Rheumatoid Arthritis After SARS-CoV-2 Infection: A New Risk Factor?

Öz

OBJECTİVE: In rheumatoid arthritis (RA) etiopathogenesis, viral infections role as environmental trigger factors. The new corona virus SARS-COV-2 has been reported to trigger the autoimmunity and inflammatory arthritis. The aim of the study is to compare the patients diagnosed as RA after COVİD-19 with regular RA patients and to assess the possible mechanisms in RA development. MATERİALS AND METHODS: Two groups were formed in newly diagnosed RA patients depending on COVİD-19 history before the initiation of joint symptoms. Gender, age, comorbidity, working status, smoking habits, family history, joint involvement pattern, symptom duration, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), disease activity scores (DAS28-ESR), rheumatoid factor (RF), anti-cyclic citrulline peptide (anti-CCP) was recorded. Wilcoxon test was used for data that does not show normal distribution, paired-t test used for data showing normal distribution, p <0.05 is considered statistically significant. RESULTS: Of 61 newly diagnosed RA patients, 67.2% (n=41) had no previous history of COVID-19, and 32.8% (n=20) had a history of COVID-19 infection. There was no statistical difference in terms of age, gender, family history, smoking habit, working status and comorbidity between both groups. Symptom durations were statistically similar in both groups with and without a history of COVID-19, 24 weeks (2-62), 18 weeks (2-120), respectively. Joint involvement patterns were polysymmetric in 90% and oligoarticular in 10% in patients with COVID-19 history. Without COVID-19 group, 87.8% were polysymmetric and 12.2% were oligoarticular. ESR, CRP, DAS28-ESR levels and presence of RF and anti-CCP were also similar in both groups. CONCLUSION: In this study, demographic, clinical and laboratory features were found to be similar with classical RA findings in patients who developed RA after COVID-19 infection. SARS-CoV-2 infection specifically targets the respiratory tract, thus may lead RA-associated autoimmunity. As a result; larger and prospective studies are needed to elucidate the relationship between RA and COVID-19.

Anahtar Kelimeler

• COVID-19
• SARS-CoV-2
• Rheumatoid arthritis

SARS-Cov-2 Enfeksiyonu Sonrası Gelişen Romatoid Artrit: Yeni Bir Risk Faktörü Mü?

Öz

AMAÇ: Romatoid artrit (RA) etyopatogenezinde viral enfeksiyonlar çevresel tetikleyici faktörler olarak rol almaktadır. Yeni corona virüs SARS-CoV-2’nin neden olduğu hastalığın (COVİD-19) otoimmüniteyi ve inflamatuar artritleri tetiklediği bildirilmiştir. Çalışmanın amacı, COVİD-19 sonrası RA tanısı alan hastaları klasik RA özellikleriyle karşılaştırmak ve RA gelişimindeki olası mekanizmaları irdelemektir. GEREÇ VE YÖNTEM: Romatoloji polikliniğine başvurarak RA tanısı alan olgular retrospektif olarak çalışmaya dahil edildi. Eklem yakınmaları başlamadan önce COVİD-19 öyküsü olan ve olmayan hastalar olarak iki grup oluşturuldu. Cinsiyet, yaş, komorbidite, çalışma durumu, sigara, aile öyküsü, eklem tutulum paterni, semptom süresi, eritrosit sedimantasyon hızı (ESR) ve C-reaktif protein (CRP), hastalık aktivite skorları (DAS28-ESR), romatoid faktör (RF), anti-siklik sitrülline peptid (anti-CCP) kaydedildi. Normal dağılım göstermeyen veriler için Wilcoxon testi, normal dağılım gösteren veriler için paired-t testi kullanıldı, p <0.05 istatistiksel olarak anlamlı kabul edildi. BULGULAR: 61 yeni tanı RA hastasının %67.2 si (n=41) önceden COVİD-19 öyküsü yoktu, %32.8’inde (n=20) COVİD-19 enfeksiyon öyküsü mevcuttu. Her iki grup arasında yaş, cinsiyet, aile öyküsü, sigara alışkanlığı, çalışma durumu, komorbidite açısından istatiksel fark saptanmadı. Her iki grupta semptom süreleri istatiksel açıdan benzerdi, COVİD-19 öyküsü olan ve olmayan grupta sırasıyla 24 hafta (2-62), 18 hafta (2-120) saptandı. Eklem tutulum paternleri COVİD-19 geçirmiş hastalarda %90’ı polisimetrik, %10’u oligoartikülerdi. COVİD-19 öyküsü olmayan hastalarda %87.8’i polisimetrik, %12.2’si oligoartikülerdi, her iki grup arasında fark saptanmadı. ESR, CRP, DAS28-ESR düzeyleri ve RF ve anti-CCP varlığı da her iki grupta benzerdi. SONUÇ: Bu çalışmada klasik RA bulgularıyla COVİD-19 enfeksiyonu sonrası RA gelişen hastalarda demografik, klinik ve laboratuar özellikler benzer bulunmuştur. SARS-CoV-2 enfeksiyonun solunum yollarını özellikle hedef alması RA ilişkili otoimmünite gelişme ihtimalini düşündürmektedir. Sonuç olarak; RA ve COVİD-19 ilişkisini aydınlatmak için daha geniş çaplı ve ileriye dönük çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• COVİD-19
• SARS-CoV-2
• romatoid artrit

Kaynakça

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