Battling with post-Covid syndrome?

Covid infection can worsen pre-existing autoimmune conditions or even trigger new-onset autoimmune diseases, warns Dr Gourishankar Reddy

Post-Covid, many people are showing symptoms of lupus, arthritis, and dryness of the eyes and mouth. Covid viruses are causing long-lasting complications because of auto-immune and musculoskeletal manifestations which are a part of long Covid aliments. Autoimmune illnesses refer to conditions wherein our immune system, which normally does not attack cells, protein tissues or organs of the body itself, breaches a level of tolerance and then fails to identify the body and starts attacking it. That is why it is called autoimmunity.

What is post-Covid syndrome?

Covid seems to have left a trail of morbidity among survivors. Most of them have recovered completely, but a few continue to show acute and chronic Covid-related health issues. Acute diseases like Myocardial ischemia, cerebral strokes, deep venous thrombosis, and other thromboembolic events are more common in Covid survivors than in the normal population.

Few post-Covid patients could have what is called MIS-A (a multisystem inflammatory syndrome in adults) or MIS-C (a multisystem inflammatory syndrome in children) wherein they have persistent fever plus one or more of the following: stomach pain, red eyes, loose motions, giddiness, vomiting, rash etc.

Most have chronic respiratory issues like prolonged breathlessness and cough, with or without oxygen dependency.

Does Covid infection cause autoimmune disease?

Apart from persistent generalised weakness, few patients have muscle pains, joint pains, back and pelvic pain, dryness of eyes and mouth, difficulty in swallowing, rashes, swelling of limbs and photosensitivity. Few also present with serious symptoms like ARDS, renal failure, and pleural and pericardial effusions. These symptoms are suggestive of the autoimmune process in the body. Depending upon the cluster of predominant symptoms and a few serological tests, a specific autoimmune disease can be narrowed down.

An interesting fact surfacing is that Covid infection can worsen pre-existing autoimmune conditions or even trigger new-onset autoimmune diseases. Few recent research articles speculate this relation, but robust trial data is still awaited to establish the confirmed association.

How many days after Covid infection do these symptoms appear generally?

There are instances of documented cases from all over the world showing symptoms of an autoimmune disease starting from 14 days to 30 days after infection.

How can Covid infection cause autoimmune disease?

There are few hypotheses which can explain how Covid infection can precipitate or trigger autoimmune disease. They are called: molecular mimicry (antibodies produced by the body against the virus also damage host organ cells because the organs have similar antigens like the virus), continued viral persistence or activation (persistent viral antigens continue to drive immune-mediated injury), bystander killing, epitope spreading etc. To summarise, viral infection can trigger autoimmune disease.

Is this seen only in Covid infection?

Several other viruses like HIV, Hepatitis C virus, EBV (Epstein-Barr virus) have been found to trigger autoimmune diseases like rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), multiple sclerosis (MS) etc in the past. There are reports of even dengue fever precipitating SLE symptoms. The Covid virus is a recent addition to the list.

How difficult is it to diagnose or treat this condition?

It can be easily diagnosed and controlled with timely medications. One needs to undergo a few blood tests including serological tests for specific antibodies and rarely biopsies of muscles and organs are involved to establish the diagnosis. Once confirmed, the treatment can be initiated.

Can it be cured?

If we diagnose autoimmune conditions at the earliest, an appropriate treatment plan to control the disease can be made before irreversible damage occurs. Generally, autoimmune conditions cannot be cured completely but are well-controlled like DM/HTN.

Although most of them continue to lead a normal life, few do present late with severe life-threatening symptoms.

Can we prevent these diseases?

Prevention of Covid itself prevents the triggering of such conditions in susceptible individuals. Mostly its seen in the young population ranging from 20 years to 40 years as per the available data.

Hence continue to take precautions, do not lower your guard, report on the occurrence of symptoms and get timely treatment.

(The author is head of MICU at a leading chain of hospitals in Bengaluru.)