In this blog, we're going to talk about a topic that's frequently brought up – the relationship between rheumatology and autoimmune disorders and COVID-19. This topic has become increasingly relevant in my practice, and I'm excited to share my insights gathered over the recent years, as well as a recent study that piqued my interest.
The COVID Connection:
Let's begin with a common scenario: a patient who had COVID19, considered mild who experienced joint pain in the aftermath. This pain was clearly inflammatory, with characteristics such as worse in mornings, lasting over 30 minutes, and with joint swelling. This is just one example of many similar cases I've encountered. The patient's primary care physician ordered tests for rheumatoid factor and CCP, markers for rheumatoid arthritis, and found positive results, leading to a referral to a rheumatologist.
Similarly, another patient who recovered well from COVID19 developed a rash, joint pain, mouth and nasal ulcers, and patchy hair loss. Their tests revealed a positive ANA and DSDNA, which suggested a diagnosis of lupus.
There are two cases but there have been many more. And the question is always: was this due to Covid19?
In my practice, it's evident that a link exists between COVID19 and various rheumatologic disorders. However, establishing causation remains challenging.
While we've seen countless COVID cases, it's hard to definitively conclude whether COVID directly causes autoimmune disorders. But the growing body of evidence suggests a correlation. Importantly, what my patients describe aligns with what the studies are revealing. Frequently, patients report experiencing joint pain and other symptoms after recovering from COVID. When antibody tests support these symptoms, it's reasonable to attribute them to a rheumatologic disorder triggered by COVID. In fact, this is in keeping with the “two hits” theory. Indeed, in rheumatology cases, we think that very often, patients require more than one "hit" to develop a rheumatologic disorder. The first "hit" could be a genetic predisposition, while the second “hit” is often an environmental factor, which can include a viral infection like COVID. This isn't unique to COVID; other viruses have been linked to rheumatologic disorders as well.
There have been many case reports that have described cases of patients with Covid19 that subsequently developed an autoimmune disorder. We have seen cases of rheumatoid arthritis, psoriatic arthritis, reacting arthritis or inflammatory bowel disease and even myasthenia gravis, to just name a few. While not irrefutable proof, it strongly suggests that COVID can exacerbate existing or latent rheumatologic conditions.
Cohort studies, especially those nationwide studies that compare pre-COVID and post-COVID eras, are particularly valuable. In fact, a systematic review in the recent 'Arthritis Care and Research' journal looked at this association and reported that up to 30% of patients post Covid19 had developed reactive arthritis, which in majority resolved within 6 months. Some others developed more chronic inflammatory rheumatologic disorders such as rheumatoid arthritis, inflammatory bowel disease, spondyloarthropathy, and reactive arthritis that persisted and required treatment.
Knowing that not all joint pain resolved after Covid10 underscores the importance of seeking prompt medical attention, as early intervention may prevent chronic conditions from developing.
In the realm of medicine, science continually evolves, and definitive proof sometimes lags behind clinical observations. While we can't say with absolute certainty that COVID causes autoimmune disorders, there's a strong case to be made based on clinical experiences and emerging evidence.
You can watch the video related to this blog on our Rheumatology 101 Youtube channel
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