Department of Clinical Immunology & Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, India.
Department of Internal Medicine No. 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
Clin Rheumatol. 2021 Jul;40(7):2611-2619. doi: 10.1007/s10067-021-05691-x. Epub 2021 Mar 17.
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.
新型冠状病毒肺炎（COVID-19）的临床表现一直在不断演变。目前已认识到各种 COVID-19 后综合征。多种病毒被认为与自身免疫性疾病的发病机制有关，我们预计严重急性呼吸综合征相关冠状病毒 2（SARS-CoV-2）也会出现类似的结果。SARS-CoV-2 可侵犯多种组织和器官，易导致血管内皮炎，从而引起包括血栓形成在内的血管表现。SARS-CoV-2 已被证明可激活 Toll 样受体和补体系统，持续诱导 NETosis，导致自身抗体形成，从而易引发全身性自身免疫。有报道称 COVID-19 后可出现反应性关节炎和结缔组织疾病，如狼疮和炎性肌病。其他报道的自身免疫性疾病包括溶血性贫血、免疫性血小板减少症、皮肤血管炎和类似格林-巴利的急性脱髓鞘性疾病。儿童多系统炎症综合征及其成人对应物是另一种 COVID-19 后实体，其表现为川崎病和葡萄球菌中毒性休克综合征的混合体。SARS-CoV-2 感染期间，患有风湿性疾病的患者可能会出现疾病发作，也可能出现新的自身免疫特征。在急性 COVID-19 期间使用的免疫抑制剂可能会影响结果，而风湿性疾病患者的合并症可能会掩盖这些表现。迫切需要对 COVID 后康复的患者进行随访，并监测自身抗体的产生情况，以了解风湿性疾病的表现。关键点• COVID-19 与先天和获得性免疫反应以及各种自身抗体的产生有关。• COVID-19 后可能会出现各种免疫介导的表现，如关节炎、肌炎、溶血性贫血、血小板减少症和急性脱髓鞘。• 需要进行纵向队列研究，以描述、预测和测试 COVID-19 后患者的各种风湿性表现。
