Pathogenic implications, incidence, and outcomes of COVID-19 in autoimmune inflammatory joint diseases and autoinflammatory disorders

Abstract

As the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread rapidly, there are still many unresolved questions of how this virus would impact on autoimmune inflammatory joint diseases and autoinflammatory disorders. The main aim of this paper is to describe the main studies focusing their attention on COVID-19 incidence and outcomes of rheumatoid arthritis (RA), spondylarthritis (SpA), and autoinflammatory disease cohorts. We also revised possible pathogenic mechanisms associated with. Available data suggest that, in patients with RA and SpA, the immunosuppressive therapy, older age, male sex, and the presence of comorbidities (hypertension, lung disease, diabetes, CVD, and chronic renal insufficiency/end-stage renal disease) could be associated with an increased risk of infections and high rate of hospitalization. Other studies have shown that lower odds of hospitalization were associated with bDMARD or tsDMARDs monotherapy, driven largely by anti-TNF therapies. For autoinflammatory diseases, considering the possibility that COVID-19 could be associated with a cytokine storm syndrome, the question of the susceptibility and severity of SARS-CoV-2 infection in patients displaying innate immunity disorders has been raised. In this context, data are very scarce and studies available did not clarify if having an autoinflammatory disorder could be or not a risk factor to develop a more severe COVID-19. Taking together these observations, further studies are likely to be needed to fully characterize these specific patient groups and associated SARS-CoV-2 infection.

Prevalence and risk of COVID-19 in patients with rheumatic diseases: a systematic review and meta-analysis

“…However, studies have also reported no influence from anti-rheumatic drugs on risk of severe COVID-19 outcomes, although the accuracy of data for partial drugs was unstable [ 45 , 46 ]. In more details, it has been suggested that no substantial risk was detected csDMARDS [ 42 ] as we show.…”

“…Both csDMARDs and bDMARDs linked with a higher risk of serious infections [ 41 ]. These drugs target key molecules involved in the immune response against infectious antigens and therefore may increase susceptibility to viruses and bacteria [ 42 ]. It has been confirmed in multiple studies, in which medium-dose and above (> 5mg) glucocorticoids (GC) have increased risk of hospitalization in rheumatic patients who develop COVID-19 [ 43 , 44 ].…”

Safety of Biologic-DMARDs in Rheumatic Musculoskeletal Disorders: A Population-Based Study over the First Two Waves of COVID-19 Outbreak

“…Furthermore, our study confirms that immunosuppressant therapy (in particular band ts-DMARDs) seems not to be associated with higher risk of COVID-19 complications nor with severe prognosis. These findings are consistent with published data about the safety of the aforementioned therapies [21,[35][36][37], particularly referring to the association between anti-TNF treatments, and both the reduced odds of hospitalization and the lower rate of complications during COVID-19, since also in our cohort the most used biologic drugs were anti-TNFs (24/37). Interestingly, the hospitalization rate in our cohort of RMD patients is even lower compared to the study performed by Gianfrancesco et al (24% vs. 46%, respectively) [21].…”

“…Furthermore, our study confirms that immunosuppressant therapy (in particular band ts-DMARDs) seems not to be associated with higher risk of COVID-19 complications nor with severe prognosis. These findings are consistent with published data about the safety of the aforementioned therapies [21,[35][36][37], particularly referring to the association between anti-TNF treatments, and both the reduced odds of hospitalization and the lower…”

Myocarditis, Pericarditis and Cardiomyopathy After COVID-19 Vaccination

“…The impact of the global health crisis due to the virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)—the causative pathogen of the coronavirus disease 2019 (COVID-19)—has begun to alter with the timely development, approval and administration of vaccines [ 1 ]. Although SARS-CoV-2 infection primarily targets the respiratory system [ [2] , [3] , [4] , [5] , [6] ], it is now recognised that the infection and its clinical manifestations are systemic [ [7] , [8] , [9] , [10] , [11] , [12] ], and also affecting the cardiovascular system of adults and children [ [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] ]. Cardiac complications of variable severity with acute and long-term sequelae are now known to include acute myocardial injury, arrhythmias, vasculitis and endothelial dysfunction, thrombosis, myocardial fibrosis, and myocarditis [ [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ].…”