COVID-19 and systemic lupus erythematosus: a case series

Gartshteyn, Yevgeniya; Askanase, Anca; Schmidt, Nancyanne M; Bernstein, Elana J.; Khalili, Leila; Drolet, Rachel; Broderick, Rachel; Geraldino‐Pardilla, Laura; Kapoor, Teja

doi:10.1016/s2665-9913(20)30161-2

Cited by 63 publications

(58 citation statements)

References 9 publications

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“…The largest publication to date from the GRA's physician-reported registry described 85 patients with SLE, 48 (56%) of whom required hospitalization, in accordance with our observations (35). In a case series of 10 COVID-19 cases and an additional 8 presumed cases in patients with SLE, the use of immunosuppressants on admission was similar between patients with mild COVID-19 and those with severe disease (36). Similarly, our data did not show any association between the use of immunosuppressants and increased risk of hospitalization.…”

Section: Discussionsupporting

confidence: 85%

Leveraging the United States Epicenter to Provide Insights on COVID‐19 in Patients With Systemic Lupus Erythematosus

Fernández-Ruiz

Masson

Kim

et al. 2020

Arthritis & Rheumatology

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Objective To characterize patients with systemic lupus erythematosus (SLE) affected by coronavirus disease 2019 (COVID‐19) and to analyze associations of comorbidities and medications on infection outcomes. Methods Patients with SLE and reverse transcriptase–polymerase chain reaction–confirmed COVID‐19 were identified through an established New York University lupus cohort, query of 2 hospital systems, and referrals from rheumatologists. Data were prospectively collected via a web‐based questionnaire and review of medical records. Data on baseline characteristics were obtained for all patients with COVID‐19 to analyze risk factors for hospitalization. Data were also collected on asymptomatic patients and those with COVID‐19–like symptoms who tested negative or were not tested. Statistical analyses were limited to confirmed COVID‐19–positive patients. Results A total of 226 SLE patients were included: 41 with confirmed COVID‐19, 19 who tested negative for COVID‐19, 42 with COVID‐19–like symptoms who did not get tested, and 124 who remained asymptomatic without testing. Of the SLE patients with confirmed COVID‐19, hospitalization was required in 24 (59%) and intensive care unit–level of care in 4, and 4 died. Hospitalized patients tended to be older, nonwhite, Hispanic, have higher body mas index (BMI), history of nephritis, and at least 1 comorbidity. An exploratory (due to limited sample size) logistic regression analysis identified race, presence of at least 1 comorbidity, and BMI as independent predictors of hospitalization. Conclusion In general, the variables predictive of hospitalization in our SLE patients were similar to those identified in the general population. Further studies are needed to understand additional risk factors for poor COVID‐19 outcomes in patients with SLE.

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Section: Discussionsupporting

confidence: 85%

Leveraging the United States Epicenter to Provide Insights on COVID‐19 in Patients With Systemic Lupus Erythematosus

Fernández-Ruiz

Masson

Kim

et al. 2020

Arthritis & Rheumatology

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“…Although limited by the small number of cases, the study did not find significant differences in immunosuppressant use in patients with mild vD 1 6 5 X Xs severe COVID-19. 204 As COVID-19 rapidly extended to other regions of the United States, other groups published on the outcomes of patients with rheumatic diseases and COVID-19. Wallace D 1 6 6 X Xet al described their COVID-19 experience at a tertiary care academic center in Michigan, reporting D 1 6 7 X X5 patients with SLE, of whom D 1 6 8 X X4 were hospitalized, D 1 6 9 X X3 required invasive ventilation, and D 1 7 0 X X1 died of COVID-19.…”

Section: X)mentioning

confidence: 99%

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

Fernández-Ruiz

Paredes

Niewold

2021

Translational Research

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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.

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“…Among 16 (4%) patients with SLE and confirmed or suspected COVID-19 from the Columbia Lupus Cohort, 7 were hospitalized and 3 developed respiratory failure [ 34 ]. In another study of 226 SLE patients from New York City, 41 developed COVID-19 confirmed by PCR (remaining were asymptomatic, or symptomatic with negative or no testing) [ 35 •].…”

Section: Covid-19 Infection In Patients With Sle: Observational Studimentioning

confidence: 99%

SARS-CoV-2 and Systemic Lupus Erythematosus

Thanou

Sawalha

2021

Curr Rheumatol Rep

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Purpose of Review To summarize current knowledge of the impact of coronavirus disease 19 (COVID-19) on patients with systemic lupus erythematosus (SLE). Recent Findings Several observational studies, including case series, patient surveys, and patient registries, have examined the incidence and severity of COVID-19 in patients with SLE. Due to methodologic limitations (focus on sicker patients, exclusion of asymptomatic or mild cases, limited or inaccurate viral testing), it is difficult to determine the risk and outcomes of COVID-19 in SLE patients. Corticosteroids might be associated with increased hospitalizations from COVID-19 in individuals with autoimmune rheumatic diseases. Some immune suppressive treatments do not appear to significantly increase the risk of contracting COVID-19 or poor subsequent outcomes; however, data on the safety of specific drugs remain scarce. Studies in nonautoimmune cohorts have shown more severe COVID-19 in ethnic and racial minorities, populations also more heavily impacted by SLE. Such results have been attributed to highly prevalent socioeconomic disparities and comorbidities. The complex interplay between SARS-CoV-2 and the host immunologic milieu may have particular implications for patients with SLE that remain to be explored. Concerns have been raised of COVID-19 heightening the risk of thromboembolic events in the presence of an SLE-induced procoagulant state. Summary Limitations in epidemiologic data available to date do not allow for assessing the risk and severity of COVID-19 in patients with SLE. Other than corticosteroids, prior use of some immune suppressive medications does not appear to increase the risk for infection with SARS-CoV-2 however, more comprehensive studies are needed.

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COVID-19 and systemic lupus erythematosus: a case series

Cited by 63 publications

References 9 publications

Leveraging the United States Epicenter to Provide Insights on COVID‐19 in Patients With Systemic Lupus Erythematosus

Leveraging the United States Epicenter to Provide Insights on COVID‐19 in Patients With Systemic Lupus Erythematosus

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

SARS-CoV-2 and Systemic Lupus Erythematosus

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