“…These similarities potentially can lead to loss of tolerance to self-peptides and result in autoimmunity. Recently, an epitope mapping analysis has identified immunogenic linear epitopes, 2′-O-ribose methyltransferase, RNA-dependent RNA polymerase and 3′-to-5′ exonuclease proteins from autoimmune dermatomyositis patients matching with the SARS-CoV-2 peptides [ 56 ]. Fig.…”
Section: Sars-cov-2 Infection and Autoimmunitymentioning
The coronavirus disease-2019 (COVID-19) pandemic is likely to pose new challenges to the rheumatology community in the near and distant future. Some of the challenges, like the severity of COVID-19 among patients on immunosuppressive agents, are predictable and are being evaluated with great care and effort across the globe. A few others, such as atypical manifestations of COVID-19 mimicking rheumatic musculoskeletal diseases (RMDs) are being reported. Like in many other viral infections, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can potentially lead to an array of rheumatological and autoimmune manifestations by molecular mimicry (cross-reacting epitope between the virus and the host), bystander killing (virus-specific CD8 + T cells migrating to the target tissues and exerting cytotoxicity), epitope spreading, viral persistence (polyclonal activation due to the constant presence of viral antigens driving immune-mediated injury) and formation of neutrophil extracellular traps. In addition, the myriad of antiviral drugs presently being tried in the treatment of COVID-19 can result in several rheumatic musculoskeletal adverse effects. In this review, we have addressed the possible spectrum and mechanisms of various autoimmune and rheumatic musculoskeletal manifestations that can be precipitated by COVID-19 infection, its therapy, and the preventive strategies to contain the infection. Keywords Coronavirus disease-2019 (COVID-19) • Rheumatic musculoskeletal diseases (RMDs) • Autoimmunity • Rheumatology Abbreviations AAV Anti-neutrophil cytoplasmic antibodyassociated vasculitis ACE2 Angiotensin-converting enzyme 2 ANA Antinuclear antibodies AIDS Acquired immunodeficiency syndrome APCs Antigen-presenting cells APS Antiphospholipid antibody syndrome ARDS Acute respiratory distress syndrome CAHA Coronavirus-associated hemostatic lung abnormality CART Chimeric antigen receptor T cell CCL2 Chemokine (C-C motif) ligand 2 CK Creatine kinase COVID-19 Coronavirus disease-2019 CSF Cerebrospinal fluid CRS Cytokine release syndrome CXCL8 C-X-C motif chemokine ligand 8 DADA-2 Deficiency of adenosine deaminase-2 DIC Disseminated intravascular coagulation Rheumatology INTERNATIONAL Sanket Shah and Debashish Danda have contributed equally as first authors.
“…These similarities potentially can lead to loss of tolerance to self-peptides and result in autoimmunity. Recently, an epitope mapping analysis has identified immunogenic linear epitopes, 2′-O-ribose methyltransferase, RNA-dependent RNA polymerase and 3′-to-5′ exonuclease proteins from autoimmune dermatomyositis patients matching with the SARS-CoV-2 peptides [ 56 ]. Fig.…”
Section: Sars-cov-2 Infection and Autoimmunitymentioning
The coronavirus disease-2019 (COVID-19) pandemic is likely to pose new challenges to the rheumatology community in the near and distant future. Some of the challenges, like the severity of COVID-19 among patients on immunosuppressive agents, are predictable and are being evaluated with great care and effort across the globe. A few others, such as atypical manifestations of COVID-19 mimicking rheumatic musculoskeletal diseases (RMDs) are being reported. Like in many other viral infections, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can potentially lead to an array of rheumatological and autoimmune manifestations by molecular mimicry (cross-reacting epitope between the virus and the host), bystander killing (virus-specific CD8 + T cells migrating to the target tissues and exerting cytotoxicity), epitope spreading, viral persistence (polyclonal activation due to the constant presence of viral antigens driving immune-mediated injury) and formation of neutrophil extracellular traps. In addition, the myriad of antiviral drugs presently being tried in the treatment of COVID-19 can result in several rheumatic musculoskeletal adverse effects. In this review, we have addressed the possible spectrum and mechanisms of various autoimmune and rheumatic musculoskeletal manifestations that can be precipitated by COVID-19 infection, its therapy, and the preventive strategies to contain the infection. Keywords Coronavirus disease-2019 (COVID-19) • Rheumatic musculoskeletal diseases (RMDs) • Autoimmunity • Rheumatology Abbreviations AAV Anti-neutrophil cytoplasmic antibodyassociated vasculitis ACE2 Angiotensin-converting enzyme 2 ANA Antinuclear antibodies AIDS Acquired immunodeficiency syndrome APCs Antigen-presenting cells APS Antiphospholipid antibody syndrome ARDS Acute respiratory distress syndrome CAHA Coronavirus-associated hemostatic lung abnormality CART Chimeric antigen receptor T cell CCL2 Chemokine (C-C motif) ligand 2 CK Creatine kinase COVID-19 Coronavirus disease-2019 CSF Cerebrospinal fluid CRS Cytokine release syndrome CXCL8 C-X-C motif chemokine ligand 8 DADA-2 Deficiency of adenosine deaminase-2 DIC Disseminated intravascular coagulation Rheumatology INTERNATIONAL Sanket Shah and Debashish Danda have contributed equally as first authors.
“…Although it is too early to draw firm conclusions from this preliminary data, the possibility of asymptomatic virus infections in patients leading onto relapses of IIM merits further exploration. [ 16 ] Even though none of our patients had symptomatic COVID-19, an asymptomatic infection cannot be ruled out. At this juncture, it seems logical that rheumatologists remain aware of the possibility of relapses of IIM after COVID-19.…”
Teleconsultation has assumed a central role in the management of chronic and disabling rheumatic diseases, such as the idiopathic inflammatory myopathies (IIM), during COVID-19. However, the feasibility, challenges encountered, and outcomes remain largely unexplored. Here, we describe our teleconsultation experience in a prospectively followed cohort of adult and juvenile IIM. 250 IIM enrolled into the MyoCite cohort (2017-ongoing) were offered the option of audio/visual teleconsultation using WhatsApp during the nationwide lockdown. Clinical outcomes (major/minor relapse) and prescription changes were compared between IIM subsets. Socio-demographic and clinico-serological characteristics of those who sought teleconsultation were compared with those who did not. 151 teleconsultations were sought over a 93 day period by 71 (52.2%) of 136 IIM (median age 38 years, F:M 4.5:1). Nearly one-third (38%) consulted on an emergency basis, with voice consultations being the primary medium of communication. Over a quarter (26.8%) reported relapse (15.5% minor, 11.3% major), these being more common in JDM [71.4%, OR 8.9 (1.5–51)] as compared with adult IIM, but similar across various antibody-based IIM subtypes. Patients who relapsed required more consultations [2(2–3) vs 1(1–2),
p
0.009]. The demographic and socioeconomic profile of the patients seeking consultation (
n
= 71) was not different from those who did not (
n
= 65). Voice-based teleconsultations may be useful to diagnose and manage relapses in IIM during the pandemic. Patient education for meticulous and timely reporting may be improve care, and larger multicentre studies may identify subsets of IIM that require greater care and early tele-triage for effective management of the condition.
“…Besides, Beydon et al have reported a case of COVID-19 that presented as acute myositis. 5 The latest research also revealed three immunogenic linear epitopes with high sequence identity to SARS-CoV-2 proteins in patients with autoimmune DM, which means that latent exposure to SARS-CoV-2 might promote musculoskeletal autoimmune disease development 6 ; therefore, the patients with DM should be a priority group for COVID-19 prevention.…”
In late 2019, the coronavirus disease 2019 (COVID-19) broke out in Wuhan and then spread over China, which greatly affected the medical practices and health care systems. With most of the hospital’s outpatient services closed, the routine clinical diagnosis and treatment for patients with dermatomyositis has been disturbed. We conducted telephone follow-up for 52 patients to know the changes in the condition and the continuation of drug therapy and to ensure the continuity, safety, and effectiveness of the treatment of patients with dermatomyositis during COVID-19.
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