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. 2021 Mar 12:12:645013.
doi: 10.3389/fimmu.2021.645013. eCollection 2021.

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

Kuo-Tung Tang  1   2   3 , Bo-Chueh Hsu  4 , Der-Yuan Chen  5   6   7
Affiliations

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

Kuo-Tung Tang et al. Front Immunol. .

Abstract

Background: Numerous cases of the coronavirus disease 2019 (COVID-19) with autoimmune and rheumatic manifestations have been reported. Despite the available reviews that summarized its autoimmune/rheumatic manifestations, a systematic approach is still lacking. Therefore, we conducted a comprehensive systematic review in order to give an overview upon these rare but clinically significant manifestations. Methods: We performed a literature search of PubMed and EMBASE as of October 9, 2020. All articles relevant to either systemic or organ-specific autoimmune and rheumatic manifestations potentially associated with COVID-19 were collected. The reviewed literature were limited to adults ≥18 years. Results: Although most of the existing evidence was based on case reports or case series without a long-term follow-up, a variety of autoimmune/rheumatic manifestations were associated with COVID-19. The manifestations that have a consistent association with COVID-19 include autoimmune cytopenia, cutaneous vasculitis, encephalitis, and Guillain-Barre syndrome. Such association is conflicting as regards to antiphospholipid syndrome, hemophagocytic lymphohistiocytosis, and myasthenia gravis. Conclusion: Our systematic review indicated the potential of the COVID-19 virus to trigger a myriad of autoimmune and rheumatic manifestations, which should be considered amid global efforts to combat COVID-19.

Keywords: COVID-19; SARS-CoV-2; autoimmune disease; rheumatic disease; treatment.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Selection of studies to be included in the systematic review.
Figure 2
Figure 2
The prevalence of (A) criteria and (B) non-criteria antiphospholipid antibodies (aPL) based on the revised Sapporo criteria for antiphospholipid antibody syndrome in COVID-19 patients with moderate to severe disease. *Determined by two tests based on different principles per the International Society of Thrombosis and Haemostasis criteria. **Moderate-to-high titer aPL. ***95% exact confidence intervals. AB2GPI, anti-β2glycoprotein I antibody; ACA, anticardiolipin antibody; aPI, antiphosphatidylinositol antibody; aPL, antiphospholipid antibodies; aPS, antiphosphotidylserine antibody; aPT, antiprothrombin antibody; COVID-19, the coronavirus disease 2019; LA, lupus anticoagulant.
Figure 3
Figure 3
The summary of autoimmune and rheumatic manifestations associated with the coronavirus disease 2019 (COVID-19). AB2GPI, anti-β2glycoprotein I antibody; ACA, anticardiolipin antibody; AIHA, autoimmune hemolytic anemia; GBS, Guillain-Barré syndrome; HLH, hemophagocytic lymphohistiocytosis; IBD, inflammatory bowel disease; ITP, immune thrombocytopenic purpura; LA, lupus anticoagulant; SARD, systemic autoimmune rheumatic disease; SLE, systemic lupus erythematosus.
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