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01-07-2021 | Vasculitis | Review Article

COVID-19 and the clinical course of rheumatic manifestations

Authors: Sakir Ahmed, Olena Zimba, Armen Yuri Gasparyan

Published in: Clinical Rheumatology | Issue 7/2021

Abstract

The manifestations of COVID-19 have been evolving over time. Various post-COVID-19 syndromes are being recognised. Various viruses have been implicated in the pathogenesis of autoimmune diseases, and we expect a similar outcome with the severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2). The SARS-CoV-2 virus penetrates various tissues and organs and has a predisposition to lead to endotheliitis that may cause vascular manifestations including thrombosis. SARS-CoV-2 has been shown to activate Toll-like receptors and the complement system. It perpetuates NETosis and leads to autoantibody formation. These predispose to systemic autoimmunity. Both reactive arthritis and connective tissue disorders such as lupus and inflammatory myositis have been reported after COVID-19. Other reported autoimmune disorders include haemolytic anaemia, immune thrombocytopenia, cutaneous vasculitis, and Guillain Barré–like acute demyelinating disorders. The multi-system inflammatory syndrome in children and its adult counterpart are another post-COVID-19 entity that presents as an admixture of Kawasaki disease and staphylococcal toxic shock syndrome. Patients with preexisting rheumatic diseases may flare during the SARS-CoV-2 infection. They may develop novel autoimmune features also. The immune-suppressants used during the acute COVID-19 illness may confound the outcomes whereas comorbidities present in patients with rheumatic diseases may mask them. There is an urgent need to follow-up patients recovering from COVID and monitor autoantibody production in the context of rheumatic manifestations.

Key Points

• COVID-19 is associated with both innate and acquired immune reactions and production of various autoantibodies.

• Various immune-mediated manifestations such as arthritis, myositis, haemolytic anaemia, thrombocytopenia, and acute demyelination may develop after COVID-19.

• Longitudinal cohort data are warranted to describe, predict, and test prevent various rheumatic manifestations in post-COVID-19 subjects.

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Title: COVID-19 and the clinical course of rheumatic manifestations
Authors: Sakir Ahmed
Olena Zimba
Armen Yuri Gasparyan
Publication date: 01-07-2021
Publisher: Springer International Publishing
Keywords: Vasculitis
Vasculitis
SARS-CoV-2
Thrombocytopenia
COVID-19
Thrombosis
Post-COVID Syndrome
Hemolytic Anemia
Kawasaki Disease
Kawasaki Disease
Kawasaki Disease
Published in: Clinical Rheumatology / Issue 7/2021
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-021-05691-x

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