COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease
Ruth Fernandez‐Ruiz, Jacqueline L Paredes, Timothy B. Niewold
Abstract
As the world navigates the coronavirus disease 2019 (COVID-19) pandemic, there is a growing need to assess its impact in patients with autoimmune rheumatic diseases, such as systemic lupus erythematosus (SLE). Patients with SLE are a unique population when considering the risk of contracting COVID-19 and infection outcomes. The use of systemic glucocorticoids and immunosuppressants, and underlying organ damage from SLE are potential susceptibility factors. Most patients with SLE have evidence of high type I interferon activity, which may theoretically act as an antiviral line of defense or contribute to the development of a deleterious hyperinflammatory response in COVID-19. Other immunopathogenic mechanisms of SLE may overlap with those described in COVID-19, thus, studies in SLE could provide some insight into immune responses occurring in severe cases of the viral infection. We reviewed the literature to date on COVID-19 in patients with SLE and provide an in-depth review of current research in the area, including immune pathway activation, epidemiology, clinical features, outcomes, and the psychosocial impact of the pandemic in those with autoimmune disease. (Translational Research 2021; 232:1336) Abbreviations: Act-1 = Adaptor protein NF- activator; ACE2 = Angiotensin-converting enzyme 2; AZA = Azathioprine; C5aR1 = C5a receptor; COVID-19 = Coronavirus disease 2019; C-19-GRA = COVID-19 Global Rheumatology Alliance; CYC = Cyclophosphamide; EBV = Epstein-Barr virus; HCQ = Hydroxychloroquine; ICU = Intensive care unit; IFN = Interferon; IRF = Interferon regulatory factor; ISG = Interferon-stimulated gene; IFNAR = Interferon-/ receptor; IL = Interleukin; JAK = Janus kinase; LOF = Loss-of-function; MASP-2 = Manna-binding lectin associated serine protease-2; mTOR = Mechanistic (mammalian) target of rapamycin; MMF = Mycophenolate mofetil