LONG COVID AS A RHEUMATOLOGICAL CHALLENGE: POST-INFECTIOUS AUTOIMMUNITY MECHANISMS AND CLINICAL PHENOTYPES

Katarzyna Kowalska; Aleksandra  Kowalewska-Kurek; Hanna Grygorcewicz; Laura Mikuła; Justyna Strycharczuk

doi:10.31435/ijitss.2(50).2026.6027

Authors

Katarzyna Kowalska M. Kopernik Provincial Multispecialty Oncology and Traumatology Center in Łódź, ul. Pabianicka 62, 93-513 Łódź, Poland https://orcid.org/0000-0001-6027-2620
Aleksandra Kowalewska-Kurek University Clinical Hospital No. 2 of the Pomeranian Medical University (PUM) in Szczecin, al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland https://orcid.org/0009-0004-7686-0872
Hanna Grygorcewicz University Clinical Hospital No. 2 of the Pomeranian Medical University (PUM) in Szczecin, al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland https://orcid.org/0009-0009-1260-8308
Laura Mikuła Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0000-4827-2492
Justyna Strycharczuk Independent Public Healthcare Institution of the Ministry of the Interior and Administration in Opole, Krakowska 44, 45-075 Opole, Poland https://orcid.org/0009-0002-6612-2070

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.6027

Keywords:

Long COVID; Post-Infectious Autoimmunity; Rheumatological Manifestations; Immune Dysregulation; SARS-CoV-2

Abstract

COVID-19 has become an important factor modulating the autoimmune response, and its rheumatological consequences include both transient musculoskeletal complaints and full-blown autoimmune diseases. Patients experience activation of innate immunity, dysregulation of T and B lymphocytes, formation of autoantibodies, and NETosis. The rheumatological complications of COVID-19 cover a wide spectrum of phenotypes, ranging from joint pain and myalgia, through reactive arthritis, myopathies, and SLE-like phenotypes, to vascular changes associated with endothelial dysfunction and resembling vasculitis. In patients with rheumatic diseases, the course of infection is more often severe, and the risk of Long COVID is significantly increased. Rare cases of de novo autoimmune diseases have also been observed after COVID-19 vaccination. Diagnosis requires an integrated immunological and clinical assessment, and understanding the molecular basis of Long COVID is key to identifying risk factors and developing personalized therapies.

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