COVID-19 is associated with lupus flare and persistent disease activity: longitudinal data from the ReumaCov-Brazil Register study

Background This study aimed to evaluate flares in systemic lupus erythematosus (SLE) patients over a period of six months after COVID-19. Methods A multicenter, observational, and prospective cohort study was performed. SLE adult patients with COVID-19 (case group) were compared to SLE patients without COVID-19 (control group). Assessments were performed at baseline (V0), immediately after COVID-19 (V1), and three and six months after infection (V2 and V3). Disease activity was evaluated using the patient global assessment (PGA) and the modified SLE Disease Activity Index 2000 (mSLEDAI-2 K). Flare was defined as an increase in the mSLEDAI-2 K score of greater than three, and persistent disease activity was defined as mSLEDAI-2 K score greater than three over two consecutive visits. Results A total of 715 patients were included, 363 in the case group and 352 in the control group. Patients in the case group were slightly older than controls [mean age 41.0 (SD 12.38) vs. 38.8 (SD 12.07) years; p = 0.017]. Longitudinal analyses showed differences in disease activity trajectories between groups, particularly for PGA. Flare and/or persistent disease activity occurred more frequently in the case group [74 (18.5%) vs. 33 (10.5%); p = 0.001], and COVID-19 during follow-up was associated with this outcome [OR 1.70 (95% CI 1.06–2.74); p = 0.029]. However, in the sensitivity analysis restricted to laboratory-confirmed COVID-19, the difference in the categorical outcome was not statistically significant. New SLE manifestations were also more frequent following COVID-19. Conclusions The findings suggest a possible association between COVID-19 and subsequent SLE disease activity.