Differences in SARS-CoV-2 antigen persistence in individuals with systemic autoimmune rheumatic diseases compared to the general population: A RECOVER-Adult cohort study

• April 2026
• Arthritis & Rheumatology

Publication Details

DOI: 10.1002/art.70205

Abstract

Objective: Individuals with systemic autoimmune rheumatic diseases (SARDs) are at risk for worse acute and post-acute COVID-19 outcomes, though whether individuals with SARDs have longer persistence of viral antigens after COVID-19 has not been studied.

Methods: This retrospective cohort study evaluated post-COVID-19 differences in SARS-CoV-2 antigen (spike, spike protein that contains the receptor-binding domain, and nucleocapsid) positivity between individuals with SARDs (COVID-19 and Rheumatic Diseases [RheumCARD]) and without SARDs (Researching COVID to Enhance Recovery [RECOVER]-Adult). SARS-CoV-2 antigens were measured in collected samples using a validated ultrasensitive single molecule array. This digital enzyme-linked immunosorbent assay used antibody-coated magnetic beads to capture antigen molecules, which were loaded into microwell arrays and detected through enzymatic cleavage of a fluorescent substrate. We used logistic regression to estimate unadjusted and adjusted (for age, sex, infection year, vaccination status, and COVID-19 treatment) odds ratios for SARS-CoV-2 antigen positivity at months 3 and 6 following COVID-19.

Results: Among 210 individuals with SARDs in RheumCARD and 348 individuals without SARDs in RECOVER-Adult, any SARS-CoV-2 antigen positivity was more common in those with SARDs (36.7% in RheumCARD vs 18.9% in RECOVER-Adult; P < 0.001). Those with SARDs had higher odds of nucleocapsid antigen positivity (adjusted odds ratio [aOR] 3.73, 95% confidence interval [CI] 1.28-10.85) or any antigen positivity (aOR 2.89, 95% CI 1.43-5.85) three months after COVID-19 infection and higher odds of nucleocapsid antigen positivity (aOR 6.62, 95% CI 1.09-40.30) six months after COVID-19 infection.

Conclusion: Individuals with SARDs were more likely to have SARS-CoV-2 antigen positivity at months 3 and 6 following COVID-19 infection compared with individuals without SARDs, not explained by demographics, variant, vaccination, or treatment.

Authors

Naomi J Patel, Zoe Swank, Jiaqi Wang, Xiaosong Wang, Lauren A O'Keeffe, Madison Negron, Liya S Getachew, Louise L Hansen, Grace Qian, Alene A Saavedra, Kevin T Mueller, Natalie A Davis, Kathleen M M Vanni, Sandria Savage, Julie S Lam, Zachary S Wallace, David R Walt, Jeffrey A Sparks, RECOVER‐Adult

Keywords

Not available