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

Authors
  • Shah, Sanket1
  • Danda, Debashish2
  • Kavadichanda, Chengappa1
  • Das, Saibal1
  • Adarsh, M. B.1
  • Negi, Vir Singh1
  • 1 Jawaharlal Institute of Postgraduate Medical Education and Research,
  • 2 Christian Medical College,
Type
Published Article
Journal
Rheumatology International
Publisher
Springer Berlin Heidelberg
Publication Date
Jul 14, 2020
Pages
1–16
Identifiers
DOI: 10.1007/s00296-020-04639-9
PMID: 32666137
PMCID: PMC7360125
Source
PubMed Central
Keywords
License
Unknown

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.

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