: In some people, COVID infection can cause autoimmune problems. 

What is the link between COVID and autoimmune conditions?

COVID infection increases your risk of developing an autoimmune disease. In fact, there’s evidence that people infected with COVID had a 42% increased chance of developing an autoimmune disease within 3 to 15 months after COVID infection. Experts don’t know for sure why this happens. It’s possible that a COVID infection confuses your immune system and causes it to react against your own body. 

A study of people hospitalized with COVID found that about half had autoantibodies in their blood. Autoantibodies are immune system proteins that react against your own body’s cells. They are a feature of many autoimmune disorders. But this isn’t a clear-cut link. 

While having autoantibodies increases your chance of having an autoimmune disease, it doesn’t guarantee it. In fact, the same study found that these autoantibodies were present in about 15% of healthy people without any symptoms of disease. Researchers are still trying to understand the unique role that COVID plays in autoimmune conditions.    

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And it’s not just COVID that has been linked to autoimmunity. Many other viruses can also increase your chance of having an autoimmune disease, including:

• Mono (Epstein-Barr virus)

• Cytomegalovirus

• Strep throat

• Scarlet fever

• Escherichia coli

Which autoimmune conditions have been linked to COVID-19 infection?

COVID infections have been linked to many different autoimmune conditions. The list may grow longer as researchers learn more. 

Currently there’s evidence that COVID can increase your risk for:

• Graves’ disease

• Multiple sclerosis (MS)

• Immune thrombocytopenia (ITP)

• Vasculitis

• Spondyloarthritis

• Guillain-Barré syndrome

• Multisystem inflammatory syndrome in children (MIS-C)

• Diabetes

• Sjögren’s disease

• Lupus 

• Inflammatory bowel disease (IBD)

• Celiac disease 

This list may change as the medical community and scientists learn more about COVID. 

Can COVID cause other long-term health problems?

Yes. COVID infections can cause long-term health problems, even after recovery. 

Even though the rates of long COVID are going down, about 1 in 10 adults in the U.S. who have had COVID infection report having symptoms of long COVID, such as:

• Fatigue

• Shortness of breath

• Headaches

• Joint pain

• Sleep disturbances

• Gastrointestinal problems

• Anxiety and depression

Experts are still trying to understand what causes it, how long symptoms may last, and how best to treat them. But it’s possible that — at least in part — long COVID could be a type of autoimmune process. This is especially likely because we already know that other viruses can trigger autoimmune disease. 

How does COVID-19 cause autoimmune diseases?

In people with a genetic predisposition, an infection can sometimes (but not always) trigger an autoimmune condition. There are a number of theories about how this might happen: 

• Molecular mimicry: This is when the immune system gets confused and mistakes the body’s own cells for foreign germs, like the virus that causes COVID. It happens because the immune system can’t tell the difference between molecules on the surface of the virus and similar molecules on the surface of normal body cells. It results in the immune system targeting healthy body cells, which may contribute to autoimmune reactions.

• Overactive immune response: COVID and other viruses may cause a large, broad  inflammatory response. This may result in widespread damage to the body in addition to fighting off the infection. This can be considered a type of “collateral damage.”

• Epitope spreading: The immune system begins by targeting a specific protein on the virus or bacteria. But then the immune system gets overactivated and starts acting on multiple targets, causing wider damage.   

Who is most at risk of developing an autoimmune disease from COVID-19?

It’s not clear. Researchers continue to learn more about who might be most at risk for developing an autoimmune condition after COVID infection. 

That said, there are known risk factors for long COVID, and there’s some evidence that long COVID may be an autoimmune condition. 

Risk factors for long COVID include:

• Having severe COVID illness

• Being female

• Being of older age

• Having a health condition like diabetes or asthma

• Having a BMI of 30 and above

• Not being vaccinated against COVID

Some of these risk factors — like being female or having a high BMI — are also risk factors for autoimmune disorders. This is true even in people who never have COVID infection.

It’s likely that genetics also play a role in determining if someone develops an autoimmune condition after COVID infection. Many other autoimmune conditions are caused when a person with a genetic predisposition encounters an environmental trigger (like an infection). So the same is likely to be true for people after COVID infection.    

How does the COVID vaccine affect risk of autoimmune diseases?

Getting vaccinated against COVID lowers your chance of developing an autoimmune disease after COVID infection. Some researchers have noted a small increase in autoimmune diseases after COVID vaccination itself, while other studies showed no increased risk of autoimmune disease with vaccination. 

But even studies that reported a small increased risk from vaccination noted that the risk of developing an autoimmune condition is higher after getting infected with COVID itself. 

What if you already have an autoimmune disease?

Early in the pandemic, experts suspected that people with autoimmune diseases might be more at risk for severe COVID. The research on this is mixed. 

There is evidence that some autoimmune diseases lead to a more severe course of COVID. But other autoimmune diseases actually lower your risk for severe COVID. This might have to do with the type of medications people with autoimmune diseases take. Some medications may help fight off COVID, while others may increase the risk for more severe illness. 

Since there’s still a lot of uncertainty, prevention is your best protection. Try to avoid people who are sick, and do your best to stay on top of your existing autoimmune condition. And if you do get COVID infection, connect with your healthcare team to get the best treatment for you.

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Written by:

Karen Hovav, MD, FAAP

Karen Hovav, MD, FAAP, has more than 15 years of experience as an attending pediatrician in a variety of clinical settings. She has worked in a large academic center in an urban city, a small community hospital, a private practice, and an urgent care clinic.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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