The “Severe Acute Respiratory Syndrome-related Coronavirus type 2” (SARS-CoV-2), the infectious agent responsible for the still ongoing “Coronavirus Disease 2019” (COVID-19) pandemic, represents a major environmental trigger and an important piece of the mosaic of autoimmunity and autoinflammation. Several de novo-onset or flares/relapses of autoimmune/autoinflammatory diseases have been reported associated either directly or indirectly with the viral agent. COVID-19 represents an - unfortunate but unique -opportunity for shedding new light and unexpected insights on virus-associated autoimmune/autoinflammatory diseases. These have, in turn, enabled the discovery of novel aspects of the COVID-19 infection, offering
already approved, effective and safe drugs, as options to be repurposed in the fight against the novel coronavirus. However, there is still a dearth of information concerning the long-term impact of the virus on autoimmunity and autoinflammationd arising during post-COVID or Long COVID, which warrants further investigation. The notion that viruses are a trigger for, and linked to the pathophysiology of, autoimmune diseases has been an accepted tenet
for over half a century. Hence, it is no surprise that SARS-COV2 and COVID-19 have, from the onset of the pandemic, been implicated in a robust spectrum of autoimmune phenomena and even clinically manifested autoimmune diseases. Since it is well established that the etiology of autoimmune diseases is multifactorial (i.e., genetic, environment, sex, accelerating factors), the links
of COVID-19 to autoimmune disease should include appropriate consideration of these factors and appropriate controls (e.g., age and sex-matched non-COVID acute respiratory disease). It is widely recognized that the pathogenesis of autoimmune diseases in general, and systemic rheumatic diseases (SRD) in
particular, is a multifactorial ‘mosaic’ that includes genetic, environmental, hormonal, and other accelerating or risk factors. Even within these ‘mosaic tiles’, the variables and variants are numerous, making a unified statement about how they relate to a specific SRD i.e., systemic lupus erythematosus (SLE), systemic sclerosis (SSc), autoimmune inflammatory myopathies (AIM), etc., extremely challenging.