COVID-19 shares clinical features with anti-melanoma differentiation-associated protein 5 positive dermatomyositis and adult Still's disease
COVID-19 shares clinical features with anti-melanoma differentiation-associated protein 5 positive dermatomyositis and adult Still's disease
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DOI：
10.55563/clinexprheumatol/44kaji
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发表时间：
2021-05-01
影响因子：
3.7
通讯作者：
Takeuchi, T.
中科院分区：
文献类型：
--
作者：
Kondo, Y.;Kaneko, Y.;Takeuchi, T.
目的探讨2019冠状病毒病（COVID-19）与抗黑素瘤分化相关蛋白5 （MDA5）自身抗体阳性皮肌炎、成人斯蒂尔氏病等以高铁蛋白血症为特征的自身免疫性和自身炎症性风湿病的异同。方法回顾性分析连续、新诊断、未经治疗的COVID-19、抗mda5皮肌炎或成人Still's病患者。我们比较了他们的临床、实验室和放射学特征，包括巨噬细胞激活综合征的患病率和每一种疾病的肺部受累。结果纳入主要分析的COVID-19、抗mda5皮肌炎和成人发病斯蒂尔斯病合并高铁蛋白血症（血清铁蛋白bb0 = 500ng/dL）患者分别为22例、14例和59例。COVID-19和成人Still's病均表现为高热、血清c反应蛋白升高等高炎症状态，而COVID-19和抗mda5皮肌炎均表现为严重的间质性肺疾病和低氧血症。虽然两组中三分之二的患者符合用于系统性幼年特发性关节炎的巨噬细胞活化综合征的标准，但在抗mda5皮肌炎和COVID-19中，即使在严重或危重病例中，HScore（噬血细胞淋巴组织细胞病的指标）也很低。COVID-19和抗mda5皮肌炎患者的胸部计算机断层扫描结果相似。结论covid -19与以高铁蛋白血症为特征的风湿病具有抗mda5皮肌炎和成人Still病等临床特征。这些发现应该进一步研究，以阐明不仅是COVID-19的发病机制，还有上述风湿病的发病机制。
ObjectiveTo investigate the similarities and differences between Coronavirus disease 2019 (COVID-19) and autoimmune and autoinflammatory rheumatic diseases characterised by hyperferritinaemia, such as antimelanoma differentiation associated protein 5 (MDA5) autoantibody-positive dermatomyositis and adult Still's disease.MethodsWe reviewed consecutive, newly diagnosed, untreated patients with COVID-19, anti-MDA5 dermatomyositis, or adult Still's disease. We compared their clinical, laboratory, and radiological characteristics, including the prevalence of macrophage activation syndrome and lung involvement in each disease.ResultsThe numbers of patients with COVID-19, anti-MDA5 dermatomyositis, and adult-onset Still's disease with hyperferritinaemia (serum ferritin >= 500ng/dL) who were included for main analysis were 22, 14, and 59, respectively. COVID-19 and adult Still's disease both featured hyperinflammatory status, such as high fever and elevated serum C-reactive protein, whereas COVID-19 and anti-MDA5 dermatomyositis both presented with severe interstitial lung disease and hypoxaemia. While two-thirds of the patients in each group met the criteria for macrophage-activated syndrome that is used in systemic juvenile idiopathic arthritis, the HScore, an indicator of haemophagocytic lymphohistiocytosis, was low in anti-MDA5 dermatomyositis and COVID-19 even in severe or critical cases. The findings of chest computed tomography were similar between COVID-19 and anti-MDA5 dermatomyositis.ConclusionCOVID-19 shared clinical features with rheumatic diseases characterised by hyperferritinaemia, including anti-MDA5 dermatomyositis and adult Still's disease. These findings should be investigated further in order to shed light on the pathogenesis of not only COVID-19 but also the aforementioned rheumatic diseases.