COVID-19 Outcomes in Idiopathic Inflammatory Myopathies

Abstract

BACKGROUNDIdiopathic inflammatory myopathies (IIMs) are chronic systemic autoimmune diseases defined by symmetrical, proximal muscle weakness, dysphagia, and interstitial lung disease (ILD). 1 Patients with IIM are predisposed to proinflammatory states, often immunocompromised by both their disease and medication regimens, and may have preexisting pulmonary conditions. Given these factors, it is imperative to review the outcomes of IIM patients with COVID-19 infections to anticipate the COVID-19 prognoses and complications of these patients. This can be difficult in rare diseases such as IIM, which is only found in 10 per 100,000 people. 1 In this report, we analyze the clinical characteristics and patterns noted in 8 cases of COVID-19 in patients with preexisting IIM. To our knowledge, this is the first publication to examine COVID-19 exclusively in the IIM population. METHODSA registry of Montefiore Medical Center patients that met the 2017 EULAR/ACR classification criteria for IIM was created. It included demographics, IIM subtype, clinical manifestations, comorbidities (including hypertension, diabetes mellitus, osteoporosis, gastroesophageal reflux disease), and treatment history. Interstitial lung disease presence, progression, and severity were determined by computed tomography and pulmonary function tests. The medical charts of this myositis cohort were then reviewed for patients that had been tested positive for COVID-19 on PCR tests and/or IgG antibodies.At our medical center, the qualitative detection of nucleic acid from SARS-CoV-2 was detected using the Cepheid Xpert Xpress Flu/RSV/SARS-CoV-2 real-time PCR assay or the Hologic Aptima SARS-CoV-2 Transcription Mediated Amplification assay. IgG antibody positivity was detected with Abbott's Architect SARS-CoV-2 IgG. All 3 assays have received Emergency Use Authorization from the Food and Drug Administration. 2 Eight of the 141 patients in the myositis cohort had a positive result in 1 of the 3 assays listed previously. The medical records of these 8 patients were reviewed further to determine COVID-19 disease course. Symptoms documented included shortness of breath, loss of smell, and nonspecific viral infection symptoms, such as fever, myalgias, headache, sore throat, and sneezing. Hospital admission for COVID-19 symptoms, inflammatory markers, and requirement of supplemental oxygen and/or intubation were recorded as well. Any changes in steroid or biologic medications 6 weeks before COVID-19 were noted. COVID-19 sequelae, such

The Association of Hepatitis B and Polymyositis: Rare but Real

“…Deposition of Hepatitis B antigen antibody complexes in muscle suggests a possible etiology linking Hepatitis B to Polymyositis as the triggering antigen [5]. This is also supported by the study done by Ana Valle et al which showed that Patients with HBV had a higher frequency of myositis-associated antibodies in comparison to patients without HBV [6]. Capasso et al revealed that the pathogenesis of myopathy is an immunemediated mechanism by demonstrating HBV DNA inside intact muscle fibers [7].…”

Polymyositis concomitant with hepatitis B virus infection: Treatment challenges

“…The association between polymyositis and hepatitis B remain unclear, but the presence of antibody complexes against the hepatitis B antigen in muscle raises the possibility that link hepatitis B with polymyositis as triggering antigen [21]. It is also supported with the increase of myositisassociated antibodies found in patient with HBV infection more than patient without HBV infection [22]. Main treatment of polymyositis such as corticosteroid can cause suppression of Tcell cytotoxic which may lead to decrease immune ability against the virus and increase HBV-DNA replication through activation of corticosteroid-responsive transcriptional regulatory element which has been detected in HBV genome [9].…”