Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Clin Exp Rheumatol. 2021 May-Jun;39(3):631-638. doi: 10.55563/clinexprheumatol/44kaji. Epub 2021 Apr 8.
To investigate the similarities and differences between Coronavirus disease 2019 (COVID-19) and autoimmune and autoinflammatory rheumatic diseases characterised by hyperferritinaemia, such as antimelanoma differentiation-associated protein 5 (MDA5) autoantibody-positive dermatomyositis and adult Still's disease.
We reviewed consecutive, newly diagnosed, untreated patients with COVID-19, anti-MDA5 dermatomyositis, or adult Still's disease. We compared their clinical, laboratory, and radiological characteristics, including the prevalence of macrophage activation syndrome and lung involvement in each disease.
The numbers of patients with COVID-19, anti-MDA5 dermatomyositis, and adult-onset Still's disease with hyperferritinaemia (serum ferritin ≥500ng/dL) who were included for main analysis were 22, 14, and 59, respectively. COVID-19 and adult Still's disease both featured hyperinflammatory status, such as high fever and elevated serum C-reactive protein, whereas COVID-19 and anti-MDA5 dermatomyositis both presented with severe interstitial lung disease and hypoxaemia. While two-thirds of the patients in each group met the criteria for macrophage-activated syndrome that is used in systemic juvenile idiopathic arthritis, the HScore, an indicator of haemophagocytic lymphohistiocytosis, was low in anti-MDA5 dermatomyositis and COVID-19 even in severe or critical cases. The findings of chest computed tomography were similar between COVID-19 and anti-MDA5 dermatomyositis.
COVID-19 shared clinical features with rheumatic diseases characterised by hyperferritinaemia, including anti-MDA5 dermatomyositis and adult Still's disease. These findings should be investigated further in order to shed light on the pathogenesis of not only COVID-19 but also the aforementioned rheumatic diseases.
探讨 2019 年冠状病毒病（COVID-19）与以高血铁蛋白为特征的自身免疫和自身炎症性风湿病（如抗黑色素瘤分化相关蛋白 5（MDA5）自身抗体阳性皮肌炎和成人斯蒂尔病）之间的异同。
我们回顾了连续的、新诊断的、未经治疗的 COVID-19、抗 MDA5 皮肌炎或成人斯蒂尔病患者。我们比较了他们的临床、实验室和影像学特征，包括每种疾病中巨噬细胞活化综合征和肺部受累的患病率。
纳入主要分析的 COVID-19、抗 MDA5 皮肌炎和成人斯蒂尔病伴高血铁蛋白（血清铁蛋白≥500ng/dL）患者的数量分别为 22、14 和 59 例。COVID-19 和成人斯蒂尔病均表现出高炎症状态，如高热和血清 C 反应蛋白升高，而 COVID-19 和抗 MDA5 皮肌炎均表现出严重的间质性肺病和低氧血症。尽管每组三分之二的患者符合用于系统性幼年特发性关节炎的巨噬细胞活化综合征标准，但即使在严重或危重症病例中，H 评分（反映噬血细胞性淋巴组织细胞增生症的指标）在抗 MDA5 皮肌炎和 COVID-19 中均较低。COVID-19 和抗 MDA5 皮肌炎的胸部计算机断层扫描结果相似。
COVID-19 与以高血铁蛋白为特征的风湿病（包括抗 MDA5 皮肌炎和成人斯蒂尔病）具有相似的临床特征。这些发现应进一步研究，以便不仅阐明 COVID-19 的发病机制，还阐明上述风湿病的发病机制。
