Autoimmune and rheumatic musculoskeletal diseases as a consequence of SARS-CoV-2 infection and its treatment

Rheumatol Int. 2020 Oct;40(10):1539-1554. doi: 10.1007/s00296-020-04639-9. Epub 2020 Jul 14.

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: Autoimmunity; Coronavirus disease-2019 (COVID-19); Rheumatic musculoskeletal diseases (RMDs); Rheumatology.

Publication types

  • Review

MeSH terms

  • Antibodies, Antinuclear / immunology
  • Antibodies, Antiphospholipid / immunology
  • Antiviral Agents / adverse effects
  • Arthralgia / etiology
  • Arthralgia / immunology
  • Arthralgia / physiopathology
  • Autoimmune Diseases / etiology
  • Autoimmune Diseases / immunology
  • Autoimmune Diseases / physiopathology*
  • Betacoronavirus
  • Blood Coagulation Disorders / etiology
  • Blood Coagulation Disorders / immunology
  • Blood Coagulation Disorders / physiopathology
  • COVID-19
  • COVID-19 Drug Treatment
  • Coronavirus Infections / complications
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / immunology
  • Coronavirus Infections / physiopathology*
  • Cross Reactions / immunology
  • Extracellular Traps / immunology
  • Fibrin Fibrinogen Degradation Products
  • Guillain-Barre Syndrome / etiology
  • Guillain-Barre Syndrome / immunology
  • Guillain-Barre Syndrome / physiopathology
  • Humans
  • Lupus Coagulation Inhibitor / immunology
  • Molecular Mimicry
  • Mucocutaneous Lymph Node Syndrome / etiology
  • Mucocutaneous Lymph Node Syndrome / immunology
  • Mucocutaneous Lymph Node Syndrome / physiopathology
  • Muscle Weakness / etiology
  • Muscle Weakness / immunology
  • Muscle Weakness / physiopathology
  • Musculoskeletal Diseases / etiology
  • Musculoskeletal Diseases / immunology
  • Musculoskeletal Diseases / physiopathology*
  • Myalgia / etiology
  • Myalgia / immunology
  • Myalgia / physiopathology
  • Myocarditis / etiology
  • Myocarditis / immunology
  • Myocarditis / physiopathology
  • Pandemics
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / immunology
  • Pneumonia, Viral / physiopathology*
  • Rheumatic Diseases / etiology
  • Rheumatic Diseases / immunology
  • Rheumatic Diseases / physiopathology*
  • SARS-CoV-2

Substances

  • Antibodies, Antinuclear
  • Antibodies, Antiphospholipid
  • Antiviral Agents
  • Fibrin Fibrinogen Degradation Products
  • Lupus Coagulation Inhibitor
  • fibrin fragment D