Objective: The role of systemic autoimmunity in post-coronavirus disease-2019 (COVID-19) patients from real-world data is still unknown. The aim of our study was to evaluate the presence of rheumatic and antiphospholipid antibodies in post-COVID-19 patients and examine their frequencies and the clinical outcomes. Material and Methods: The data of 393 people who had COVID-19 and were followed up in our outpatient clinic were retrospectively analyzed. In our descriptive study, clinical and biochemical parameters as well as the presence of antinuclear antibodies, antiphospholipid antibodies, romatoid factor and immunoglobulin G cyclic citrullinated peptide 3rd generation were evaluated in all patients. Results: One hundred fifty nine of 393 (40.5%) patients had at least one autoimmune reactivity. 31 patients with 1 or more autoantibodies positivity and/or accompanying musculoskeletal symptoms after COVID-19 were referred to the rheumatology outpatient clinic. Autoimmune disease was diagnosed in 9 of these patients. The distribution of autoimmune disease diagnoses is as follows; systemic lupus erythematosus (SLE) or SLE-like syndrome was diagnosed in 3 patients, mixed connective tissue disease in 3 patients, Sjögren's syndrome in 2 patients and scleroderma in 1 patient. Conclusion: Although it is not possible to establish a cause-and-effect relationship due to the lack of a control group in the design of our study and the lack of serologic laboratory test results before COVID-19 in patients diagnosed with autoimmune diseases, we think it may be important that autoantibodies and acute phase reactants other than ANA and CCP were found to be higher in hospitalized patients and that various systemic autoimmune reactivities were detected in 40% of post-COVID-19 patients.
Keywords: Coronavirus disease-2019; post-acute-coronavirus disease-2019 syndrome; autoantibodies; autoimmune diseases; musculoskeletal abnormality
Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID 19)] geçiren hastalarda sistemik otoimmünitenin rolü gerçek dünya verilerinde hala bilinmemektedir. Çalışmamızın amacı, COVID-19 sonrası hastalarda romatizmal ve antifosfolipid antikorların varlığını değerlendirmek ve sıklıklarını ve klinik sonuçlarını incelemekti. Gereç ve Yöntemler: COVID-19 geçiren ve polikliniğimizde takibe alınan 393 kişinin verileri retrospektif olarak incelendi. Tanımlayıcı çalışmamızda, tüm hastaların klinik ve biyokimyasal parametrelerinin yanı sıra antinükleer antikorlar, antifosfolipid antikorlar, romatoid faktör ve immünoglobulin G siklik sitrüline peptid [cyclic citrullinated peptide üçüncü nesil varlığı değerlendirildi. Bulgular: 393 hastanın 159'unda (%40,5) en az bir otoimmün reaktivite vardı. COVID-19 sonrası 1 veya daha fazla otoantikor pozitifliği ve/veya eşlik eden kas-iskelet sistemi semptomları olan 31 hasta romatoloji polikliniğine konsülte edildi. Bu hastaların 9'unda otoimmün hastalık teşhisi kondu. Otoimmün hastalık tanılarının dağılımı 3 hastada sistemik lupus eritematozus (SLE) veya SLE benzeri sendrom, 3 has tada karışık bağ dokusu hastalığı, 2 hastada Sjögren sendromu ve 1 hastada skleroderma şeklindeydi. Sonuç: Çalışmamızın tasarımında kontrol grubunun olmaması ve otoimmün hastalık tanısı almış hastalarda COVID-19 öncesi serolojik laboratuvar test sonuçlarının bulunmaması nedeniyle bir nedensonuç ilişkisi kurmak mümkün değildir. Ancak hastanede yatan hastalarda ANA ve CCP dışındaki otoantikorların ve akut faz reaktanlarının daha yüksek bulunması ve COVID-19 sonrası hastaların %40'ında çeşitli sistemik otoimmün reaktivitelerin tespit edilmiş olmasının önemli olabileceğini düşünüyoruz.
Anahtar Kelimeler: Koronavirüs hastalığı-2019; post-akut koronavirüs hastalığı-2019 sendromu; otoantikorlar; otoimmün hastalıklar; kas iskelet anomalileri
- Lingel H, Meltendorf S, Billing U, Thurm C, Vogel K, Majer C, et al. Unique autoantibody prevalence in long-term recovered SARS-CoV-2-infected individuals. J Autoimmun. 2021;122:102682. [Crossref] [PubMed] [PMC]
- Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV; WHO Clinical Case Definition Working Group on Post-COVID-19 Condition. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2022;22(4):e102-e107. [Crossref] [PubMed] [PMC]
- Caso F, Costa L, Ruscitti P, Navarini L, Del Puente A, Giacomelli R, et al. Could sars-coronavirus-2 trigger autoimmune and/or autoinflammatory mechanisms in genetically predisposed subjects? Autoimmun Rev. 2020;19(5):102524. [Crossref] [PubMed] [PMC]
- Cañas CA. The triggering of post-COVID-19 autoimmunity phenomena could be associated with both transient immunosuppression and an inappropriate form of immune reconstitution in susceptible individuals. Med Hypotheses. 2020;145:110345. [Crossref] [PubMed] [PMC]
- Ahmed S, Zimba O, Gasparyan AY. COVID-19 and the clinical course of rheumatic manifestations. Clin Rheumatol. 2021;40(7):2611-9. [Crossref] [PubMed] [PMC]
- Anaya JM, Monsalve DM, Rojas M, Rodríguez Y, Montoya-García N, Mancera-Navarro LM, et al. Latent rheumatic, thyroid and phospholipid autoimmunity in hospitalized patients with COVID-19. J Transl Autoimmun. 2021;4:100091. [Crossref] [PubMed] [PMC]
- Zacharias H, Dubey S, Koduri G, D'Cruz D. Rheumatological complications of Covid 19. Autoimmun Rev. 2021;20(9):102883. [Crossref] [PubMed] [PMC]
- Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020;130(5):2620-9. [Crossref] [PubMed] [PMC]
- Zhang Y, Xiao M, Zhang S, Xia P, Cao W, Jiang W, et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. N Engl J Med. 2020;382(17):e38. [Crossref] [PubMed] [PMC]
- Amezcua-Guerra LM, Rojas-Velasco G, Brianza-Padilla M, Vázquez-Rangel A, Márquez-Velasco R, Baranda-Tovar F, et al. Presence of antiphospholipid antibodies in COVID-19: a case series study. Ann Rheum Dis. 2021;80(5):e73. [Crossref] [PubMed]
- Skendros P, Mitsios A, Chrysanthopoulou A, Mastellos DC, Metallidis S, Rafailidis P, et al. Complement and tissue factor-enriched neutrophil extracellular traps are key drivers in COVID-19 immunothrombosis. J Clin Invest. 2020;130(11):6151-7. [PubMed] [PMC]
- Borghi MO, Beltagy A, Garrafa E, Curreli D, Cecchini G, Bodio C, et al. Anti-phospholipid antibodies in COVID-19 are different from those detectable in the anti-phospholipid syndrome. Front Immunol. 2020;11:584241. [Crossref] [PubMed] [PMC]
- Novelli L, Motta F, De Santis M, Ansari AA, Gershwin ME, et al. The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19-a systematic review of the literature. J Autoimmun. 2021;117:102592. [Crossref] [PubMed] [PMC]
- Pascolini S, Vannini A, Deleonardi G, Ciordinik M, Sensoli A, Carletti I, et al. COVID-19 and immunological dysregulation: can autoantibodies be useful? Clin Transl Sci. 2021;14(2):502-8. [PubMed] [PMC]
- Vlachoyiannopoulos PG, Magira E, Alexopoulos H, Jahaj E, Theophilopoulou K, Kotanidou A, et al. Autoantibodies related to systemic autoimmune rheumatic diseases in severely ill patients with COVID-19. Ann Rheum Dis. 2020;79(12):1661-3. [Crossref] [PubMed]
- Lerma LA, Chaudhary A, Bryan A, Morishima C, Wener MH, Fink SL. Prevalence of autoantibody responses in acute coronavirus disease 2019 (COVID-19). J Transl Autoimmun. 2020;3:100073. [Crossref] [PubMed] [PMC]
- Peker BO, Şener AG, Kaptan Aydoğmuş F. Antinuclear antibodies (ANAs) detected by indirect immunofluorescence (IIF) method in acute COVID-19 infection; future roadmap for laboratory diagnosis. J Immunol Methods. 2021;499:113174. [Crossref] [PubMed] [PMC]
- Seeßle J, Waterboer T, Hippchen T, Simon J, Kirchner M, Lim A, et al. Persistent symptoms in adult patients 1 year after coronavirus disease 2019 (COVID-19): a prospective cohort study. Clin Infect Dis. 2022;74(7):1191-8. [Crossref] [PubMed] [PMC]
- Lim SH, Ju HJ, Han JH, Lee JH, Lee WS, Bae JM, et al. Autoimmune and autoinflammatory connective tissue disorders following COVID-19. JAMA Netw Open. 2023;6(10):e2336120. [Crossref] [PubMed] [PMC]
- Chang R, Yen-Ting Chen T, Wang SI, Hung YM, Chen HY, Wei CJ. Risk of autoimmune diseases in patients with COVID-19: a retrospective cohort study. EClinicalMedicine. 2023;56:101783. [Crossref] [PubMed] [PMC]
- Tesch F, Ehm F, Vivirito A, Wende D, Batram M, Loser Fet al. Incident autoimmune diseases in association with SARS-CoV-2 infection: a matched cohort study. Clin Rheumatol. 2023;42(10):2905-14. Erratum in: Clin Rheumatol. 2023;42(10):2919-20. [PubMed] [PMC]
- Sapkota HR, Nune A. Long COVID from rheumatology perspective-a narrative review. Clin Rheumatol. 2022;41(2):337-48. [Crossref] [PubMed] [PMC]
- Derksen VFAM, Kissel T, Lamers-Karnebeek FBG, van der Bijl AE, Venhuizen AC, Huizinga TWJ, et al. Onset of rheumatoid arthritis after COVID-19: coincidence or connected? Ann Rheum Dis. 2021;80(8):1096-8. [PubMed]
- Roongta R, Chattopadhyay A, Ghosh A. Correspondence on 'onset of rheumatoid arthritis after COVID-19: coincidence or connected?' Ann Rheum Dis. 2023;82(6):e136. [PubMed]
- Gusev E, Sarapultsev A, Solomatina L, Chereshnev V. SARS-CoV-2-specific immune response and the pathogenesis of COVID-19. Int J Mol Sci. 2022;23(3):1716. [Crossref] [PubMed] [PMC]
- Hammoudeh SM, Hammoudeh AM, Bhamidimarri PM, Al Safar H, Mahboub B, Künstner A, et al. Systems immunology analysis reveals the contribution of pulmonary and extrapulmonary tissues to the immunopathogenesis of severe COVID-19 patients. Front Immunol. 2021;12:595150. [Crossref] [PubMed] [PMC]
- Mobasheri L, Nasirpour MH, Masoumi E, Azarnaminy AF, Jafari M, Esmaeili SA. SARS-CoV-2 triggering autoimmune diseases. Cytokine. 2022;154:155873. [Crossref] [PubMed] [PMC]
- Boix V, Merino E. Post-COVID syndrome. The never ending challenge. Med Clin (Barc). 2022;158(4):178-80. English, Spanish. [Crossref] [PubMed] [PMC]
- Lippi G, Sanchis-Gomar F, Henry BM. COVID-19 and its long-term sequelae: what do we know in 2023? Pol Arch Intern Med. 2023;133(4):16402. [Crossref] [PubMed]
- Twomey R, DeMars J, Franklin K, Culos-Reed SN, Weatherald J, Wrightson JG. Chronic fatigue and postexertional malaise in people living with long COVID: an observational study. Phys Ther. 2022;102(4):pzac005. [Crossref] [PubMed] [PMC]
- Ciaffi J, Vanni E, Mancarella L, Brusi V, Lisi L, Pignatti F, et al. Post-acute COVID-19 joint pain and new onset of rheumatic musculoskeletal diseases: a systematic review. Diagnostics (Basel). 2023;13(11):1850. [Crossref] [PubMed] [PMC]
.: İşlem Listesi