Autoimmune and rheumatic musculoskeletal diseases as a consequence of SARS-CoV-2 infection and its treatment
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Rheumatology INTERNATIONAL
REVIEW
Autoimmune and rheumatic musculoskeletal diseases as a consequence of SARS‑CoV‑2 infection and its treatment Sanket Shah1 · Debashish Danda2 · Chengappa Kavadichanda1 · Saibal Das3 · M. B. Adarsh1 · Vir Singh Negi1 Received: 3 June 2020 / Accepted: 28 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The coronavirus disease-2019 (COVID-19) pandemic is likely to pose new challenges to the rheumatology community in the near and distant future. Some of the challenges, like the severity of COVID-19 among patients on immunosuppressive agents, are predictable and are being evaluated with great care and effort across the globe. A few others, such as atypical manifestations of COVID-19 mimicking rheumatic musculoskeletal diseases (RMDs) are being reported. Like in many other viral infections, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can potentially lead to an array of rheumatological and autoimmune manifestations by molecular mimicry (cross-reacting epitope between the virus and the host), bystander killing (virus-specific CD8 + T cells migrating to the target tissues and exerting cytotoxicity), epitope spreading, viral persistence (polyclonal activation due to the constant presence of viral antigens driving immune-mediated injury) and formation of neutrophil extracellular traps. In addition, the myriad of antiviral drugs presently being tried in the treatment of COVID-19 can result in several rheumatic musculoskeletal adverse effects. In this review, we have addressed the possible spectrum and mechanisms of various autoimmune and rheumatic musculoskeletal manifestations that can be precipitated by COVID-19 infection, its therapy, and the preventive strategies to contain the infection. Keywords Coronavirus disease-2019 (COVID-19) · Rheumatic musculoskeletal diseases (RMDs) · Autoimmunity · Rheumatology Sanket Shah and Debashish Danda have contributed equally as first authors. * Vir Singh Negi [email protected] Sanket Shah [email protected] Debashish Danda [email protected] Chengappa Kavadichanda [email protected] Saibal Das [email protected] M. B. Adarsh [email protected] 1
Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
2
Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
3
Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
Abbreviations AAV Anti-neutrophil cytoplasmic antibodyassociated vasculitis ACE2 Angiotensin-converting enzyme 2 ANA Antinuclear antibodies AIDS Acquired immunodeficiency syndrome APCs Antigen-presenting cells APS Antiphospholipid antibody syndrome ARDS Acute respiratory distress syndrome CAHA Coronavirus-associated hemostatic lung abnormality CAR-T Chimeric antigen receptor T cell CCL2 Chemokine (C–C motif) ligand 2 CK Creatine kinase COVID-1
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