Thoughts on COVID-19 and autoimmune diseases

Askanase, Anca; Khalili, Leila; Buyon, Jill P.

doi:10.1136/lupus-2020-000396

Cited by 42 publications

(46 citation statements)

References 18 publications

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“…In a literature review, Favalli et al [11], hypothesized a two-way association between rheumatoid arthritis (RA) and COVID-19: microorganisms can indeed produce acute and chronic arthritis through direct colonisation of the joints or inducing an autoimmune response to the infection. At the same time, an increase in risk of infection in RA subjects compared to the general population due to the impairment of the immune system typical of autoimmune disorders is well documented: Askanase et al [12] pointed out a lack of knowledge in the COVID-related respiratory complications in subjects with autoimmune diseases, in particular for SLE subjects that may be susceptible to the more severe manifestations of COVID-19, such as pneumonia. They even suggested that high type I interferon levels, found clustered in SLE families [13], may exert, on the contrary, a protective effect on COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Association between autoimmune diseases and COVID-19 as assessed in both a test-negative case–control and population case–control design

Murtas¹,

Andreano²,

Gervasi³

et al. 2020

Autoimmun Highlights

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Background COVID-19 epidemic has paralleled with the so called infodemic, where countless pieces of information have been disseminated on putative risk factors for COVID-19. Among those, emerged the notion that people suffering from autoimmune diseases (AIDs) have a higher risk of SARS-CoV-2 infection. Methods The cohort included all COVID-19 cases residents in the Agency for Health Protection (AHP) of Milan that, from the beginning of the outbreak, developed a web-based platform that traced positive and negative cases as well as related contacts. AIDs subjects were defined ad having one the following autoimmune disease: rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjogren disease, ankylosing spondylitis, myasthenia gravis, Hashimoto’s disease, acquired autoimmune hemolytic anemia, and psoriatic arthritis. To investigate whether AID subjects are at increased risk of SARS-CoV-2 infection, and whether they have worse prognosis than AIDs-free subjects once infected, we performed a combined analysis of a test-negative design case–control study, a case–control with test-positive as cases, and one with test-negative as cases (CC-NEG). Results During the outbreak, the Milan AHP endured, up to April 27th 2020, 20,364 test-positive and 34,697 test-negative subjects. We found no association between AIDs and being positive to COVID-19, but a statistically significant association between AIDs and being negative to COVID-19 in the CC-NEG. If, as likely, test-negative subjects underwent testing because of respiratory infection symptoms, these results imply that autoimmune diseases may be a risk factor for respiratory infections in general (including COVID-19), but they are not a specific risk factor for COVID-19. Furthermore, when infected by SARS-CoV-2, AIDs subjects did not have a worse prognosis compared to non-AIDs subjects. Results highlighted a potential unbalance in the testing campaign, which may be correlated to the characteristics of the tested person, leading specific frail population to be particularly tested. Conclusions Lack of availability of sound scientific knowledge inevitably lead unreliable news to spread over the population, preventing people to disentangle them form reliable information. Even if additional studies are needed to replicate and strengthen our results, these findings represent initial evidence to derive recommendations based on actual data for subjects with autoimmune diseases.

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Section: Introductionmentioning

confidence: 99%

Association between autoimmune diseases and COVID-19 as assessed in both a test-negative case–control and population case–control design

Murtas¹,

Andreano²,

Gervasi³

et al. 2020

Autoimmun Highlights

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“…[1][2][3] As a life-threatening condition, most of the research has primarily focused on the respiratory system for survival rate improvement, leaving the effects on other systems or districts still unclear or unknown. [4][5][6][7] Regarding eye involvement in COVID -19, only few data are currently available. 8 The subfamily of Orthocoronavirinae -in which SARS-CoVs belong to the Betacoronavirus genusis already known to occasionally affect ocular structures.…”

Section: Introductionmentioning

confidence: 99%

Retinal involvement and ocular findings in COVID‐19 pneumonia patients 

Pirraglia

Ceccarelli

Cerini

et al. 2020

Preprint

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Background: changes in immune and coagulation systems and possible viral spread through blood-brain barrier have been described in SARS-CoV-2 infection. In this study, we evaluate the possible retinal involvement and ocular findings in severe COVID-19 pneumonia patients. Methods: a cross sectional study was conducted on 46 patients affected by severe COVID-19 who were hospitalized in one Intensive Care Unit (ICU) and in two Infectious Diseases wards, including a bedside eye screening, corneal sensitivity assessment and retinography. Results: a total of 43 SARS-CoV-2 positive pneumonia patients affected with COVID-19 pneumonia were included, 25 males and 18 females, with a median age of 70 [IQR 59-78]. Except for one patient with unilateral posterior chorioretinitis of opportunistic origin, of whom aqueous tap was negative for SARS-CoV-2, no further retinal manifestation related to COVID-19 infection was found in our cohort. We found 3 patients (7%) with bilateral conjunctivitis in whom PCR analysis on conjunctival swab provided negative results for SARS-CoV-2. No alterations of corneal sensitivity were found.Conclusion: we demonstrated the absence of retinal involvement in SARS-CoV-2 pneumonia patients. Ophthalmologic evaluation in COVID-19, particularly in patients hospitalized in an ICU setting, may be useful to reveal systemic co-infections by opportunistic pathogens.

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“…They can suffer from comorbidity like chronic kidney disease and obesity and consequently have more severe forms of COVID-19 [66,67]. Recently, the ACR advise patients with SLE to talk to their rheumatologist and follow recommendations before the interruption of the therapy during SARS-CoV-2 infection [50,68] However, there are no current specific advice and therapeutic strategy for patients with SLE.…”

Section: Recommendations For Patients With Rheumatic Diseases and Covmentioning

confidence: 99%

Coronavirus disease 2019 (COVID-19) during pregnancy in patients with rheumatic diseases

2020

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The novel coronavirus outbreak induces many concerns about the management of pregnancy, as well as rheumatic and musculoskeletal diseases. The very rapid spread of the infection throughout all inhabited continents leads to a fast-growing number of infected with SARS-CoV-2 and requires answers and special recommendations to the most vulnerable group of people: pregnant woman and patients on immunomodulatory or immunosuppressive treatment. A systematic literature search was performed in Embase, MEDLINE, and Scopus database for studies describing COVID-19 infection in pregnant women diagnosed with rheumatic and musculoskeletal diseases. From the 1,115 initially identified articles, we selected 29 publications in the English language, from which 18 were eligible according to the inclusion criteria. Limited number of cases and further researches are required to evaluate the risk of transmission of SARS-CoV-2 from mother to her infant as well as clinical features of infection in pregnant women. The conclusions of different authors, despite the small number of cases, suggest that there is no vertical transmission in women diagnosed with COVID-19 pneumonia. Although the World Health Organization recently reported that pregnant patients do not have a higher risk of infection than the rest of the population, Royal College of Obstetricians & Gynecologists and The Royal College of Midwives for COVID-19 infection in pregnancy published Guidelines for pregnant women with suspected SARS-CoV-2 infection. Considerations about patients with rheumatic diseases on the immunosuppressive treatment required European League Against Rheumatism, American College of Rheumatology, British Society for Rheumatology, and Australian Rheumatology Association to publish recommendations for patients with rheumatic diseases and COVID-19. These algorithms are very important to the medical society, but many concerns, absence of experience, and many questions are still unanswered and need time to be resolved and proceed successfully in this global pandemic situation.

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Thoughts on COVID-19 and autoimmune diseases

Cited by 42 publications

References 18 publications

Association between autoimmune diseases and COVID-19 as assessed in both a test-negative case–control and population case–control design

Association between autoimmune diseases and COVID-19 as assessed in both a test-negative case–control and population case–control design

Retinal involvement and ocular findings in COVID‐19 pneumonia patients

Coronavirus disease 2019 (COVID-19) during pregnancy in patients with rheumatic diseases

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Thoughts on COVID-19 and autoimmune diseases

Cited by 42 publications

References 18 publications

Association between autoimmune diseases and COVID-19 as assessed in both a test-negative case–control and population case–control design

Association between autoimmune diseases and COVID-19 as assessed in both a test-negative case–control and population case–control design

Retinal involvement and ocular findings in COVID‐19 pneumonia patients&nbsp;

Coronavirus disease 2019 (COVID-19) during pregnancy in patients with rheumatic diseases

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Retinal involvement and ocular findings in COVID‐19 pneumonia patients