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Review
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Korean J Intern Med. 2026;41(4):597-619. Published online July 1, 2026.
DOI: https://doi.org/10.3904/kjim.2025.301
- Autoimmune diseases in the era of COVID-19: emerging mechanisms, clinical implications, vaccine considerations, and future directions
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Jaehyun Kong1,2, Seohyun Hong1,2, Jiyeon Oh1,2, Sooji Lee1,2, Lee Smith3,4, Francesco Branda5, Hanseul Cho6, Jiyoung Hwang1,2, Dong Keon Yon1,2,7
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1Department of Medicine, Kyung Hee University College of Medicine, Seoul, Korea
2Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
3Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
4Department of Public Health, Faculty of Medicine, Biruni University, Istanbul, Turkey
5Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
6Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
7Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
- Corresponding author: Dong Keon Yon ,Tel: +82-2-6935-2476, Fax: +82-504-478-0201, Email: yonkkang@gmail.com
- Received: September 3, 2025; Revised: February 19, 2026 Accepted: March 20, 2026.
- Abstract
- The coronavirus disease 2019 (COVID-19) pandemic has highlighted a complex, bidirectional relationship between SARSCoV-2 infection and autoimmune diseases. This review examines how SARS-CoV-2 infection influences the incidence, progression, and outcomes of five major autoimmune conditions: systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease, and Guillain–Barré syndrome. Patients with autoimmune diseases are at increased risk of severe COVID-19 due to intrinsic immune dysregulation and the use of immunosuppressive therapies, both of which impair antiviral host defenses. Conversely, COVID-19 has been implicated in the initiation and exacerbation of autoimmune responses through mechanisms such as molecular mimicry and bystander activation. Concerns have also arisen regarding the safety and efficacy of COVID-19 vaccines in immunocompromised populations. Although vaccines are generally tolerated in these individuals, certain immunosuppressive therapies may attenuate humoral and cellular immune responses. Strategies such as adjusting immunosuppressive regimens and optimizing the timing of vaccination have been proposed to improve vaccine efficacy. Disease-specific considerations are essential to balance infection risk with adequate control of autoimmune activity. Overall, this review underscores the importance of individualized treatment strategies, close clinical monitoring, and interdisciplinary care in managing patients with autoimmune diseases during the COVID-19 pandemic. A deeper understanding of these interactions will be critical for improving patient outcomes and preparing for future pandemics involving immune-mediated diseases.
Keywords :Autoimmune diseases; COVID-19; Immunosuppressive therapy; Vaccine; Immune system diseases
