A systematic review of the incidence, management and prognosis of new-onset autoimmune connective tissue diseases after COVID-19

• Published in: Rheumatology international Vol. 43; no. 7; pp. 1221 - 1243
• Main Authors: Kouranloo, Koushan, Dey, Mrinalini, Elwell, Helen, Nune, Arvind
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2023; Springer Nature B.V
• Subjects: Adult; Autoimmune Diseases; Connective tissue diseases; Connective Tissue Diseases - diagnosis; Connective Tissue Diseases - epidemiology; Connective Tissue Diseases - therapy; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 - therapy; Female; Humans; Incidence; Lupus; Lupus Erythematosus, Systemic - diagnosis; Lupus Nephritis; Male; Medicine; Medicine & Public Health; Middle Aged; Mixed Connective Tissue Disease; Myositis; Prognosis; Rheumatology; Scleroderma, Systemic - diagnosis; Scleroderma, Systemic - epidemiology; Scleroderma, Systemic - therapy; Systematic Review; COVID-19; Pandemic; SARS-CoV-2; Autoimmune connective tissue diseases; Rheumatic disease
• ISSN: 1437-160X; 0172-8172; 1437-160X
• DOI: 10.1007/s00296-023-05283-9

A literature review on new-onset autoimmune connective tissue diseases (ACTDs) following COVID-19 is lacking. We evaluated potential associations between COVID-19 and the development of new-onset ACTDs. The “population” was adults with disease terms for ACTDs, including systemic lupus erythematosus (SLE), Sjogren’s syndrome, systemic sclerosis (SSc), idiopathic inflammatory myositis (IIM), anti-synthetase syndrome, mixed CTD and undifferentiated CTD, and “intervention” as COVID-19 and related terms. Databases were searched for English-language articles published until September 2022. We identified 2236 articles with 28 ultimately included. Of the 28 included patients, 64.3% were female, with a mean age was 51.1 years. The USA reported the most cases (9/28). ACTD diagnoses comprised: 11 (39.3%) IIM (including four dermatomyositis); 7 (25%) SLE; four (14.3%) anti-synthetase syndrome; four (14.3%) SSc; two (7.1%) other ACTD (one lupus/MCTD overlap). Of eight, four (14.3%) patients (including that with lupus/MCTD) had lupus nephritis. The average time from COVID-19 to ACTD diagnosis was 23.7 days. A third of patients were admitted to critical care, one for treatment of haemophagocytic lymphohistiocytosis in SLE (14 sessions of plasmapheresis, rituximab and intravenous corticosteroids) and nine due to COVID-19. 80% of patients went into remission of ACTD following treatment, while three (10%) patients died—one due to macrophage activation syndrome with anti-synthetase syndrome and two from unreported causes. Our results suggest a potential association between COVID-19 and new-onset ACTDs, notably in young females, reflecting more comprehensive CTD epidemiology. The most common diagnosis in our cohort was IIM. The aetiology and mechanisms by which ACTDs emerge following COVID-19 remain unknown and require further research.