Systemic lupus erythematosus and COVID-19 during pregnancy

Abstract

Background: The ongoing corona virus disease 2019 (COVID-19) pandemic is having a worldwide impact. Valuable information on the clinical characteristics of COVID-19 in pregnant patients with an autoimmune disease, such as systemic lupus erythematosus (SLE), is currently lacking. Methods: Herein, we describe the clinical presentation of 2 pregnant patients with SLE and mild symptomatic COVID-19 infection. Results: In both pregnant SLE patients, a watchful-waiting approach without initiation of treatment for COVID-19 was taken. No adverse outcomes were reported and both pregnancies resulted in healthy neonates born at term. In one patient we observed a flare in SLE disease activity, most likely attributed to discontinuing SLE treatment. Conclusion: Our report highlights the importance of multidisciplinary collaboration between health care professionals as well as individualized treatment decisions during unprecedented periods such as the current COVID-19 pandemic. Discontinuation of immunosuppressive drugs during the acute phase of a COVID-19 infection should be considered on a case-by-case basis. Maternal treatment decisions should be in line with current recommendations for treatment of rheumatic and musculoskeletal diseases during COVID-19 infection and in line with treatment of COVID- 19 during pregnancy.

A novel case of lupus nephritis and mixed connective tissue disorder in a COVID-19 patient

“…Out of the total papers, eleven articles were from Asia [ 19 , 22 , 25 , 30 , 32 , 33 , 36 , 39 , 41 , 43 , 44 ], eight from Europe [ 15 , 17 , 18 , 20 , 24 , 27 , 38 , 45 ], eleven from North America [ 14 , 16 , 26 , 28 , 29 , 34 , 35 , 37 , 40 , 42 , 46 ], two from South America [ 21 , 31 ] and one from Africa [ 23 ].…”

Incidence of COVID-19 Hospitalisation in Patients with Systemic Lupus Erythematosus: A Nationwide Cohort Study from Denmark

“…On the other hand glucocorticoids might increase the risk of hospitalisation and a subsequent severe outcome [11,12]. Furthermore, studies suggest that pausing the SLE treatment during COVID-19 infection leads to a flare up in the SLE [13][14][15].…”

SARS-Cov2 acute and post-active infection in the context of autoimmune and chronic inflammatory diseases

“…SLE flare risk was evaluated after SARS-Cov2 infection revealing that treatment discontinuation rather than COVID-19, usually mild, is at the origin of disease flares [ 96 ]. As a consequence, drug withdrawal should be avoided or evaluated with caution on a case-by-case basis including during pregnancy [ 111 ]. When considering the risk of a flare following COVID-19 vaccination in SLE patients, the risk remains similar in pre- and post-vaccination [ 112 , 113 ].…”