text: Identification of a Vulnerable Group for Post Acute Sequelae of SARS CoV 2 PASC People with Autoimmune Diseases Recover More Slowly from COVID 19 Evidence is emerging that a significant percentage of COVID 19 cases experience symptom persistence beyond 30 days and go on to develop post acute sequelae Our objective was to compare the risk for COVID 19 symptom persistence by self reported use of medications for autoimmune disease among participants of an on line COVID 19 registry A community based online survey collected weekly data on COVID 19 symptom presentation Participants who completed informed consent online reported a positive COVID 19 test result within 14 days prior to enrollment and also reported demographics underlying illnesses and medication use were included Symptom presence and severity were evaluated weekly after enrollment and compared between participants reporting use of medications for autoimmune conditions and all others Logistic regression was used to evaluate the odds of more severe acute illness and symptom persistence approximately 30 days after enrollment A total of 1 518 COVID 19 positive participants were included Participants reporting use of medications for autoimmune disease n 70 were more likely to have experienced symptoms at all time points over a 30 day time period and were more likely to report more severe presentation of COVID 19 during acute illness adjusted OR 95 CI 1 32 0 76 2 29 compared to those reporting not taking medications for autoimmune disease At about 30 days after enrollment users of medications for autoimmune disease were more than twice as likely to report three or more symptoms adjusted OR 95 CI 2 53 1 21 5 29 In particular their risk of persistent shortness of breath and fatigue was elevated adjusted OR 95 CI 2 66 1 15 6 18 and 4 73 2 17 10 34 respectively Individuals with underlying autoimmune conditions appear to be particularly vulnerable to post acute sequelae from COVID 19 early intervention might be considered 