Does withdrawal of immunosuppression in rheumatoid arthritis after SARS-CoV-2 infection increase the risk of vasculitis?

Singh, Sukhraj; Vaghaiwalla, Zareen; Thway, Myint; Kaeley, Gurjit S.

doi:10.1136/bcr-2020-241125

Cited by 4 publications

(5 citation statements)

References 18 publications

(25 reference statements)

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“…Our study confirms the knowledge in the literature, as 40% COVID-19 may trigger several autoimmune pathways. Beyond the disease flares, patients with autoimmune rheumatic disease may also develop novel autoimmune characteristics such as psoriasis, vasculitis, and autoimmune colitis (22)(23)(24). Consistent with this, we found in our study that 13% of our patients had newly-emerging extra-articular SpA symptoms in the post-COVID period.…”

Section: Discussionsupporting

confidence: 89%

Effects of COVID-19 on axial spondyloarthritis disease flare

Armağan¹,

Atalar²,

Özdemir³

et al. 2022

GMJ

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The coronavirus disease-2019 outbreak has become a major global health problem since December 2019. COVID-19 has heterogeneous clinical features ranging from an asymptomatic course to multi-organ failure. It is also a major cause of morbidity and mortality in some patients. In this context, patients with chronic diseases are more susceptible to these effects. The cascade of inflammatory mediators in COVID-19 may lead to many systemic symptoms (1,2). Although direct involvement of the skeletal muscles by viral agents has not been shown, approximately 15% of the cases could have arthralgia and myalgia at several sites (3).Spondyloarthritis (SpA) refers to a group of chronic inflammatory arthritis, which can be further classified according to the distribution of joint involvement as predominantly axial (SpA) or peripheral SpA. Axial forms of SpA, which consist of ankylosing spondylitis and non-radiographic axial SpA are the most frequent types and usually present with chronic lower back pain, peripheral arthritis, enthesitis, dactylitis, or in association with extra-articular manifestations include psoriasis, uveitis, and inflammatory bowel disease (4,5). Non-steroidal antiinflammatory drugs (NSAID) are frequently used in axial SpA patients along with other immunosuppressive and biological agents (6). Bath Ankylosing Spondylitis Disease Activity Index

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Section: Discussionsupporting

confidence: 89%

Effects of COVID-19 on axial spondyloarthritis disease flare

Armağan¹,

Atalar²,

Özdemir³

et al. 2022

GMJ

View full text Add to dashboard Cite

show abstract

“…We identified 16 reports describing 18 cases (12 women/6 men) of new-onset ANCA-associated vasculitis in COVID-19 patients and presumably related to this disease [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. The main characteristics of these cases are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Another patient died as a consequence of multiple infections [23]. Notably, three of these cases had a preexistent autoimmune disease [12,13,23]. Another case simultaneously developed an antiphospholipid syndrome [18].…”

Section: Resultsmentioning

confidence: 99%

Vasculitis flare after COVID-19: report of two cases in patients with preexistent controlled IgA vasculitis and review of the literature

et al. 2022

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has been related to several autoimmune diseases, triggering the appearance of autoantibodies and endothelial dysfunction. Current evidence has drawn attention to vasculitis-like phenomena and leukocytoclastic vasculitis in some COVID-19 patients. Moreover, it has been hypothesized that COVID-19 could induce flares of preexisting autoimmune disorders. Here, we present two patients with previously controlled IgA vasculitis who developed a renal and cutaneous flare of vasculitis after mild COVID-19, one of them with new-onset ANCA vasculitis. These patients were treated with glucocorticoids and immunosuppressants achieving successful response. We also provide a focused literature review and conclude that COVID-19 may be associated with triggering of vasculitis and could induce flares of previous autoimmune diseases.

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“…Autoimmune rheumatic conditions, encompassing disorders like rheumatoid arthritis, lupus, and vasculitis, are characterized by an aberrant immune response, often resulting in inflammatory processes and organ damage, particularly affecting pulmonary function [68,69]. When compounded with the respiratory distress precipitated by COVID-19, the susceptibility to acute respiratory failure escalates [70,71]. The progression towards a severe clinical presentation is underscored by the intricate phenomenon termed a "cytokine storm", activated by conceivable immunological mechanisms triggered by the viral incursion [71,72].…”

Section: Covid-19 and Acute Respiratory Failure In Autoimmune Rheumat...mentioning

confidence: 99%

“…When compounded with the respiratory distress precipitated by COVID-19, the susceptibility to acute respiratory failure escalates [70,71]. The progression towards a severe clinical presentation is underscored by the intricate phenomenon termed a "cytokine storm", activated by conceivable immunological mechanisms triggered by the viral incursion [71,72]. Perturbations in immune modulation, alongside potential autoinflammatory and autoimmune cascades, engender an exacerbated release of cytokines from immune cells, thereby exacerbating the inflammatory milieu [69,73].…”

Section: Covid-19 and Acute Respiratory Failure In Autoimmune Rheumat...mentioning

confidence: 99%

Acute Respiratory Failure in Autoimmune Rheumatic Diseases: A Review

Poli,

Sciorio,

Piacentini

et al. 2024

JCM

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This review examines respiratory complications in autoimmune rheumatic diseases within intensive care units (ICUs). The respiratory system, primarily affected in diseases like rheumatoid arthritis, systemic lupus erythematosus, and scleroderma, often leads to respiratory failure. Common manifestations include alveolar hemorrhage, interstitial fibrosis, and acute respiratory distress syndrome. Early recognition and treatment of non-malignant conditions are crucial to prevent rapid disease progression, with ICU mortality rates ranging from 30% to 60%. Delayed immunosuppressive or antimicrobial therapy may result in organ system failure. Collaboration with rheumatic specialists is vital for accurate diagnosis and immediate intervention. Mortality rates for rheumatic diseases in the ICU surpass those of other conditions, underscoring the need for specialized care and proactive management. The review emphasizes comprehensive assessments, distinguishing disease-related complications from underlying issues, and the importance of vigilant monitoring to enhance patient outcomes.

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Does withdrawal of immunosuppression in rheumatoid arthritis after SARS-CoV-2 infection increase the risk of vasculitis?

Cited by 4 publications

References 18 publications

Effects of COVID-19 on axial spondyloarthritis disease flare

Effects of COVID-19 on axial spondyloarthritis disease flare

Vasculitis flare after COVID-19: report of two cases in patients with preexistent controlled IgA vasculitis and review of the literature

Acute Respiratory Failure in Autoimmune Rheumatic Diseases: A Review

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