COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease

Abstract

As the world navigates the Coronavirus disease 2019 (COVID-19) pandemic, there is a growing need to assess its impact in patients with autoimmune rheumatic diseases, such as systemic lupus erythematosus (SLE). Patients with SLE are a unique population when considering the risk of contracting COVID-19 and infection outcomes. The use of systemic glucocorticoids and immunosuppressants, and underlying organ damage from SLE are potential susceptibility factors. Most patients with SLE have evidence of high type I IFN activity, which may theoretically act as an antiviral line of defense or contribute to the development of a deleterious hyperinflammatory response in COVID-19. Other immunopathogenic mechanisms of SLE may overlap with those described in COVID-19, and thus studies in SLE could provide some insight into immune responses occurring in severe cases of the viral infection. We reviewed the literature to date on COVID-19 in patients with SLE and provide an in-depth review of current research in the area, including immune pathway activation, epidemiology, clinical features, outcomes, and the psychosocial impact of the pandemic in those with autoimmune disease.

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

“…We particularly emphasise the scarcity of robust information regarding treatment in immunosuppressed patients with COVID-19. ► We present a case of a patient with deteriorating COVID- 19 under the effect of RTX, who experienced a rapid and notable improvement after IVIg treatment. Despite lacking strong evidence, IVIg might be a promising therapeutic choice in RTX-treated patients and its use considered in this population.…”

Treatment-Resistant Acute Upper Limb Ischemia in a Patient With Systemic Lupus Erythematous and Concomitant SARS-CoV-2 Infection: A Case Report

“…Moreover, the treatment of SLE includes immunosuppressants and corticosteroids that could increase patients’ vulnerability to infections. On the other hand, recent studies have shown that immunosuppressive therapies seem to reduce systemic inflammation and the risk of developing respiratory distress syndrome in COVID-19 patients [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] .…”

“…Male sex, older age, obesity, arterial hypertension, and atherosclerotic disease, well-known conditions predisposing to endothelial dysfunction, are significantly related to cardiac and vascular complication during COVID-19 disease 3 , 6 . Furthermore, COVID-19 infection likely induces or exacerbates autoimmune disease in predisposed patients, although in absence of definitive data [7] , [8] , [9] , [10] , [11] , [12] , [13] .…”

COVID-19: Unmasking Emerging SARS-CoV-2 Variants, Vaccines and Therapeutic Strategies

“…Some earlier studies aimed to investigate if SARS-CoV-2 infection modulates SLE disease prevalence, however they have not found a substantial vulnerability of COVID-19 in infected SLE patients [48,49]. A small cohort study by Fernandez-Ruiz et al reported that COVID-19 confirmed SLE patients have a higher hospitalization rate compared to the general population, independent of mortality rate [50]. The immunosuppressive treatment in SLE patients has not shown a higher rate of SARS-CoV-2 infection or COVID-19 symptoms [51].…”