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Ciloglu O, Karaali E, Yilmaz A, Çetinkaya PD, Unlu N, Kaya H, Unal N, Keklikcioglu B. Examination of SARS-CoV-2 RNA in joint synovial fluid of patients with COVID-19 and acute knee arthritis. Technol Health Care 2024:THC240317. [PMID: 38788104 DOI: 10.3233/thc-240317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
BACKGROUND It has not yet been fully established that there is coronavirus disease 2019 (COVID-19) involvement in the synovial fluid and it remains a topic of debate. OBJECTIVE The aim of this study was to evaluate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in knee joint synovial fluid of patients with COVID-19. METHODS This retrospective study was conducted with an initial screening of patients who were admitted to a tertiary pandemic hospital due to COVID-19 symptoms, and underwent treatment for COVID-19 between March and June 2020. RESULTS A total of 2476 patients were hospitalized or received treatment for a possible diagnosis of COVID-19. While the RT-PCR test was positive in 318 patients (12.8%), 2158 (87.2%) were computed tomography positive but reverse transcription-polymerase chain reaction (RT-PCR) negative. Twelve patients were consulted due to acute joint effusion. Of five patients with knee joint effusion and a positive RT-PCR test, the synovial tissue RT-PCR test was positive in only one patient. CONCLUSION This paper is the first to show the presence of SARS-CoV-2 in synovial fluid. This can be considered of importance for the determination and elimination of the route of transmission, thereby preventing further development and spread of the disease.
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Affiliation(s)
- Osman Ciloglu
- Department of Orthopaedic and Traumatology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Evren Karaali
- Department of Orthopaedic and Traumatology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Ahmet Yilmaz
- Department of Orthopaedic and Traumatology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Pelin Duru Çetinkaya
- Department of Chest Diseases, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Nurdan Unlu
- Department of Anesthesia and Critical Care, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Hatice Kaya
- Department of Anesthesia and Critical Care, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Nevzat Unal
- Department of Microbiology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Burak Keklikcioglu
- Department of Orthopaedic and Traumatology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
- Department of Physical Medicine and Rehabilitation, Turkmenbasi Medical Center, Adana, Turkey
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Ismael AT, Yves‐Zakari KOD, Tchenadoyo BYL, Mamadou BMB, Nadège YW, Aziz A, Rachidou A, Fanata M. Covid-19-related right hip monoarthritis: A case report and literature review. Clin Case Rep 2024; 12:e8462. [PMID: 38268619 PMCID: PMC10805996 DOI: 10.1002/ccr3.8462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/20/2023] [Accepted: 01/12/2024] [Indexed: 01/26/2024] Open
Abstract
This article presents the case of a young patient with severe acute left hip pain who tested positive for COVID-19. The diagnostic approach and management are presented, followed by a review of the literature. This 11-year-old student was admitted for acute left hip pain of abrupt onset, inflammatory, evolving for 24 h in a febrile context with no change in general condition. The initial workup revealed a hyperleukocytosis in the blood count, CRP 198.52 mg/L, and a 95 mm SV. The pelvic X-ray was unremarkable, and the hip ultrasound showed synovial hypertrophy, with no effusion on Doppler examination. The situation worsened 24 h later with the onset of acute respiratory distress syndrome. The chest X-ray showed bilateral alveolar interstitial lung disease, and the CT scan showed hyperdensity and crazy paving. The COVID-19 RDT test on a nasopharyngeal sample came back positive, as did the RT-PCR. Death occurred a few hours later in acute respiratory distress. Our case is consistent with what has been reported in the literature, but requires further study on an international scale to better define the phenotype of the disease.
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Affiliation(s)
- Ayouba Tinni Ismael
- Rheumatology DepartmentNiamey National HospitalNiameyNiger
- Rheumatology DepartmentBogodogo University HospitalOuagadougouBurkina Faso
| | | | | | | | | | - Abdoul Aziz
- Rheumatology DepartmentBogodogo University HospitalOuagadougouBurkina Faso
| | | | - Moussa Fanata
- Rheumatology DepartmentNiamey National HospitalNiameyNiger
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3
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Gremese E, Tolusso B, Bruno D, Paglionico AM, Perniola S, Ferraccioli G, Alivernini S. COVID-19 illness: Different comorbidities may require different immunological therapeutic targets. Eur J Clin Invest 2023; 53:e14096. [PMID: 37724937 DOI: 10.1111/eci.14096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/02/2023] [Accepted: 07/26/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The SARS-CoV-2 pandemic has led to more than 6,870.000 deaths worldwide. Despite recent therapeutic advances, deaths in Intensive Care Units still range between 34 and 72%, comprising substantial unmet need as we move to an endemic phase. The general agreement is that in the first few days of infection, antiviral drugs and neutralizing monoclonal antibodies should be adopted. When the patient is hospitalized and develops severe pneumonia, progressing to a systemic disease, immune modifying therapy with corticosteroids is indicated. Such interventions, however, are less effective in the context of comorbidities (e.g., diabetes, hypertension, heart failure, atrial fibrillation, obesity and central nervous system-CNS diseases) which are by themselves associated with poor outcomes. Such comorbidities comprise common and some distinct underlying inflammatory pathobiology regulated by differential cytokine taxonomy. METHODS Searching in the PubMed database, literature pertaining to the biology underlying the different comorbidities, and the data from the studies related to various immunological treatments for the Covid-19 disease were carefully analyzed. RESULTS Several experimental and clinical data have demonstrated that hypertension and atrial fibrillation present an IL-6 dependent signature, whereas diabetes, obesity, heart failure and CNS diseases may exhibit an IL-1a/b predominant signature. Distinct selective cytokine targeting may offer advantage in treating severe COVID-19 illness based on single or multiple associated comorbidities. When the patient does not immediately respond, a broader target range through JAKs pathway inhibitors may be indicated. CONCLUSIONS Herein, we discuss the biological background associated with distinct comorbidities which might impact the SARS-CoV-2 infection course and how these should to be addressed to improve the current therapeutic outcome.
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Affiliation(s)
- Elisa Gremese
- Clinical Immunology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
- Immunology Core Facility, GSTEP, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Barbara Tolusso
- Immunology Core Facility, GSTEP, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Dario Bruno
- Clinical Immunology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Anna Maria Paglionico
- Clinical Immunology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Simone Perniola
- Clinical Immunology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | | | - Stefano Alivernini
- Catholic University of the Sacred Heart, Rome, Italy
- Immunology Core Facility, GSTEP, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- Rheumatology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
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4
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Zarpoosh M, Amirian P. COVID-associated arthritis after severe and non-severe COVID-19: A systematic review. Immun Inflamm Dis 2023; 11:e1035. [PMID: 37904701 PMCID: PMC10566449 DOI: 10.1002/iid3.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/03/2023] [Accepted: 09/22/2023] [Indexed: 11/01/2023] Open
Abstract
AIM Since the coronavirus outbreak became a global health emergency in 2020, various immune-based effects, such as inflammatory arthritis (IA), have been recorded. This study aimed to determine the role of COVID-19 severity on post-COVID arthritis. METHODS We systematically reviewed 95 patients who developed arthritis after severe and non-severe COVID-19 infection by searching the databases, including PubMed, SCOPUS, and EMBASE. We used the term "COVID-associated arthritis" because there was no definite diagnostic method for classifying arthritides after COVID-19 infection, and the diagnosed arthritis types were based on the authors' viewpoints. RESULTS After evaluating the data between the two severe and non-severe COVID-19-infected groups of patients, the results showed that the COVID-19 severity may affect the pattern of joint involvement in IA. In both groups, combination therapy, including oral nonsteroidal anti-inflammatory drugs with different types of corticosteroids, was the most common treatment. In addition, the mean age and comorbidities rate was higher in the severe COVID-19 group. Even though the patients in the severe COVID-19 group developed more serious COVID-19 symptoms, they experienced milder arthritis with better outcomes and more delayed onsets that required less aggressive therapy. CONCLUSION We conclude that there may be an inverse relationship between COVID-19 severity and arthritis severity, possibly due to weaker immunity conditions following immunosuppressant treatments in patients with severe COVID-19.
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Affiliation(s)
- Mahsa Zarpoosh
- Kermanshah University of Medical Science (KUMS)KermanshahIran
| | - Parsa Amirian
- Kermanshah University of Medical Science (KUMS)KermanshahIran
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5
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Brahem M, Jomaa O, Arfa S, Sarraj R, Tekaya R, Berriche O, Hachfi H, Younes M. Acute arthritis following SARS-CoV-2 infection: About two cases. Clin Case Rep 2023; 11:e7334. [PMID: 37205154 PMCID: PMC10185734 DOI: 10.1002/ccr3.7334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 02/22/2023] [Accepted: 04/25/2023] [Indexed: 05/21/2023] Open
Abstract
Joint involvement in COVID-19 may occur at different stages of the disease and maybe represented by non-specific arthralgia or by acute arthritis. We report two cases of COVID-19 infection that were complicated by postviral reactive arthritis. Case 1: A 47-year-old male was presented 20 days after a COVID-19 infection with acute right knee arthritis. On biologic data, erythrocyte sedimentation rate and C-reactive protein were normal, and immunologic data were negative. A joint puncture was performed showing a turbid fluid. Testing for microcrystals was negative, as well as the synovial fluid culture. An infectious investigation was conducted, which was negative. The patient's complaints improved significantly, with analgesics and non-steroidal anti-inflammatory drugs (NSAID). Case 2: A 33-year-old female presented with acute left knee arthritis evolving for 48 h, free of fever, after a COVID-19 infection treated 15 days ago. On examination, besides knee arthritis, the osteoarticular examination was normal. A biological inflammatory syndrome was noted in laboratory tests. A yellow fluid with multiple PNN was detected in the joint fluid aspiration, with a negative culture. The patient was treated by analgesics and NSAID. The follow-up was highlighted by the arthritis resolution. Conclusion: Both of our cases are consistent with what has already been reported in the literature confirming the development of PostCOVID arthritis and strengthen the impending necessity of wider studies to identify rheumatologic manifestations in the short- and long-terms after surviving COVID-19.
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Affiliation(s)
- Mouna Brahem
- Rheumatology DepartmentTaher Sfar University HospitalMahdiaTunisia
| | - Olfa Jomaa
- Rheumatology DepartmentTaher Sfar University HospitalMahdiaTunisia
| | - Sondess Arfa
- Endocrinology and Internal Medicine DepartmentTaher Sfar University HospitalMahdiaTunisia
| | - Rihab Sarraj
- Rheumatology DepartmentTaher Sfar University HospitalMahdiaTunisia
| | - Rami Tekaya
- Rheumatology DepartmentTaher Sfar University HospitalMahdiaTunisia
| | - Olfa Berriche
- Endocrinology and Internal Medicine DepartmentTaher Sfar University HospitalMahdiaTunisia
| | - Haifa Hachfi
- Rheumatology DepartmentTaher Sfar University HospitalMahdiaTunisia
| | - Mohamed Younes
- Rheumatology DepartmentTaher Sfar University HospitalMahdiaTunisia
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6
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De Stefano L, Rossi S, Montecucco C, Bugatti S. Transient monoarthritis and psoriatic skin lesions following COVID-19. Ann Rheum Dis 2023; 82:e86. [PMID: 32753423 DOI: 10.1136/annrheumdis-2020-218520] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Ludovico De Stefano
- Division of Rheumatology, IRCCS S Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Silvia Rossi
- Division of Rheumatology, IRCCS S Matteo, Pavia, Italy
| | - Carlomaurizio Montecucco
- Division of Rheumatology, IRCCS S Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Serena Bugatti
- Division of Rheumatology, IRCCS S Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
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7
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Slouma M, Abbes M, Mehmli T, Dhahri R, Metoui L, Gharsallah I, Louzir B. Reactive arthritis occurring after COVID-19 infection: a narrative review. Infection 2023; 51:37-45. [PMID: 35655110 PMCID: PMC9162104 DOI: 10.1007/s15010-022-01858-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/15/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Reactive arthritis is acute aseptic arthritis occurring 1 to 4 weeks after a distant infection in a genetically predisposed individual. It may occur after COVID-19 infection. We summarize, in this article, the current findings of reactive arthritis following COVID-19 infection. METHODS A literature search has been performed from December 2019 to December 2021. We included case reports of reactive arthritis occurring after COVID-19 infection. We collected demographic, clinical, and paraclinical data. RESULTS A total of 22 articles were reviewed. There were 14 men and 11 women with a mean age of 44.96 + 17.47 years. Oligoarticular involvement of the lower limbs was the most frequent clinical presentation. The time between arthritis and COVID infection ranged from 6 to 48 days. The diagnosis was based on clinical and laboratory findings. The pharmacological management was based on non-steroidal anti-inflammatory drugs in 20 cases. Systemic or local steroid therapy was indicated in 13 patients. Sulfasalazine was indicated in two cases. Alleviation of symptoms and recovery were noted in 22 cases. The mean duration of the clinical resolution was 16 + 57 days. CONCLUSION The diagnosis of reactive arthritis should be considered in patients with a new onset of arthritis following COVID-19 infection. Its mechanism is still unclear.
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Affiliation(s)
- Maroua Slouma
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Maissa Abbes
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Takoua Mehmli
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Rim Dhahri
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Leila Metoui
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Imen Gharsallah
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Bassem Louzir
- grid.415617.0Department of Internal Medicine, Military Hospital, Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
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8
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Sung LH, Surmachevska N, Rubio JE. A case of de novo seronegative inflammatory oligoarthritis associated with COVID-19 infection. CLINICAL IMMUNOLOGY COMMUNICATIONS 2022; 2:159-161. [PMID: 38013974 PMCID: PMC9580240 DOI: 10.1016/j.clicom.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
Infection with SARS-CoV-2 (COVID-19) virus is characterized by an acute respiratory viral illness, often accompanied by extrapulmonary manifestations. Musculoskeletal symptoms such as myalgias and arthralgias are observed in 60 - 70% of cases. Inflammatory arthritis associated with SARS-CoV-2 infection has been reported in the literature, however, nearly all such cases describe a post-viral or reactive phenomenon occurring a few weeks following the infection. We report a unique case of de novo arthritis at the onset of a confirmed COVID-19 infection in a 55-year-old woman. Magnetic resonance imaging demonstrated synovial enhancement consistent with synovitis. Her disease was deemed refractory after failing several immunosuppressive agents. Lastly, we compare our patient's clinical presentation with two other similar cases to understand the natural history of this emerging syndrome.
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Affiliation(s)
- Lily H Sung
- Department of Medicine, Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA 02139, United States
- Harvard Medical School, Boston, MA, United States
| | - Natalya Surmachevska
- Harvard Medical School, Boston, MA, United States
- Division of Rheumatology & Clinical Immunology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, United States
| | - Jose E Rubio
- Harvard Medical School, Boston, MA, United States
- Division of Rheumatology & Clinical Immunology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, United States
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, United States
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9
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Serrano M, Espinosa G, Serrano A, Cervera R. COVID-19 and the antiphospholipid syndrome. Autoimmun Rev 2022; 21:103206. [PMID: 36195247 PMCID: PMC9527199 DOI: 10.1016/j.autrev.2022.103206] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/28/2022] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has resulted in a global pandemic. Most COVID-19 patients are asymptomatic or have flu-like symptoms. However, around 15% of the patients may have severe disease, including unilateral or bilateral pneumonia with acute respiratory distress syndrome and progressive hypoxemia that may require mechanical ventilation assistance. A systemic inflammatory response syndrome occurs in the most severe forms of COVID-19, with multiorgan involvement which can be life threatening caused by a cytokine storm. Although what best characterizes COVID-19 are the manifestations of the respiratory system, it has been shown that it also acts at the cardiovascular level, producing coagulation abnormalities, which causes thrombotic events mainly in the arteries/arterioles, microcirculation and venous system, and potentially increased mortality risk. This multiorgan vascular disease overlaps with other known microangiopathies, such as thrombotic microangiopathy or paroxysmal nocturnal hemoglobinuria, where complement overactivation plays an important role in the pathophysiology of thrombosis. Furthermore, coagulopathy secondary to COVID-19 occurs in the context of an uncontrolled inflammatory response, reminiscent of APS, especially in its catastrophic form. This review summarizes the current knowledge regarding the relationship between COVID-19 and the APS.
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Affiliation(s)
- Manuel Serrano
- Department of Immunology, Healthcare Research Institute I+12, Hospital 12 de Octubre, Madrid, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic, Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Antonio Serrano
- Department of Immunology, Healthcare Research Institute I+12, Hospital 12 de Octubre, Madrid, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain,Corresponding author at: Servei de Malalties Autoimmunes, Hospital Clínic, Villarroel, 170, 08036 Barcelona, Catalonia, Spain
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10
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Franke V, Meyer S, Schulze-Tanzil GG, Braun T, Kokozidou M, Fischlein T, Silawal S. Complement Regulation in Immortalized Fibroblast-like Synoviocytes and Primary Human Endothelial Cells in Response to SARS-CoV-2 Nucleocapsid Protein and Pro-Inflammatory Cytokine TNFα. Life (Basel) 2022; 12:1527. [PMID: 36294967 PMCID: PMC9604721 DOI: 10.3390/life12101527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Case reports are available showing that patients develop symptoms of acute arthritis during or after recovery from SARS-CoV-2 infection. Since the interrelation is still unknown, our aim was to study the impact of the SARS-CoV-2 nucleocapsid protein (NP) on human fibroblast-like synoviocytes and human endothelial cells (hEC) in terms of complement and cytokine regulation. Methods: Non-arthritic (K4IM) synoviocyte, arthritic (HSE) synoviocyte cell lines and primary hEC were stimulated with recombinant NP and/or TNFα. Analyses of cell viability, proliferation, gene and protein expression of cytokines and complement factors were performed. Results: NP suppressed significantly the vitality of hEC and proliferation of HSE. NP alone did not induce any significant changes in the examined gene expressions. However, NP combined with TNFα induced significantly higher TNFα in HSE and K4IM as well as higher IL-6 and CD55 gene expression in HSE and suppressed C3aR1 gene expression in hEC. HSE proliferated twice as fast as K4IM, but showed significantly lesser gene expressions of CD46, CD55, CD59 and TNFα with significantly higher IL-6 gene expression. CD35 gene expression was undetectable in K4IM, HSE and hEC. Conclusions: NP might contribute in combination with other inflammatory factors to complement regulation in arthritis.
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Affiliation(s)
- Vincent Franke
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Prof. Ernst Nathan Str. 1, 90419 Nuremberg, Germany
| | - Sophie Meyer
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Prof. Ernst Nathan Str. 1, 90419 Nuremberg, Germany
| | - Gundula Gesine Schulze-Tanzil
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Prof. Ernst Nathan Str. 1, 90419 Nuremberg, Germany
| | - Tobias Braun
- Department of Cardiac Surgery, Cardiovascular Center, General Hospital Nuremberg and Paracelsus Medical University, Breslauer Str. 201, 90471 Nuremberg, Germany
| | - Maria Kokozidou
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Prof. Ernst Nathan Str. 1, 90419 Nuremberg, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Cardiovascular Center, General Hospital Nuremberg and Paracelsus Medical University, Breslauer Str. 201, 90471 Nuremberg, Germany
| | - Sandeep Silawal
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Prof. Ernst Nathan Str. 1, 90419 Nuremberg, Germany
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Zheng Q, Wang D, Lin R, Lv Q, Wang W. IFI44 is an immune evasion biomarker for SARS-CoV-2 and Staphylococcus aureus infection in patients with RA. Front Immunol 2022; 13:1013322. [PMID: 36189314 PMCID: PMC9520788 DOI: 10.3389/fimmu.2022.1013322] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a global pandemic of severe coronavirus disease 2019 (COVID-19). Staphylococcus aureus is one of the most common pathogenic bacteria in humans, rheumatoid arthritis (RA) is among the most prevalent autoimmune conditions. RA is a significant risk factor for SARS-CoV-2 and S. aureus infections, although the mechanism of RA and SARS-CoV-2 infection in conjunction with S. aureus infection has not been elucidated. The purpose of this study is to investigate the biomarkers and disease targets between RA and SARS-CoV-2 and S. aureus infections using bioinformatics analysis, to search for the molecular mechanisms of SARS-CoV-2 and S. aureus immune escape and potential drug targets in the RA population, and to provide new directions for further analysis and targeted development of clinical treatments. Methods The RA dataset (GSE93272) and the S. aureus bacteremia (SAB) dataset (GSE33341) were used to obtain differentially expressed gene sets, respectively, and the common differentially expressed genes (DEGs) were determined through the intersection. Functional enrichment analysis utilizing GO, KEGG, and ClueGO methods. The PPI network was created utilizing the STRING database, and the top 10 hub genes were identified and further examined for functional enrichment using Metascape and GeneMANIA. The top 10 hub genes were intersected with the SARS-CoV-2 gene pool to identify five hub genes shared by RA, COVID-19, and SAB, and functional enrichment analysis was conducted using Metascape and GeneMANIA. Using the NetworkAnalyst platform, TF-hub gene and miRNA-hub gene networks were built for these five hub genes. The hub gene was verified utilizing GSE17755, GSE55235, and GSE13670, and its effectiveness was assessed utilizing ROC curves. CIBERSORT was applied to examine immune cell infiltration and the link between the hub gene and immune cells. Results A total of 199 DEGs were extracted from the GSE93272 and GSE33341 datasets. KEGG analysis of enrichment pathways were NLR signaling pathway, cell membrane DNA sensing pathway, oxidative phosphorylation, and viral infection. Positive/negative regulation of the immune system, regulation of the interferon-I (IFN-I; IFN-α/β) pathway, and associated pathways of the immunological response to viruses were enriched in GO and ClueGO analyses. PPI network and Cytoscape platform identified the top 10 hub genes: RSAD2, IFIT3, GBP1, RTP4, IFI44, OAS1, IFI44L, ISG15, HERC5, and IFIT5. The pathways are mainly enriched in response to viral and bacterial infection, IFN signaling, and 1,25-dihydroxy vitamin D3. IFI44, OAS1, IFI44L, ISG15, and HERC5 are the five hub genes shared by RA, COVID-19, and SAB. The pathways are primarily enriched for response to viral and bacterial infections. The TF-hub gene network and miRNA-hub gene network identified YY1 as a key TF and hsa-mir-1-3p and hsa-mir-146a-5p as two important miRNAs related to IFI44. IFI44 was identified as a hub gene by validating GSE17755, GSE55235, and GSE13670. Immune cell infiltration analysis showed a strong positive correlation between activated dendritic cells and IFI44 expression. Conclusions IFI144 was discovered as a shared biomarker and disease target for RA, COVID-19, and SAB by this study. IFI44 negatively regulates the IFN signaling pathway to promote viral replication and bacterial proliferation and is an important molecular target for SARS-CoV-2 and S. aureus immune escape in RA. Dendritic cells play an important role in this process. 1,25-Dihydroxy vitamin D3 may be an important therapeutic agent in treating RA with SARS-CoV-2 and S. aureus infections.
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Affiliation(s)
- Qingcong Zheng
- Department of Orthopedics, 900th Hospital of Joint Logistics Support Force, Fuzhou, China
| | - Du Wang
- Arthritis Clinical and Research Center, Peking University People’s Hospital, Beijing, China
| | - Rongjie Lin
- Department of Orthopedics, 900th Hospital of Joint Logistics Support Force, Fuzhou, China
| | - Qi Lv
- Department of Orthopedics, 900th Hospital of Joint Logistics Support Force, Fuzhou, China
| | - Wanming Wang
- Department of Orthopedics, 900th Hospital of Joint Logistics Support Force, Fuzhou, China
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12
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Dombret S, Skapenko A, Schulze-Koops H. Reactive arthritis after SARS-CoV-2 infection. RMD Open 2022; 8:rmdopen-2022-002519. [PMID: 36096524 PMCID: PMC9471204 DOI: 10.1136/rmdopen-2022-002519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/08/2022] [Indexed: 12/02/2022] Open
Abstract
SARS-CoV-2 has been recognised as a potential trigger of inflammatory arthritis in individuals with inflammatory rheumatic diseases as well as in previously unaffected individuals. However, new-onset arthritis after COVID-19 is a heterogeneous phenomenon that complicates differential diagnosis. For example, acute arthritis with features of viral arthritis has been reported after COVID-19, as has crystal-induced arthritis. Arthritides mimicking reactive arthritis (ReA) have also been described, but these patients often do not fulfil the typical features of ReA: several reports describe cases of patients older than 45 years at the onset of arthritis, and the characteristic genetic feature of ReA, HLA-B27, is rarely found. Because viral infections are much less likely to cause ReA than bacterial infections, and respiratory infections are rarely the cause of ReA, it is currently unknown whether SARS-CoV-2 can cause true ReA. Here, we report the case of a 30-year-old patient who presented with acute pain, swelling and redness in the left metatarsophalangeal (MTP) joint and ankle 7 days after resolution of a SARS-CoV-2 infection. Diagnostics revealed arthritis of the MTP2, synovitis of the upper ankle with significant joint effusion and peritendinitis of the flexor tendons. Based on the clinical manifestations and diagnostic test results, ReA appeared to be the most likely cause. A screening for typical ReA-associated infections was negative. The patient was treated with NSAIDs and intra-articular and systemic glucocorticoids. At a follow-up visit after discontinuation of glucocorticoids, the patient was symptom-free. Overall, we observed a ReA with typical clinical, genetic and patient characteristics after SARS-CoV-2 infection, and we conclude that a direct association with COVID-19 is highly plausible.
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Affiliation(s)
- Sophia Dombret
- Division of Rheumatology and Clinical Immunology, Ludwig Maximilians University Munich, Department of Medicine IV, Munich, Germany
| | - Alla Skapenko
- Division of Rheumatology and Clinical Immunology, Ludwig Maximilians University Munich, Department of Medicine IV, Munich, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Ludwig Maximilians University Munich, Department of Medicine IV, Munich, Germany
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13
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Farisogullari B, Pinto AS, Machado PM. COVID-19-associated arthritis: an emerging new entity? RMD Open 2022; 8:rmdopen-2021-002026. [PMID: 36100294 PMCID: PMC9471208 DOI: 10.1136/rmdopen-2021-002026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/20/2022] [Indexed: 11/03/2022] Open
Abstract
The current COVID-19 pandemic raises several clinical challenges. Cases of COVID-19-associated arthritis have been reported, and inconsistently described as either COVID-19 viral arthritis or COVID-19 reactive arthritis. We aimed to review all the reported cases of 'COVID-19-associated arthritis', which we propose, is a better term to define the entire spectrum of new-onset arthritis believed to be associated with SARS-CoV-2 infection. We performed a systematic literature review using MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews to search for articles published up to 13 December 2021. We included cohort studies, case series and case reports describing patients diagnosed with COVID-19 reactive or viral arthritis by a physician, irrespective of fulfilment of classification criteria. To identify relevant studies, medical subject headings and keywords related to 'COVID-19/SARS-CoV-2 infection' and 'reactive arthritis' were used. Our search retrieved 419 articles, of which 31 were included in the review. A total of 33 cases were reported in these 31 articles, the majority being adults (28/33=85%) with peripheral joint involvement (26/33=79%). Most of the patients responded well to treatment and the disease was self-limiting. These 33 case reports describe a possible causal relationship between exposure to SARS-CoV-2 and the onset of arthritis. However, since these cases were reported during a pandemic, other aetiologies cannot be fully excluded. The exact mechanism through which SARS-CoV-2 might trigger arthritis is not fully understood and robust epidemiological data to support a causal relationship are still lacking.
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Affiliation(s)
- Bayram Farisogullari
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Ana S Pinto
- Department of Rheumatology, Unidade Local de Saúde da Guarda EPE, Guarda, Portugal
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK .,National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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14
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Ohmura SI, Homma Y, Hanai S, Miyamoto T. Successful Use of Certolizumab Pegol for Refractory Psoriatic Arthritis Triggered by COVID-19 Infection. Intern Med 2022; 61:433-438. [PMID: 34803106 PMCID: PMC8866779 DOI: 10.2169/internalmedicine.8643-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Recently, the coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has spread worldwide. Although nearly all patients incur mild-to-moderate disease from this viral infection, some develop severe manifestations with a poor prognosis. COVID-19 can also induce autoimmune disease; several cases of arthritis following COVID-19 have been documented in the literature, such as reactive arthritis and chronic arthritis. We herein report a case of psoriatic arthritis triggered by COVID-19. Although the arthritis had been refractory to glucocorticoids and methotrexate, certolizumab pegol subsequently led to remission.
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Affiliation(s)
| | - Yoichiro Homma
- Department of General Internal Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Shiho Hanai
- Department of Dermatology, Seirei Hamamatsu General Hospital, Japan
| | - Toshiaki Miyamoto
- Department of Rheumatology, Seirei Hamamatsu General Hospital, Japan
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15
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Bohn MK, Yousef P, Steele S, Sepiashvili L, Adeli K. MultiInflammatory Syndrome in Children: A View into Immune Pathogenesis from a Laboratory Perspective. J Appl Lab Med 2022; 7:311-321. [PMID: 34463724 PMCID: PMC8499820 DOI: 10.1093/jalm/jfab114] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/16/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Multiinflammatory syndrome in children (MIS-C) is a novel and rare inflammatory disorder associated with severe acute respiratory syndrome coronavirus 2 infection in school-age children. Reports in the past year have suggested a multisystem pathophysiology characterized by hyperinflammation, gastrointestinal distress, and cardiovascular complications. Clinical laboratory investigations, including routine blood testing for inflammatory (e.g., C-reactive protein, ferritin) and cardiac (e.g., troponin, brain natriuretic peptides) markers have provided insight into potential drivers of disease pathogenesis, highlighting the role of the laboratory in the differential diagnosis of patients presenting with similar conditions (e.g., Kawasaki disease, macrophage activating syndrome). CONTENT While few studies have applied high-dimensional immune profiling to further characterize underlying MIS-C pathophysiology, much remains unknown regarding predisposing risk factors, etiology, and long-term impact of disease onset. The extent of autoimmune involvement is also unclear. In the current review, we summarize and critically evaluate available literature on potential pathogenic mechanisms underlying MIS-C onset and discuss the current and anticipated value of various laboratory testing paradigms in MIS-C diagnosis and monitoring. SUMMARY From initial reports, it is clear that MIS-C has unique inflammatory signatures involving both adaptive and innate systems. Certain cytokines, inflammatory markers, and cardiac markers assist in the differentiation of MIS-C from other hyperinflammatory conditions. However, there are still major gaps in our understanding of MIS-C pathogenesis, including T cell, B cell, and innate response. It is essential that researchers not only continue to decipher initial pathogenesis but also monitor long-term health outcomes, particularly given observed presence of circulating autoantibodies with unknown impact.
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Affiliation(s)
- Mary Kathryn Bohn
- Department of Pediatric Laboratory Medicine & Molecular Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Peter Yousef
- Department of Pediatric Laboratory Medicine & Molecular Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Shannon Steele
- Department of Pediatric Laboratory Medicine & Molecular Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lusia Sepiashvili
- Department of Pediatric Laboratory Medicine & Molecular Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Khosrow Adeli
- Department of Pediatric Laboratory Medicine & Molecular Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
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16
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Mondal S, Sinha D, Ghosh A. Coronavirus Disease-19 associated arthritis – An observational study. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_133_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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17
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Larionova R, Byvaltsev K, Kravtsova О, Takha E, Petrov S, Kazarian G, Valeeva A, Shuralev E, Mukminov M, Renaudineau Y, Arleevskaya M. SARS-Cov2 acute and post-active infection in the context of autoimmune and chronic inflammatory diseases. J Transl Autoimmun 2022; 5:100154. [PMID: 35434592 PMCID: PMC9005220 DOI: 10.1016/j.jtauto.2022.100154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/31/2022] [Indexed: 12/11/2022] Open
Abstract
The clinical and immunological spectrum of acute and post-active COVID-19 syndrome overlaps with criteria used to characterize autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Indeed, following SARS-Cov2 infection, the innate immune response is altered with an initial delayed production of interferon type I (IFN-I), while the NF-kappa B and inflammasome pathways are activated. In lung and digestive tissues, an alternative and extrafollicular immune response against SARS-Cov2 takes place with, consequently, an altered humoral and memory T cell response leading to breakdown of tolerance with the emergence of autoantibodies. However, the risk of developing severe COVID-19 among SLE and RA patients did not exceed the general population except in those having pre-existing neutralizing autoantibodies against IFN-I. Treatment discontinuation rather than COVID-19 infection or vaccination increases the risk of developing flares. Last but not least, a limited number of case reports of individuals having developed SLE or RA following COVID-19 infection/vaccination have been reported. Altogether, the SARS-Cov2 pandemic represents an unique opportunity to investigate the dangerous interplay between the immune response against infectious agents and autoimmunity, and to better understand the triggering role of infection as a risk factor in autoimmune and chronic inflammatory disease development.
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Key Words
- ACE2, angiotensin converting enzyme 2
- ACPA, anti-cyclic citrullinated peptide autoAb
- ANA, antinuclear autoAb
- AutoAb, autoantibodies
- BAFF/BlySS, B-cell-activating factor/B lymphocyte stimulator
- CCL, chemokine ligand
- COVID-19, coronavirus disease 2019
- DMARDs, disease-modifying anti-rheumatic drugs
- E, envelope
- HEp-2, human epithelioma cell line 2
- IFN-I, interferon type I
- IFNAR, IFN-alpha receptors
- IL, interleukin
- IRF, interferon regulatory factor
- ISGs, IFN-stimulated genes
- ITP, immune-thrombocytopenic purpura
- Ig, immunoglobulin
- Infection
- Inflammation
- Jak, Janus kinase
- LDH, lactate dehydrogenase
- M, membrane
- MDA-5, melanoma differentiation-associated protein
- MERS-Cov, Middle East respiratory syndrome coronavirus
- MIS-C, multisystem inflammatory syndrome in children
- N, nucleocapsid
- NET, nuclear extracellular traps
- NF-κB, nuclear factor-kappa B
- NK, natural killer
- NLRP3, NOD-like receptor family
- Rheumatoid arthritis
- Risk factors
- SARS-Cov2
- Systemic lupus erythematosus
- T cell receptor, TLR
- Toll-like receptor, TMPRSS2
- aPL, antiphospholipid
- mAb, monoclonal Ab
- open reading frame, PACS
- pathogen-associated molecular patterns, pDC
- pattern recognition receptors, RA
- peptidylarginine deiminase 4, PAMPs
- plasmacytoid dendritic cells, PMN
- polymorphonuclear leukocytes, PRRs
- post-active COVID-19 syndrome, PAD-4
- primary Sjögren's syndrome, SLE
- pyrin domain containing 3, ORF
- reactive oxygen species, rt-PCR
- receptor binding domain, RF
- regulatory T cells, VDJ
- retinoic acid-inducible gene I, ROS
- reverse transcription polymerase chain reaction, S
- rheumatoid arthritis, RBD
- rheumatoid factor, RIG-I
- severe acute respiratory coronavirus 2, SjS
- signal transducer and activator of transcription, TCR
- single-stranded ribonucleic acid, STAT
- spike, SAD
- systemic autoimmune disease, SARS-Cov2
- systemic lupus erythematosus, SSc
- systemic sclerosis, ssRNA
- transmembrane serine protease 2, TNF
- tumor necrosis factor, Treg
- variable, diversity and joining Ig genes
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Affiliation(s)
- Regina Larionova
- Central Research Laboratory, Kazan State Medical Academy, Kazan, Russia
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, Kazan, Russia
| | - K Byvaltsev
- Institute of Fundamental Medicine, Kazan (Volga Region) Federal University, Kazan, Russia
| | - Оlga Kravtsova
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, Kazan, Russia
| | - Elena Takha
- Central Research Laboratory, Kazan State Medical Academy, Kazan, Russia
| | - Sergei Petrov
- Central Research Laboratory, Kazan State Medical Academy, Kazan, Russia
- Institute of Environmental Sciences, Kazan (Volga Region) Federal University, Kazan, Russia
| | - Gevorg Kazarian
- Central Research Laboratory, Kazan State Medical Academy, Kazan, Russia
| | - Anna Valeeva
- Central Research Laboratory, Kazan State Medical Academy, Kazan, Russia
| | - Eduard Shuralev
- Central Research Laboratory, Kazan State Medical Academy, Kazan, Russia
- Institute of Environmental Sciences, Kazan (Volga Region) Federal University, Kazan, Russia
- Kazan State Academy of Veterinary Medicine Named After N.E. Bauman, Kazan, Russia
| | - Malik Mukminov
- Central Research Laboratory, Kazan State Medical Academy, Kazan, Russia
- Institute of Environmental Sciences, Kazan (Volga Region) Federal University, Kazan, Russia
| | - Yves Renaudineau
- Central Research Laboratory, Kazan State Medical Academy, Kazan, Russia
- Laboratory of Immunology, CHU Purpan Toulouse, INSERM U1291, CNRS U5051, University Toulouse III, Toulouse, France
| | - Marina Arleevskaya
- Central Research Laboratory, Kazan State Medical Academy, Kazan, Russia
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, Kazan, Russia
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18
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Gracia-Ramos AE, Martin-Nares E, Hernández-Molina G. New Onset of Autoimmune Diseases Following COVID-19 Diagnosis. Cells 2021; 10:3592. [PMID: 34944099 PMCID: PMC8700122 DOI: 10.3390/cells10123592] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 12/16/2022] Open
Abstract
There is growing evidence that coronavirus disease 2019 (COVID-19) can lead to a dysregulation of the immune system with the development of autoimmune phenomena. The consequence of this immune dysregulation ranges from the production of autoantibodies to the onset of rheumatic autoimmune disease. In this context, we conducted a systematic review to analyze the current data regarding the new-onset systemic and rheumatic autoimmune diseases in COVID-19 patients. A literature search in PubMed and Scopus databases from December 2019 to September 2021 identified 99 patients that fulfilled the specific diagnostic/classification criteria and/or nomenclature for each rheumatic autoimmune disease. The main diseases reported were vasculitis and arthritis. Idiopathic inflammatory myopathies, systemic lupus erythematosus, and sarcoidosis were also reported in a limited number of patients, as well as isolated cases of systemic sclerosis and adult-onset Still's disease. These findings highlight the potential spectrum of systemic and rheumatic autoimmune diseases that could be precipitated by SARS-CoV-2 infection. Complementary studies are needed to discern the link between the SARS-CoV-2 and new onset-rheumatic diseases so that this knowledge can be used in early diagnosis and the most suitable management.
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Affiliation(s)
- Abraham Edgar Gracia-Ramos
- Departamento de Medicina Interna, Hospital General, Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | - Eduardo Martin-Nares
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Gabriela Hernández-Molina
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
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19
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Knight JS, Caricchio R, Casanova JL, Combes AJ, Diamond B, Fox SE, Hanauer DA, James JA, Kanthi Y, Ladd V, Mehta P, Ring AM, Sanz I, Selmi C, Tracy RP, Utz PJ, Wagner CA, Wang JY, McCune WJ. The intersection of COVID-19 and autoimmunity. J Clin Invest 2021; 131:e154886. [PMID: 34710063 PMCID: PMC8670833 DOI: 10.1172/jci154886] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Acute COVID-19, caused by SARS-CoV-2, is characterized by diverse clinical presentations, ranging from asymptomatic infection to fatal respiratory failure, and often associated with varied longer-term sequelae. Over the past 18 months, it has become apparent that inappropriate immune responses contribute to the pathogenesis of severe COVID-19. Researchers working at the intersection of COVID-19 and autoimmunity recently gathered at an American Autoimmune Related Diseases Association Noel R. Rose Colloquium to address the current state of knowledge regarding two important questions: Does established autoimmunity predispose to severe COVID-19? And, at the same time, can SARS-CoV-2 infection trigger de novo autoimmunity? Indeed, work to date has demonstrated that 10% to 15% of patients with critical COVID-19 pneumonia exhibit autoantibodies against type I interferons, suggesting that preexisting autoimmunity underlies severe disease in some patients. Other studies have identified functional autoantibodies following infection with SARS-CoV-2, such as those that promote thrombosis or antagonize cytokine signaling. These autoantibodies may arise from a predominantly extrafollicular B cell response that is more prone to generating autoantibody-secreting B cells. This Review highlights the current understanding, evolving concepts, and unanswered questions provided by this unique opportunity to determine mechanisms by which a viral infection can be exacerbated by, and even trigger, autoimmunity. The potential role of autoimmunity in post-acute sequelae of COVID-19 is also discussed.
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Affiliation(s)
- Jason S. Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Roberto Caricchio
- Section of Rheumatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA
- Howard Hughes Medical Institute, New York, New York, USA
- Laboratory of Human Genetics of Infectious Diseases, INSERM, Necker Hospital for Sick Children, Paris, France
- Imagine Institute, University of Paris, Paris, France
| | - Alexis J. Combes
- Department of Pathology, ImmunoX Initiative, UCSF Immunoprofiler Initiative, UCSF CoLabs, UCSF, San Francisco, California, USA
| | - Betty Diamond
- Center for Autoimmune and Musculoskeletal Diseases, Northwell Health’s Feinstein Institute for Medical Research, New York, New York, USA
| | - Sharon E. Fox
- Pathology and Laboratory Medicine Service, Southeast Louisiana Veterans Healthcare System, New Orleans, Louisiana, USA
- Department of Pathology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - David A. Hanauer
- Department of Pediatrics and School of Information, University of Michigan, Ann Arbor, Michigan, USA
| | - Judith A. James
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Yogendra Kanthi
- National Heart, Lung, and Blood Institute Division of Intramural Research, Bethesda, Maryland, USA
| | - Virginia Ladd
- American Autoimmune Related Diseases Association Inc., Eastpointe, Michigan, USA
| | - Puja Mehta
- Centre for Inflammation and Tissue Repair, University College London, London, United Kingdom
| | - Aaron M. Ring
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ignacio Sanz
- Division of Rheumatology, Emory University, Atlanta, Georgia, USA
| | - Carlo Selmi
- Rheumatology and Clinical Immunology, Humanitas Research Hospital–Scientific Institute for Research, Hospitalization and Healthcare, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Russell P. Tracy
- Department of Pathology and Laboratory Medicine and Department of Biochemistry, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Paul J. Utz
- Division of Immunology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Catriona A. Wagner
- American Autoimmune Related Diseases Association Inc., Eastpointe, Michigan, USA
| | | | - William J. McCune
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
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20
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Neves TR, Lourenço AL, Alves P, Teiga C, Caetano AP. Bilateral shoulder arthritis in COVID-19 patient after prolonged mechanical ventilation assist: a case report. Radiol Case Rep 2021; 16:2894-2898. [PMID: 34367388 PMCID: PMC8325760 DOI: 10.1016/j.radcr.2021.06.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022] Open
Abstract
Prolonged immobilization and, in particular, mechanical ventilation, have been linked to muscle atrophy. Anecdotal reports in the literature describe rhabdomyolysis as a potential late complication of COVID-19 infection which, in severe cases, may coexist with fluid collections. We report a case of a 28-year-old patient that had been recently hospitalized with SARS-CoV-2 pneumonia, with need for invasive ventilation support. Days after being discharged, the patient presents with retrosternal thoracalgia irradiating to the left upper limb. On physical examination, abduction and external rotation were limited due to pain complaints and there was soft tissue swelling of the corresponding shoulder and arm. Imaging evaluation was essential to establish the underlying condition, revealing bilateral arthritis communicating with large rotator cuff collections, which was considered of septic nature.
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Affiliation(s)
- Teresa Resende Neves
- Radiology Department, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Luísa Lourenço
- Radiology Department, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
| | - Pedro Alves
- Radiology Department, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
| | - Carlos Teiga
- Radiology Department, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
| | - António Proença Caetano
- Radiology Department, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), 1069-166, Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
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21
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Post-COVID-19 Arthritis and Sacroiliitis: Natural History with Longitudinal Magnetic Resonance Imaging Study in Two Cases and Review of the Literature. Viruses 2021; 13:v13081558. [PMID: 34452422 PMCID: PMC8402767 DOI: 10.3390/v13081558] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 12/24/2022] Open
Abstract
Severe acute respiratory coronavirus-2 syndrome (SARS-CoV-2) is a well-known pandemic infectious disease caused by an RNA virus belonging to the coronaviridae family. The most important involvement during the acute phase of infection concerns the respiratory tract and may be fatal. However, COVID-19 may become a systemic disease with a wide spectrum of manifestations. Herein, we report the natural history of sacroiliac inflammatory involvement in two females who developed COVID-19 infection with mild flu-like symptoms. After the infection they reported inflammatory back pain, with magnetic resonance imaging (MRI) studies showing typical aspects of sacroiliitis. Symptoms improved with NSAIDs therapy over the following months while MRI remained positive. A literature review was performed on this emerging topic. To our knowledge, this is the first MRI longitudinal study of post-COVID-19 sacroiliitis with almost one year of follow-up. Predisposing factors for the development of articular involvement are unclear but a long-lasting persistence of the virus, demonstrated by nasopharyngeal swab, may enhance the probability of altering the immune system in a favourable background.
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22
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Kuschner Z, Ortega A, Mukherji P. A case of SARS-CoV-2-associated arthritis with detection of viral RNA in synovial fluid. J Am Coll Emerg Physicians Open 2021; 2:e12452. [PMID: 34337594 PMCID: PMC8313035 DOI: 10.1002/emp2.12452] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022] Open
Abstract
Severe acute respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) provokes symptoms ranging from mild viral illness to a systemic inflammatory syndrome with multi-organ failure and has been associated with cases of arthritis. We report a clinical case of SARS-CoV-2 associated arthritis in which analysis of synovial fluid detected SARS-CoV-2 ribonucleic acid.
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Affiliation(s)
- Zachary Kuschner
- Long Island Jewish Hospital and John T Mather Memorial HospitalNorthwell HealthNew YorkNew YorkUSA
| | - Alexandra Ortega
- Long Island Jewish Hospital and Manhasset University HospitalNorthwell HealthNew YorkNew YorkUSA
| | - Pinaki Mukherji
- Long Island Jewish HospitalNorthwell HealthNew YorkNew YorkUSA
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23
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[Post-Corona-Virus-Disease‑19 arthritis. Manifestation under the clinical picture of a reactive arthritis]. Z Rheumatol 2021; 80:555-558. [PMID: 34241692 PMCID: PMC8267768 DOI: 10.1007/s00393-021-01045-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 01/20/2023]
Abstract
A total of 13 case reports of reactive arthritis reported in the literature in connection with coronavirus disease 2019 (COVID‑19) are reviewed. Men were affected more frequently than women. The arthritis was manifested 4-44 days after the infection or the occurrence of the COVID‑19 symptoms. Acute arthritis was monoarticular or oligoarticular. Only 1 out of 7 patients examined was human-leucocyte-antigen(HLA)-B27 positive. A direct viral infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could not be detected in the synovial fluid and was not investigated in the synovial membrane. The arthritis was successfully treated with nonsteroidal anti-inflammatory drugs and/or intra-articular or systemic corticosteroids. The pathogenesis of post-COVID‑19 reactive arthritis is unknown.
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24
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MacDonald L, Alivernini S, Tolusso B, Elmesmari A, Somma D, Perniola S, Paglionico A, Petricca L, Bosello SL, Carfì A, Sali M, Stigliano E, Cingolani A, Murri R, Arena V, Fantoni M, Antonelli M, Landi F, Franceschi F, Sanguinetti M, McInnes IB, McSharry C, Gasbarrini A, Otto TD, Kurowska-Stolarska M, Gremese E. COVID-19 and RA share an SPP1 myeloid pathway that drives PD-L1+ neutrophils and CD14+ monocytes. JCI Insight 2021; 6:147413. [PMID: 34143756 PMCID: PMC8328085 DOI: 10.1172/jci.insight.147413] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/02/2021] [Indexed: 12/15/2022] Open
Abstract
We explored the potential link between chronic inflammatory arthritis and COVID-19 pathogenic and resolving macrophage pathways and their role in COVID-19 pathogenesis. We found that bronchoalveolar lavage fluid (BALF) macrophage clusters FCN1+ and FCN1+SPP1+ predominant in severe COVID-19 were transcriptionally related to synovial tissue macrophage (STM) clusters CD48hiS100A12+ and CD48+SPP1+ that drive rheumatoid arthritis (RA) synovitis. BALF macrophage cluster FABP4+ predominant in healthy lung was transcriptionally related to STM cluster TREM2+ that governs resolution of synovitis in RA remission. Plasma concentrations of SPP1 and S100A12 (key products of macrophage clusters shared with active RA) were high in severe COVID-19 and predicted the need for Intensive Care Unit transfer, and they remained high in the post-COVID-19 stage. High plasma levels of SPP1 were unique to severe COVID-19 when compared with other causes of severe pneumonia, and IHC localized SPP1+ macrophages in the alveoli of COVID-19 lung. Investigation into SPP1 mechanisms of action revealed that it drives proinflammatory activation of CD14+ monocytes and development of PD-L1+ neutrophils, both hallmarks of severe COVID-19. In summary, COVID-19 pneumonitis appears driven by similar pathogenic myeloid cell pathways as those in RA, and their mediators such as SPP1 might be an upstream activator of the aberrant innate response in severe COVID-19 and predictive of disease trajectory including post-COVID-19 pathology.
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Affiliation(s)
- Lucy MacDonald
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
| | - Stefano Alivernini
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
- Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Barbara Tolusso
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
- Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Aziza Elmesmari
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
| | - Domenico Somma
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
| | - Simone Perniola
- Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Annamaria Paglionico
- Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Petricca
- Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Silvia L. Bosello
- Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angelo Carfì
- Institute of Internal Medicine and Geriatrics and
| | - Michela Sali
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Egidio Stigliano
- Department of Woman and Child Health and Public Health, Area of Pathology, and U.O.S.D. Coordinamento attività di Settorato, and
| | - Antonella Cingolani
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rita Murri
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Arena
- Department of Woman and Child Health and Public Health, Area of Pathology, and U.O.S.D. Coordinamento attività di Settorato, and
| | - Massimo Fantoni
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Antonelli
- Emergency Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Emergency Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Francesco Franceschi
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione, Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Iain B. McInnes
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
| | - Charles McSharry
- Institute of Infection, Immunity and Inflammation, University of Glasgow, United Kingdom
| | - Antonio Gasbarrini
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Thomas D. Otto
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
| | - Mariola Kurowska-Stolarska
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
| | - Elisa Gremese
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
- Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
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25
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El Hasbani G, Jawad A, Uthman I. Axial and peripheral spondyloarthritis triggered by sars-cov-2 infection: a report of two cases. Reumatismo 2021; 73:59-63. [PMID: 33874649 DOI: 10.4081/reumatismo.2021.1374] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/16/2021] [Indexed: 11/23/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can show musculoskeletal symptoms such as peripheral arthritis. In rare cases, peripheral arthritis can develop after the resolution of SARS-CoV-2. We present two cases of spondyloarthritis induced by SARS-CoV-2; one case with axial and peripheral spondyloarthritis and the other with peripheral spondyloarthritis. Both cases refer to Lebanese patients who were HLA-B27 positive. These two cases highlight the possible predisposition of HLA-B27 positive patients to the development of spondyloarthritis symptoms triggered by SARS-CoV-2.
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Affiliation(s)
- G El Hasbani
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut.
| | - A Jawad
- Rheumatology department, Royal London Hospital, London.
| | - I Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut.
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26
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Tang KT, Hsu BC, Chen DY. Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review. Front Immunol 2021; 12:645013. [PMID: 33777042 PMCID: PMC7994612 DOI: 10.3389/fimmu.2021.645013] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 12/18/2022] Open
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.
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Affiliation(s)
- Kuo-Tung Tang
- Division of Allergy, Immunology, and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Ph.D. Program in Translational Medicine and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Bo-Chueh Hsu
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital Puli Branch, Nantou, Taiwan
| | - Der-Yuan Chen
- Translational Medicine Laboratory, China Medical University Hospital, Taichung, Taiwan.,Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
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27
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Novelli L, Motta F, Ceribelli A, Guidelli GM, Luciano N, Isailovic N, Vecellio M, Caprioli M, Clementi N, Clementi M, Mancini N, Selmi C, De Santis M. A case of psoriatic arthritis triggered by SARS-CoV-2 infection. Rheumatology (Oxford) 2021; 60:e21-e23. [PMID: 33206980 PMCID: PMC7717387 DOI: 10.1093/rheumatology/keaa691] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/21/2020] [Accepted: 09/28/2020] [Indexed: 01/02/2023] Open
Affiliation(s)
- Lucia Novelli
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Francesca Motta
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Angela Ceribelli
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Giacomo M Guidelli
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Nicoletta Luciano
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Natasa Isailovic
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Matteo Vecellio
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Center, University of Oxford
| | - Marta Caprioli
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Nicola Clementi
- Laboratory of Microbiology and Virology, Vita-Salute San Raffaele University, Milan, Italy.,Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Clementi
- Laboratory of Microbiology and Virology, Vita-Salute San Raffaele University, Milan, Italy.,Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicasio Mancini
- Laboratory of Microbiology and Virology, Vita-Salute San Raffaele University, Milan, Italy.,Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Selmi
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Biomedical Science Department, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Maria De Santis
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
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28
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Novelli L, Motta F, De Santis M, Ansari AA, Gershwin ME, Selmi C. The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 - A systematic review of the literature. J Autoimmun 2020; 117:102592. [PMID: 33401171 PMCID: PMC7833462 DOI: 10.1016/j.jaut.2020.102592] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/15/2022]
Abstract
The diverse clinical manifestations of COVID-19 is emerging as a hallmark of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. While the initial target of SARS-CoV-2 is the respiratory tract, it is becoming increasingly clear that there is a complex interaction between the virus and the immune system ranging from mild to controlling responses to exuberant and dysfunctional multi-tissue directed autoimmune responses. The immune system plays a dual role in COVID-19, being implicated in both the anti-viral response and in the acute progression of the disease, with a dysregulated response represented by the marked cytokine release syndrome, macrophage activation, and systemic hyperinflammation. It has been speculated that these immunological changes may induce the loss of tolerance and/or trigger chronic inflammation. In particular, molecular mimicry, bystander activation and epitope spreading are well-established proposed mechanisms to explain this correlation with the likely contribution of HLA alleles. We performed a systematic literature review to evaluate the COVID-19-related autoimmune/rheumatic disorders reported between January and September 2020. In particular, we investigated the cases of incident hematological autoimmune manifestations, connective tissue diseases, antiphospholipid syndrome/antibodies, vasculitis, Kawasaki-like syndromes, acute arthritis, autoimmune-like skin lesions, and neurologic autoimmune conditions such as Guillain–Barré syndrome. We screened 6263 articles and report herein the findings of 382 select reports which allow us to conclude that there are 2 faces of the immune response against SARS-CoV-2, that include a benign virus controlling immune response and a many faceted range of dysregulated multi-tissue and organ directed autoimmune responses that provides a major challenge in the management of this viral disease. The number of cases for each disease varied significantly while there were no reported cases of adult onset Still disease, systemic sclerosis, or inflammatory myositis. The immune system plays a major role in the acute progression of COVID-19. SARS-CoV-2 infection shares features with autoimmune diseases. SARS-CoV-2 can induce Guillain-Barré syndrome, arthritis, chilblain-like lesions.
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Affiliation(s)
- Lucia Novelli
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Francesca Motta
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Aftab A Ansari
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - M Eric Gershwin
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy.
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29
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Wendling D, Verhoeven F, Chouk M, Prati C. Can SARS-CoV-2 trigger reactive arthritis? Joint Bone Spine 2020; 88:105086. [PMID: 33127461 PMCID: PMC7590820 DOI: 10.1016/j.jbspin.2020.105086] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Daniel Wendling
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA 4266, Pathogens and inflammation, EPILAB, université Bourgogne Franche-Comté, Besançon, France.
| | - Frank Verhoeven
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA 4267, PEPITE, université Bourgogne Franche-Comté, Besançon, France
| | - Mickael Chouk
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France
| | - Clément Prati
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA 4267, PEPITE, université Bourgogne Franche-Comté, Besançon, France
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30
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Gremese E, Cingolani A, Bosello SL, Alivernini S, Tolusso B, Perniola S, Landi F, Pompili M, Murri R, Santoliquido A, Garcovich M, Sali M, De Pascale G, Gabrielli M, Biscetti F, Montalto M, Tosoni A, Gambassi G, Rapaccini GL, Iaconelli A, Zileri Del Verme L, Petricca L, Fedele AL, Lizzio MM, Tamburrini E, Natalello G, Gigante L, Bruno D, Verardi L, Taddei E, Calabrese A, Lombardi F, Bernabei R, Cauda R, Franceschi F, Landolfi R, Richeldi L, Sanguinetti M, Fantoni M, Antonelli M, Gasbarrini A. Sarilumab use in severe SARS-CoV-2 pneumonia. EClinicalMedicine 2020; 27:100553. [PMID: 33043284 PMCID: PMC7531933 DOI: 10.1016/j.eclinm.2020.100553] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Interleukin-6 signal blockade showed preliminary beneficial effects in treating inflammatory response against SARS-CoV-2 leading to severe respiratory distress. Herein we describe the outcomes of off-label intravenous use of Sarilumab in severe SARS-CoV-2-related pneumonia. METHODS 53 patients with SARS-CoV-2 severe pneumonia received intravenous Sarilumab; pulmonary function improvement or Intensive Care Unit (ICU) admission rate in medical wards, live discharge rate in ICU treated patients and safety profile were recorded. Sarilumab 400 mg was administered intravenously on day 1, with eventual additional infusion based on clinical judgement, and patients were followed for at least 14 days, unless previously discharged or dead. FINDINGS Of the 53 SARS-CoV-2pos patients receiving Sarilumab, 39(73·6%) were treated in medical wards [66·7% with a single infusion; median PaO2/FiO2:146(IQR:120-212)] while 14(26·4%) in ICU [92·6% with a second infusion; median PaO2/FiO2: 112(IQR:100-141.5)].Within the medical wards, 7(17·9%) required ICU admission, 4 of whom were re-admitted to the ward within 5-8 days. At 19 days median follow-up, 89·7% of medical inpatients significantly improved (46·1% after 24 h, 61·5% after 3 days), 70·6% were discharged from the hospital and 85·7% no longer needed oxygen therapy. Within patients receiving Sarilumab in ICU, 64·2% were discharged from ICU to the ward and 35·8% were still alive at the last follow-up. Overall mortality rate was 5·7%. INTERPRETATION IL-6R inhibition appears to be a potential treatment strategy for severe SARS-CoV-2 pneumonia and intravenous Sarilumab seems a promising treatment approach showing, in the short term, an important clinical outcome and good safety.
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Affiliation(s)
- Elisa Gremese
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
- Università Cattolica del Sacro Cuore, Divisione di Reumatologia, Rome, Italy
| | - Antonella Cingolani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Rome, Italy
| | - Silvia Laura Bosello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
| | - Stefano Alivernini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
- Università Cattolica del Sacro Cuore, Divisione di Reumatologia, Rome, Italy
| | - Barbara Tolusso
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
| | - Simone Perniola
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Internal Medicine and Geriatrics, Rome, Italy
- Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, Rome, Italy
| | - Maurizio Pompili
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Medicina e Chirurgia Traslazionale, Rome, Italy
| | - Rita Murri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Rome, Italy
| | - Angelo Santoliquido
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Clinic Medica e Malattie Cardiovascolari, Rome, Italy
| | - Matteo Garcovich
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
| | - Michela Sali
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Rome, Italy
| | - Gennaro De Pascale
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Rome, Italy
| | - Maurizio Gabrielli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Emergency Medicine, Rome, Italy
| | - Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Clinic Medica e Malattie Cardiovascolari, Rome, Italy
| | - Massimo Montalto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Clinic Medica e Malattie Cardiovascolari, Rome, Italy
- Università Cattolica del Sacro Cuore, Division of Internal Medicine, Rome, Italy
| | - Alberto Tosoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
| | - Giovanni Gambassi
- Università Cattolica del Sacro Cuore, Division of Internal Medicine, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Medicina Generale, Rome, Italy
| | - Gian Ludovico Rapaccini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Medicina e Chirurgia Traslazionale, Rome, Italy
| | - Amerigo Iaconelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
| | - Lorenzo Zileri Del Verme
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
| | - Luca Petricca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
| | - Anna Laura Fedele
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
| | - Marco Maria Lizzio
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
| | - Enrica Tamburrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Rome, Italy
| | - Gerlando Natalello
- Università Cattolica del Sacro Cuore, Divisione di Reumatologia, Rome, Italy
| | - Laura Gigante
- Università Cattolica del Sacro Cuore, Divisione di Reumatologia, Rome, Italy
| | - Dario Bruno
- Università Cattolica del Sacro Cuore, Divisione di Reumatologia, Rome, Italy
| | - Lucrezia Verardi
- Università Cattolica del Sacro Cuore, Divisione di Reumatologia, Rome, Italy
| | - Eleonora Taddei
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
| | - Angelo Calabrese
- Fondazione Policlinico Universitario Agostino Gemelli IRCC, Division of Pulmonary Medicine, Rome, Italy
| | - Francesco Lombardi
- Fondazione Policlinico Universitario Agostino Gemelli IRCC, Division of Pulmonary Medicine, Rome, Italy
| | - Roberto Bernabei
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Internal Medicine and Geriatrics, Rome, Italy
- Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, Rome, Italy
| | - Roberto Cauda
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Rome, Italy
| | - Francesco Franceschi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Emergency Medicine, Rome, Italy
- Università Cattolica del Sacro Cuore, Emergency Medicine, Rome, Italy
| | - Raffaele Landolfi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Clinic Medica e Malattie Cardiovascolari, Rome, Italy
- Università Cattolica del Sacro Cuore, Division of Internal Medicine, Rome, Italy
| | - Luca Richeldi
- Fondazione Policlinico Universitario Agostino Gemelli IRCC, Division of Pulmonary Medicine, Rome, Italy
| | - Maurizio Sanguinetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Rome, Italy
| | - Massimo Fantoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Rome, Italy
| | - Massimo Antonelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Rome, Italy
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Medicina e Chirurgia Traslazionale, Rome, Italy
| | - GEMELLI AGAINST COVID-19 Group
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
- Università Cattolica del Sacro Cuore, Divisione di Reumatologia, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Internal Medicine and Geriatrics, Rome, Italy
- Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Medicina e Chirurgia Traslazionale, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Clinic Medica e Malattie Cardiovascolari, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Emergency Medicine, Rome, Italy
- Università Cattolica del Sacro Cuore, Division of Internal Medicine, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Medicina Generale, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCC, Division of Pulmonary Medicine, Rome, Italy
- Università Cattolica del Sacro Cuore, Emergency Medicine, Rome, Italy
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31
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Jovani V, Pascual E, Vela P, Andrés M. Acute arthritis following SARS-CoV-2 infection. J Med Virol 2020; 93:661. [PMID: 32808685 PMCID: PMC7461394 DOI: 10.1002/jmv.26440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Vega Jovani
- Department of Rheumatology, Alicante General University Hospital-Alicante Institute of Sanitary and Biomedical Research, Alicante, Spain
| | - Eliseo Pascual
- Department of Clinical Medicine, Miguel Hernández University, Elche, Spain
| | - Paloma Vela
- Department of Rheumatology, Alicante General University Hospital-Alicante Institute of Sanitary and Biomedical Research, Alicante, Spain.,Department of Clinical Medicine, Miguel Hernández University, Elche, Spain
| | - Mariano Andrés
- Department of Rheumatology, Alicante General University Hospital-Alicante Institute of Sanitary and Biomedical Research, Alicante, Spain.,Department of Clinical Medicine, Miguel Hernández University, Elche, Spain
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32
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López-González MDC, Jovani V, Merino E, Vela P, Andrés M. Response to: 'Comparative analysis of synovial inflammation after SARS-CoV-2 infection' by Alivernini et al. Ann Rheum Dis 2020; 80:e92. [PMID: 32632033 DOI: 10.1136/annrheumdis-2020-218368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/26/2022]
Affiliation(s)
| | - Vega Jovani
- Seccion de Reumatologia, Hospital General Universitario de Alicante, Alicante, Spain
| | - Esperanza Merino
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Alicante, Spain
| | - Paloma Vela
- Seccion de Reumatologia, Hospital General Universitario de Alicante, Alicante, Spain.,Departamento de Medicina Clínica, Universidad Miguel Hernandez de Elche, Elche, Spain
| | - Mariano Andrés
- Seccion de Reumatologia, Hospital General Universitario de Alicante, Alicante, Spain .,Departamento de Medicina Clínica, Universidad Miguel Hernandez de Elche, Elche, Spain
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