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October 5, 2025Open Access

Rheumatology Meets Rehabilitation: Post-Acute COVID-19 Sequelae Clinical Phenotypes and Targeted Care in Patients with Immune-Mediated Inflammatory Rheumatic Diseases

Key Points

Of 211 patients, 51 (24.2%) with immune-mediated inflammatory rheumatic diseases met criteria for post-acute COVID-19 sequelae.
Pulmonary sequelae correlated significantly with valvular heart diseases, while gastrointestinal issues were linked to smoking and lung comorbidities.
Older age and acute-phase hypoxemia were associated with an 11.8% mortality rate among patients by January 2025.
The findings suggest a need for comprehensive diagnosis and targeted rehabilitation while avoiding excessive immunosuppression.

Abstract

Post-acute coronavirus disease sequelae (PACS/long COVID) variably affects patients with immune-mediated inflammatory rheumatic diseases (IMIRDs), complicating accurate diagnosis and longitudinal care. We conducted a retrospective observational study in a Romanian Teaching Hospital including adults with IMIRDs and confirmed infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 2020 and December 2024. PACS was defined as persistence of ≥1 symptom, ≥12 weeks post-infection. We defined every clinical phenotype (pulmonary, cardiovascular, musculoskeletal, gastrointestinal, neurological, systemic), anlysing also multisystem overlap.Demographical, clinical and paraclinical characteristics, including novel composite inflammatory indices were extracted; associations were explored with univariable tests. Of 211 IMIRD cases, 51 (24.2%) met PACS criteria. Pulmonary PACS were significantly associated with valvular heart diseases (p=0.045); cardiovascular PACS with: arrhythmias (p=0.004), obesity (p=0.018), hepatic steatosis (p=0.033), and chronic lung disease (p=0.037); musculoskeletal sequelae were significantly associated with pre-existing pulmonary fibrosis (p=0.014), gastrointestinal sequelae with current smoking (p<0.001) and pulmonary comorbidities (p=0.002), neurologic PACS with higher neutrophil-based indices and coexisting dual IMIRDs (p=0.001-0.03). Somehow unusual: systemic sequelae were associated only with the lack of corticosteroid administration (p=0.006). By January 2025, mortality was 11.8% (without having the possibility to find out the exact death cause), correlating amongst – vs. survivors – significantly with older age (p=0.015), acute-phase hypoxemia (p=0.027), and other paraclinical markers (mainly anemia). In IMIRDs, PACS is pulmonary-centered with frequent overlap and phenotype-specific clinical correlates. The findings, although objectively limited exploratory by design, guide more comprehensive diagnosis and rehabilitation-oriented follow-up, while avoiding excessive immunosuppression in the absence of objective inflammatory activity.

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