COVID-19 and Autoimmune Diseases

Yu Liu; Amr H. Sawalha; Qianjin Lu


Curr Opin Rheumatol. 2021;33(2):155-162. 

In This Article

Risk of Patients With Autoimmune Diseases During the COVID-19 Pandemic

Autoimmune diseases are heterogeneous and linked to a dysregulated immune system. Most of the patients with autoimmune diseases have received or are receiving immunomodulatory medications or biological agents. During the pandemic of COVID-19, a proportion of the autoimmune disease patients suspended their medication due to fear of the immunosuppressive effect of medications or lack of availabilities,[64] and decreased medical visits because of concerns of the contagious nature of SARS-CoV-2.[65] However, disrupted continuity of medical care and medication nonadherence are associated with rheumatologic disease flares and worsened disease activity.[66] Therefore, building a reliable telemedicine platform and education on medication adherence should be strongly recommended.

Since the beginning of this pandemic, infection risk in patients with autoimmune diseases has been a subject of interest.[67–69] The results of a cross-sectional study conducted in northeast Italy indicated that autoimmune disease patients had a similar rate of infection of SARS-CoV-2 compared with the general population.[70] Another Italian study performed in Milan also confirmed that autoimmune disease is not a risk factor of being positive for COVID-19.[71] To the contrary, the results of a multicentre retrospective study conducted in Hubei, China, indicated that patients with autoimmune diseases might be more susceptible to SARS-CoV-2 infection compared with controls. Further, this study examined family members of the patients that resided at the same environment during the outbreak as controls.[72] Of interest, the study from Milan indicated that patients with autoimmune diseases do not have a worse prognosis compared with non-autoimmune disease individuals.[71] However, a Spanish study revealed that hospitalized patients with autoimmune diseases have a more severe course of COVID-19.[73] At this time, until more data become available, it is crucial to emphasize the importance of physical distancing, wearing masks and frequent hand washing for everyone and especially in our patients with autoimmune diseases. Adherence to medications is also very important to prevent flares of autoimmune diseases that might result in organ damage.