COVID-19: autoimmunity, multisystemic inflammation and autoimmune rheumatic patients

Abstract

Coronavirus disease 2019 (COVID-19) is associated with autoimmunity and systemic inflammation. Patients with autoimmune rheumatic and musculoskeletal disease (RMD) may be at high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this review, based on evidence from the literature, as well as international scientific recommendations, we review the relationships between COVID-19, autoimmunity and patients with autoimmune RMDs, as well as the basics of a multisystemic inflammatory syndrome associated with COVID-19. We discuss the repurposing of pharmaceutics used to treat RMDs, the principles for the treatment of patients with autoimmune RMDs during the pandemic and the main aspects of vaccination against SARS-CoV-2 in autoimmune RMD patients.

Keywords: Autoimmunity; COVID-19; SARS-CoV-2; drug repurposing; multisystemic inflammatory syndrome; rheumatic and musculoskeletal diseases; vaccination.

Fig. 1.

The use of anti-COVID-19 therapies at different stages of the disease. Explanations: ¹: in stage 3, remdesivir may be used in combination with baricitinib; ²: reconvalescent plasma therapy may be used in immunosuppressed states, as well as in sustained viraemia; ³: corticosteroids might be used in hypoxia and/or MIS; ⁴Targeted therapies should be applied in MIS. See Table 1 for more details.