A systematic review of the incidence, management and prognosis of new-onset autoimmune connective tissue diseases after COVID-19

Abstract

A literature review on new-onset autoimmune connective tissue diseases (ACTDs) following COVID-19 is lacking. We evaluated potential associations between COVID-19 and the development of new-onset ACTDs. The “population” was adults with disease terms for ACTDs, including systemic lupus erythematosus (SLE), Sjogren’s syndrome, systemic sclerosis (SSc), idiopathic inflammatory myositis (IIM), anti-synthetase syndrome, mixed CTD and undifferentiated CTD, and “intervention” as COVID-19 and related terms. Databases were searched for English-language articles published until September 2022. We identified 2236 articles with 28 ultimately included. Of the 28 included patients, 64.3% were female, with a mean age was 51.1 years. The USA reported the most cases (9/28). ACTD diagnoses comprised: 11 (39.3%) IIM (including four dermatomyositis); 7 (25%) SLE; four (14.3%) anti-synthetase syndrome; four (14.3%) SSc; two (7.1%) other ACTD (one lupus/MCTD overlap). Of eight, four (14.3%) patients (including that with lupus/MCTD) had lupus nephritis. The average time from COVID-19 to ACTD diagnosis was 23.7 days. A third of patients were admitted to critical care, one for treatment of haemophagocytic lymphohistiocytosis in SLE (14 sessions of plasmapheresis, rituximab and intravenous corticosteroids) and nine due to COVID-19. 80% of patients went into remission of ACTD following treatment, while three (10%) patients died—one due to macrophage activation syndrome with anti-synthetase syndrome and two from unreported causes. Our results suggest a potential association between COVID-19 and new-onset ACTDs, notably in young females, reflecting more comprehensive CTD epidemiology. The most common diagnosis in our cohort was IIM. The aetiology and mechanisms by which ACTDs emerge following COVID-19 remain unknown and require further research.

Characteristics of emerging new autoimmune diseases after COVID‐19 vaccination: A sub‐study by the COVAD group

“…In our sample, the majority of respondents were female, with a mean age of over 50 years and an average duration of symptom onset of more than 3 weeks. This is consistent with a systematic review that reported a higher incidence of new‐onset SAIDs in female patients of a similar age and duration of onset (64.3% female, and 51.1 years and 23.7 days, respectively) 11 . Another systematic review reported similar findings (62.5% female, and 56 years and 11 days, respectively) 12 …”

“…Our study reported IIM to be the most commonly self‐reported new‐onset SAID following COVID‐19 vaccination, which is otherwise a rare disease. This is similar to the disease distribution found in a systematic review, with IIM being the most common connective tissue disease (CTD) disorder after COVID‐19 vaccination 11 . The fact that IIM is the most reported SAID likely reflects our sampling strategy/bias.…”

“…This is similar to the disease distribution found in a systematic review, with IIM being the most common connective tissue disease (CTD) disorder after COVID-19 vaccination. 11 The fact that IIM is the most reported SAID likely reflects our sampling strategy/bias. Many investigators who disseminated this survey have a particular interest in IIM, which means their patient populations would be enriched for this Additionally, the survey was circulated among IIM patient groups.…”

The relationship between infectious agents and juvenile dermatomyositis: a narrative update from the pediatric perspective

“…Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) drives a marked inflammation with risk of cytokine storm ( 36 ): A very recent study has linked SARS-CoV-2 infection to the onset of different systemic autoimmune diseases, and the most common disorder found in adults was idiopathic inflammatory myopathy, with 4 cases of dermatomyositis, after an average time of 23.7 days from COVID-19 diagnosis ( 37 ). Holzer et al.…”

Significance of antinuclear antibodies in patients with COVID-19

“…Autoantibodies known to occur in several autoimmune diseases have been detected in patients with COVID-19 during or after the illness [2]. In addition, several new autoimmune and autoinflammatory conditions have been reported, such as idiopathic inflammatory myositis or systemic lupus erythematous, after COVID-19 infections [3]. A study by Park et al [4] in this issue of the Korean Journal of Internal Medicine draws attention to the relationship between COVID-19 infection and autoimmunity.…”