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It’s one of the great scientific mysteries to emerge from the pandemic: Why do stubborn health problems such as fatigue, shortness of breath, and thinking and memory struggles persist for some people and not others?

A new study published in the European Respiratory Journal points to the role of autoimmune disease in the troubling condition known as long COVID. Autoimmune disease occurs when the immune system mistakenly attacks healthy parts of the body instead of the defending the body against the disease. It causes conditions such as rheumatoid arthritis and lupus.

Blood samples from patients with long COVID who are still suffering from fatigue and shortness of breath after a year show signs of autoimmune disease, researchers from McMaster University in Ontario, Canada, and the University of British Columbia in Vancouver, Canada, discovered. A total of 80% of the COVID-19 patients they studied had two or more antibodies that target healthy cells and tissues in the body that are known to contribute to autoimmune disease three and six months after infection. After a year, the percentage fell to 41%, with most of the healthy people showing no signs of the antibodies in their blood.

But the researchers also discovered two specific “autoantibodies” along with other proteins called cytokines that cause inflammation that persisted in approximately 30% of COVID patients a year after infection. These patients tended to be among those who still suffered with fatigue and shortness of breath.

Researchers say the results point to the need to test for signs of autoimmune disease in patients with symptoms of long COVID that lasts for a year or more. Scientists now knows certain infections can trigger autoimmune diseases such as rheumatoid arthritis. This study adds to the growing evidence that similar processes may be involved with long COVID as well, with the goal to better understand the condition and how to diagnose and treat it.