Impact of a new coronavirus infection on the clinical course of immunoinflammatory rheumatic diseases
Vadim I. Mazurov, Мазуров Вадим Иванович, Irina B. Belyaeva, Беляева Ирина Борисовна, Lubov E. Sarantseva, Саранцева Любовь Евгеньевна, Anton L. Chudinov, Чудинов Антон Леонидович, Roman A. Bashkinov, Башкинов Роман Андреевич, Evgeni A. Trofimov, Трофимов Евгений Александрович, Olga A. Smulskaya, Смульская Ольга Александровна, O. V. Inamova, Инамова Оксана Владимировна, M. S. Petrova, Петрова Марианна Семеновна, Evgeni S. Melnikov, Мельников Евгений Сергеевич
30 Aug 2021-Vol. 13, Iss: 2, pp 39-47
TL;DR: Analysis showed that patients with immunoinflammatory rheumatic diseases have a high risk of adverse outcome of new coronavirus infection, especially in cases of unstable course of the disease or exacerbation of this group of diseases.
Abstract: BACKGROUND: The COVID-19 pandemic poses a particular threat to patients suffering from immunoinflammatory rheumatic diseases. New coronavirus infection has been found to be accompanied by the development of a wide range of extrapulmonary clinical and laboratory manifestations, which are characteristic of a number of immunoinflammatory rheumatic diseases. AIM: To evaluate the features of the clinical course of immunoinflammatory rheumatic diseases in patients who underwent new coronavirus infection. MATERIALS AND METHODS: The clinical course of immunoinflammatory rheumatic diseases was analyzed in 324 patients who underwent new coronavirus infection from March 2020 to February 2021 and were treated at the Clinical Rheumatology Hospital No. 25, Saint Petersburg, for exacerbation of the underlying disease. RESULTS: Analysis showed that the risk factors for severe new coronavirus infection in patients with immunoinflammatory rheumatic diseases were: age over 60, comorbidities, use of prednisolone in a dose greater than 12,5 mg, and ESR values ≥40 mm/hour before the development of new coronavirus infection. There was no effect of immunosuppressive and biological therapy on the severity of the course of viral infection. There was no effect of immunosuppressive therapy and biological therapy on the severity of the course of viral infection in patients with immunoinflammatory rheumatic diseases. The development of the postinfectious syndrome was observed in 1 / 4 of patients, which was characterized by the formation of postinfectious arthritis in 3,6% of patients, transformation of undifferentiated arthritis into various rheumatic diseases in 49% of patients (more often into early rheumatoid arthritis), as well as exacerbation of the underlying disease in 83,4% of patients with an advanced stage of rheumatoid arthritis. In patients with mixed connective tissue disease, there was a significant increase in immunologic activity due to antinuclear factor (up to a maximum of 1:163 840). Clinical cases of the development of arthritis associated with viral infection and the debut of rheumatoid arthritis after an new coronavirus infection are presented. CONCLUSIONS: New coronavirus infection in the cohort of patients with immunoinflammatory rheumatic diseases observed in the Clinical Rheumatology Hospital No. 25, Saint Petersburg, proceeded in the variant of medium severity in half of patients, initiated the development of lung lesions in 68,6% of patients, arthritis associated with viral infection in 3,6% of patients, immunoinflammatory rheumatic diseases which transformed from undifferentiated arthritis in 49% of cases and exacerbation of the main disease in an overwhelming number of patients. Patients with immunoinflammatory rheumatic diseases have a high risk of adverse outcome of new coronavirus infection, especially in cases of unstable course of the disease or exacerbation of this group of diseases.
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TL;DR: This mini-review summarizes the current understanding of the systemic manifestations of COVID-19 and the possible role of impaired immune function in the pathogenesis of post-CO VID-19 syndrome.
Abstract: In 2020, the world suffered an epidemic of a new coronavirus infection, after which it became obvious that the consequences of this disease persist for a long time after the recovery, perhaps, for several months. This complication was called post-COVID-19 syndrome and was recognized by the World Health Organization, which was reflected in the Delphi Consensus on October 6, 2021. The clinical characteristics of this disease include a significant number of immunological manifestations, including fever, arthralgia, myalgia, flu-like symptoms, as well as autoimmune diseases manifestation. These symptoms may allude the autoimmune genesis of the COVID-19 complications. This mini-review summarizes the current understanding of the systemic manifestations of COVID-19 and the possible role of impaired immune function in the pathogenesis of post-COVID-19 syndrome.
TL;DR: The review presents the results of scientific studies devoted to the features of the course and outcomes of a new coronavirus infection COVID-19 in patients with immuno-inflammatory rheumatic diseases (IIRD) and the draft recommendations of the All-Russian Public Organization "Association of Rheumatologists of Russia" on the management and vaccination of patients with rhematic diseases in the conditions of the COVID.
Abstract: The review presents the results of scientific studies devoted to the features of the course and outcomes of a new coronavirus infection COVID-19 in patients with immuno-inflammatory rheumatic diseases (IIRD). It was noted that the risk of developing COVID-19 for patients with IVR, apparently, is similar to the population or slightly increased and mostly depends on the presence of established risk factors for its severe course (old age, obesity, diabetes mellitus, cardiovascular diseases). Patients receiving long-term immunosuppressive therapy and high doses of glucocorticoids may have a long period of positive viral replication and isolation of a viable virus, which requires dynamic monitoring of such patients and correction of anti-rheumatic therapy. The issues of post-COVID-19 joint syndrome, which can occur within the framework of post-viral arthritis or be the debut of an immuno-inflammatory rheumatic disease, are highlighted. The draft recommendations of the All-Russian Public Organization “Association of Rheumatologists of Russia” on the management and temporary recommendations of V.A. Nasonova Research Institute of Rheumatology for vaccination of patients with rheumatic diseases in the conditions of the COVID-19 pandemic are presented.
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TL;DR: It is recommended that patients be recruited into ongoing trials, which would provide much needed evidence on the efficacy and safety of various therapies for COVID-19, given that the authors could not make a determination whether the benefits outweigh harms for most treatments.
Abstract: Background There are many pharmacologic therapies that are being used or considered for treatment of COVID-19. There is a need for frequently updated practice guidelines on their use, based on critical evaluation of rapidly emerging literature. Objective Develop evidence-based rapid guidelines intended to support patients, clinicians and other health-care professionals in their decisions about treatment and management of patients with COVID-19. Methods IDSA formed a multidisciplinary guideline panel of infectious disease clinicians, pharmacists, and methodologists with varied areas of expertise. Process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. Results The IDSA guideline panel agreed on 7 treatment recommendations and provided narrative summaries of other treatments undergoing evaluations. Conclusions The panel expressed the overarching goal that patients be recruited into ongoing trials, which would provide much needed evidence on the efficacy and safety of various therapies for COVID-19, given that we could not make a determination whether the benefits outweigh harms for most treatments.
897 citations
TL;DR: Whether such therapies may pose a risk — or even a benefit — in the context of the current COVID-19 pandemic is discussed.
Abstract: COVID-19, caused by the SARS-CoV-2 virus, has become pandemic. With sharply rising infection rates, patient groups characterized by an enhanced infection risk will be challenged by the virus. In this context, patients with chronic immune-mediated inflammatory diseases are of particular interest, as these diseases are characterized by an intrinsic immune dysfunction leading to inflammation that may enhance risk for severe infection. Immune-mediated inflammatory diseases are often treated with cytokine blocking therapy. This comment discusses whether such therapies may pose a risk — or even a benefit — in the context of the current COVID-19 pandemic.
292 citations
Kenneth E. Remy1, Monty Mazer1, David A. Striker1, Ali H. Ellebedy, Andrew H. Walton1, Jacqueline Unsinger1, Teresa M. Blood1, Philip A. Mudd1, Daehan J. Yi1, Daniel A. Mannion1, Dale F. Osborne1, R. Scott Martin1, Nitin J. Anand1, James P. Bosanquet1, Jane Blood1, Anne M. Drewry1, Charles C. Caldwell2, Isaiah R. Turnbull1, Scott C. Brakenridge3, Lyle L. Moldwawer3, Richard S. Hotchkiss1 •
TL;DR: The hypothesis that COVID-19 suppresses host functional adaptive and innate immunity is supported and IL-7 administered ex vivo restored T cell IFN-ɣ production in CO VID-19 patients, and ELISpot may functionally characterize host immunity in COvid-19 and inform prospective therapies.
Abstract: COVID-19-associated morbidity and mortality have been attributed to a pathologic host response. Two divergent hypotheses have been proposed: hyperinflammatory cytokine storm; and failure of host protective immunity that results in unrestrained viral dissemination and organ injury. A key explanation for the inability to address this controversy has been the lack of diagnostic tools to evaluate immune function in COVID-19 infections. ELISpot, a highly sensitive, functional immunoassay, was employed in 27 patients with COVID-19, 51 patients with sepsis, 18 critically ill nonseptic (CINS) patients, and 27 healthy control volunteers to evaluate adaptive and innate immune status by quantitating T cell IFN-ɣ and monocyte TFN-α production. Circulating T cell subsets were profoundly reduced in COVID-19 patients. Additionally, stimulated blood mononuclear cells produced less than 40%-50% of the IFN-ɣ and TNF-α observed in septic and CINS patients, consistent with markedly impaired immune effector cell function. Approximately 25% of COVID-19 patients had increased IL-6 levels that were not associated with elevations in other canonical proinflammatory cytokines. Collectively, these findings support the hypothesis that COVID-19 suppresses host functional adaptive and innate immunity. Importantly, IL-7 administered ex vivo restored T cell IFN-ɣ production in COVID-19 patients. Thus, ELISpot may functionally characterize host immunity in COVID-19 and inform prospective therapies.
236 citations
TL;DR: Comparisons in the inflammatory processes underlying coronavirus disease 2019 (COVID-19) and rheumatoid arthritis are explored, including the role of pro-inflammatory cytokines and the potential of anti-cytokine therapies to treat COVID- 19, as well as the effect of the CO VID-19 pandemic on r heumatology.
Abstract: Coronavirus disease 2019 (COVID-19) is an infectious disease, caused by severe acute respiratory syndrome coronavirus 2, which predominantly affects the lungs and, under certain circumstances, leads to an excessive or uncontrolled immune activation and cytokine response in alveolar structures The pattern of pro-inflammatory cytokines induced in COVID-19 has similarities to those targeted in the treatment of rheumatoid arthritis Several clinical studies are underway that test the effects of inhibiting IL-6, IL-1β or TNF or targeting cytokine signalling via Janus kinase inhibition in the treatment of COVID-19 Despite these similarities, COVID-19 and other zoonotic coronavirus-mediated diseases do not induce clinical arthritis, suggesting that a local inflammatory niche develops in alveolar structures and drives the disease process COVID-19 constitutes a challenge for patients with inflammatory arthritis for several reasons, in particular, the safety of immune interventions during the pandemic Preliminary data, however, do not suggest that patients with inflammatory arthritis are at increased risk of COVID-19
156 citations
144 citations