Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

Abstract

Background: Numerous cases of the coronavirus disease 2019 (COVID-19) with autoimmune and rheumatic manifestations have been reported. Despite the available reviews that summarized its autoimmune/rheumatic manifestations, a systematic approach is still lacking. Therefore, we conducted a comprehensive systematic review in order to give an overview upon these rare but clinically significant manifestations.Methods: We performed a literature search of PubMed and EMBASE as of October 9, 2020. All articles relevant to either systemic or organ-specific autoimmune and rheumatic manifestations potentially associated with COVID-19 were collected. The reviewed literature were limited to adults ≥18 years.Results: Although most of the existing evidence was based on case reports or case series without a long-term follow-up, a variety of autoimmune/rheumatic manifestations were associated with COVID-19. The manifestations that have a consistent association with COVID-19 include autoimmune cytopenia, cutaneous vasculitis, encephalitis, and Guillain-Barre syndrome. Such association is conflicting as regards to antiphospholipid syndrome, hemophagocytic lymphohistiocytosis, and myasthenia gravis.Conclusion: Our systematic review indicated the potential of the COVID-19 virus to trigger a myriad of autoimmune and rheumatic manifestations, which should be considered amid global efforts to combat COVID-19.

Intravenous immunoglobulin as a therapeutic option for patients with worsening COVID-19 under rituximab

“…The use of IVIg has been reported to be beneficial in both situations. 18 19 Although considered, severe hyperinflammatory states just mentioned were not confirmed in this patient. As previously reported, in addition to the worsening of SARS-CoV-2 pneumonia and persistent high fever, with maintained elevation of inflammatory markers, no other organ dysfunction was noted and no substantial analytical evidence supporting them was found.…”

COVID-19 Immunobiology: Lessons Learned, New Questions Arise

“…Some researchers have questioned whether the manifestations of COVID-19 are a mere result of the infection per se or a result of autoimmune reactions initiated or exacerbated by the infection (177). Viral infections not only share common immune responses with autoimmune diseases (ADs), but also they can break immune tolerance and cause autoimmunity by a variety of mechanisms such as molecular mimicry, bystander activation and epitope spreading (178)(179)(180). The reduction of regulatory T cellsand the increased number of Th17 and cytotoxic CD8 + T-cells that are observed in severe COVID-19 (as described above), have also been described in several autoinflammatory/autoimmune diseases (181,182).…”

SARS-CoV-2 and Autoimmune Cytopenia

“…Multiple autoantibodies have been reported in association with SARS-CoV-2 infection, including antinuclear antibodies, cytoplasmic anti-neutrophil cytoplasmic antibodies, perinuclear anti-neutrophil cytoplasmic antibodies, anti-actin antibodies, and antimitochondrial antibodies [9]. High rates of lupus anticoagulant positivity rates associated with thrombosis, as well as anticardiolipin (aCL) and beta2 glycoprotein I (β2GPI), were reported in patients with COVID-19 infection [20,21].…”

“…Viral infections linked to autoimmune hematologic disorders include the human immunodeficiency virus, hepatitis C virus and cytomegalovirus, parvovirus B19, Epstein-Barr virus, and Zika virus [5][6][7]. SARS-CoV-2 infection has been associated with several autoimmune complications, including cutaneous rashes and vasculitis, autoimmune cytopenia, anti-phospholipid syndrome, central and peripheral neuropathy, myositis, and myocarditis [8,9]. In a systematic review of 94 patients with COVID-19 who developed hematologic autoimmune disorders in their course of infection, the most common hematologic autoimmune disorder was immune thrombocytopenic purpura (ITP), seen in 58%, followed by autoimmune hemolytic anemia (AIHA) in 23% [10].…”