Adults with systemic lupus erythematosus who caught COVID-19 experienced flares or persistently active disease more often than lupus patients who avoided infection, according to longitudinal data from the ReumaCov-Brazil Register published in Advances in Rheumatology.
The study was a multicenter, observational, prospective cohort designed to evaluate flares in SLE patients over the six months following COVID-19. Researchers compared SLE adults who had COVID-19, the case group, with SLE patients who did not, the control group. Assessments took place at baseline, immediately after infection, and again at three and six months after infection.
Disease activity was measured with the patient global assessment, known as PGA, and the modified SLE Disease Activity Index 2000, or mSLEDAI-2K. The investigators defined a flare as an increase in the mSLEDAI-2K score of greater than three points, and persistent disease activity as an mSLEDAI-2K score greater than three over two consecutive visits.
In total, 715 patients were included, with 363 in the case group and 352 in the control group. Patients in the case group were slightly older than controls, with a mean age of 41.0 years versus 38.8 years, a difference the authors report as statistically significant.
Longitudinal analyses showed differences in disease activity trajectories between the two groups, particularly for the PGA measure. The combined outcome of flare and/or persistent disease activity occurred more frequently in the case group, affecting 74 patients, or 18.5 percent, compared with 33 patients, or 10.5 percent, of controls.
COVID-19 during follow-up was associated with this outcome, with an odds ratio of 1.70 and a 95 percent confidence interval of 1.06 to 2.74. The authors emphasize that these findings suggest a possible association between COVID-19 and subsequent SLE disease activity rather than a definitive causal effect.
An important limitation emerged in the sensitivity analysis. When the comparison was restricted to patients with laboratory-confirmed COVID-19, the difference in the categorical outcome was no longer statistically significant. This means the association should be interpreted with caution, since the strength of the signal depended in part on how infection was verified.
The study also found that new SLE manifestations were more frequent following COVID-19, indicating that infection was linked not only to heightened activity of existing disease but also to the emergence of additional clinical features of lupus during follow-up.
Because the cohort was observational, the design cannot establish that SARS-CoV-2 infection causes flares, and unmeasured differences between infected and uninfected patients may have contributed to the results. Nevertheless, the register-based data from multiple Brazilian centers offer a prospective look at how COVID-19 may shape the course of lupus in the months after infection, and the authors conclude that the findings point to a possible association between the infection and subsequent disease activity in this patient population.
Subject of Research: The association between COVID-19 and lupus flares and persistent disease activity in a prospective Brazilian cohort
Article Title: COVID-19 is associated with lupus flare and persistent disease activity: longitudinal data from the ReumaCov-Brazil Register study
Article References: Carvalho, J. S., Reis Neto, E. T. D., Kakehasi, A. M., Ribeiro, S. L. E., Studart, S. A. S., Martins, F. P., Santo, R. C. D. E., Valadares, L. D. A., Fernandino, D. C., Dinis, V. G., Sato, E. I., Resende, G. G., Marinho, A., Mariz, H. A., Sacilotto, N. C., Ribeiro, F. M., Shinjo, S. K., Dias, L. H., Yazbek, M. A., … on behalf of ReumaCoV Brasil Registry (2026). COVID-19 is associated with lupus flare and persistent disease activity: longitudinal data from the ReumaCov-Brazil Register study. Advances in Rheumatology. https://doi.org/10.1186/s42358-026-00583-7
Image Credits: AI Generated
DOI: 10.1186/s42358-026-00583-7
Keywords: systemic lupus erythematosus, COVID-19, lupus flare, disease activity, mSLEDAI-2K, prospective cohort, ReumaCov-Brazil, rheumatology, SLEDAI, observational study, associated, lupus
News Source: Ophelia Keating. (October 28, 2026). COVID-19 Linked to Lupus Flares and Persistent Disease Activity in Brazilian Cohort. Scienmag.
