Coronavirus disease 2019 (COVID-19) in a patient with ankylosing spondylitis treated with secukinumab: a case-based review

Abstract

Severe acute respiratory syndrome coranovirus-2 (SARS-CoV-2) infection has become an important health-care issue worldwide. The coronavirus disease 2019 has also raised concerns among patients with inflammatory rheumatic conditions and their treating physicians. There are emerging data regarding the potential risks of SARS-CoV-2 for this particular patient group. However, less is known with regard to the course of COVID-19 among patients receiving IL-17 inhibitors. The aim of the current article is to review the growing body of knowledge on the course/management of COVID-19 in patients with inflammatory rheumatic diseases by presenting a SARS-CoV-2 infected case with ankylosing spondylitis under secukinumab therapy. A 61-year old patient with ankylosing spondylitis who was on secukinumab therapy for 5 months admitted with newly onset fever and gastrointestinal complaints. After being hospitalized, she developed respiratory manifestations with focal pulmonary ground-glass opacities and multiple nodular densities in both lungs. The patient was tested positive for SARS-CoV-2 infection. Substantial clinical improvement was obtained following a management plan, which included tocilizumab, hydroxychloroquine, prednisolone and enoxaparin sodium. PubMed/MEDLINE and Scopus databases were searched by using relevant keywords and their combinations. The literature search revealed four articles reporting the clinical course of COVID-19 in seven rheumatic patients on secukinumab. The clinical course of SARS-CoV-2 infection was mild in most of these patients, while one of them experienced severe COVID-19. Interleukin-17 has been related to the hyperinflammatory state in COVID-19 and IL-17 inhibitors were presented as promising targets for the prevention of aberrant inflammation and acute respiratory distress in COVID-19. However, this hypothesis still remains to be proved. Further studies are warranted in order to test the benefits and risks of IL-inhibitors in SARS-CoV-2 infected individuals.

Public interest in rheumatic diseases and rheumatologist in the United States during the COVID-19 pandemic: evidence from Google Trends

“…Interestingly, psoriatic arthritis was increased in all three periods evaluated in the study with an increase in relative search volume of axial spondyloarthritis, ankylosing spondylitis, rheumatoid arthritis, Sjögren's syndrome, antiphospholipid syndrome, scleroderma, Kawasaki disease, and ANCA-associated vasculitis in the July/August period. The gradual increased interest in rheumatic diseases might be due to the general public's lack of knowledge on potential risk that may exist between these diseases and immunosuppressive treatments with COVID-19 [30,31].…”

COVID-19 illness and autoimmune diseases: recent insights

“…A 61-year-old patient with AS who presented with gastrointestinal symptoms, newly onset fever and respiratory manifestations following the admission, then, RT-PCR test for SARS-CoV-2 resulted positive. Substantial clinical improvement was achieved with HCQ, prednisolone, tocilizumab and enoxaparin sodium [ 155 ]. Another case reported that a COVID-19 patient with AS treated with etanercept had olfactory and gustatory sensory dysfunction [ 156 ].…”

Postdischarge rheumatic and musculoskeletal symptoms following hospitalization for COVID-19: prospective follow-up by phone interviews

“…The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes a disease named coronavirus disease 2019 (COVID-19), emerged in China in December 2019 [ 1 , 2 ]. Its rapid worldwide spread leading to an unexpected pandemic has challenged as a global health threat and considerably impacted nearly all aspects of the life of individuals as well as healthcare systems [ 3 – 8 ].…”