| Abstract [eng] |
On 5 May 2023, the World Health Organisation declared an end to the COVID – 19 pandemic. Although the incidence of COVID – 19 has declined significantly, the infection and its long – term consequences remain relevant today. Emerging evidence suggests that COVID – 19 may trigger the onset of autoimmune diseases, including type 1 diabetes, psoriasis, Graves' disease, Guillain – Barré syndrome, and others. Additionally, reports indicate that some patients develop rheumatic diseases subsequent to COVID – 19 infection. This literature review explores rheumatological syndromes following COVID – 19, investigating potential pathophysiological mechanisms and the relationship between COVID – 19 and autoimmune rheumatic diseases. A more detailed analysis is provided on reactive arthritis, rheumatoid arthritis, systemic lupus erythematosus, idiopathic inflammatory myopathies, vasculitis, and systemic sclerosis. Clinical cases of rheumatological syndromes following COVID – 19, including systemic connective tissue disease and eosinophilic fasciitis, are also presented. The objective of this literature review was to assess rheumatological syndromes following COVID – 19, focusing on their diagnosis, clinical presentation, treatment options, and prognosis. The literature review was conducted using the PubMed database, with an additional search strategy employed through Google Scholar. For the clinical case descriptions, de – identified data from two patients in Lithuania were utilized. According to TriNetX, a global federated health research network, COVID – 19 increases the risk of rheumatic autoimmune diseases such as cutaneous vasculitis, polyarteritis nodosa, hypersensitivity angiitis and mixed connective tissue disease. The risk of any autoimmune disease was found to be lower when COVID – 19 was diagnosed during periods when Omicron variants were the predominant circulating strains compared to Delta variants. A positive antinuclear antibody (ANA) was more likely and predictive of autoimmune disease after COVID – 19, including systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome, cutaneous vasculitis, systemic sclerosis and idiopathic inflammatory myopathy. However, it is not clear whether SARS – CoV – 2 infection uncovers and accelerates previously subclinical rheumatic illness or causes de novo disease, as a direct causal link has not yet been proven. The most commonly diagnosed rheumatic diseases following COVID – 19 infection were systemic vasculitis and inflammatory arthritis. Kawasaki – like disease, leukocytoclastic vasculitis and IgA vasculitis were the most frequently observed vasculitides. Both Kawasaki – like disease and IgA vasculitis following COVID – 19 had more target – organ involvement than classic disease and occurred more frequently in adults than in children. Enhanced awareness and understanding of rheumatological syndromes post – COVID – 19 by clinicians can facilitate timely diagnosis and treatment, ultimately improving patient prognosis. |
