scholarly journals COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series

2020 ◽  
Vol 39 (11) ◽  
pp. 3195-3204 ◽  
Author(s):  
Clodoveo Ferri ◽  
◽  
Dilia Giuggioli ◽  
Vincenzo Raimondo ◽  
Massimo L’Andolina ◽  
...  
Keyword(s):  
Immune System ◽  
General Population ◽  
Connective Tissue ◽  
Inflammatory Arthritis ◽  
Systemic Disease ◽  
Management Strategies ◽  
Connective Tissue Diseases ◽  
Systemic Diseases ◽  
High Exposure ◽  
Disease Modifying

Abstract Introduction Covid-19 infection poses a serious challenge for immune-compromised patients with inflammatory autoimmune systemic diseases. We investigated the clinical-epidemiological findings of 1641 autoimmune systemic disease Italian patients during the Covid-19 pandemic. Method This observational multicenter study included 1641 unselected patients with autoimmune systemic diseases from three Italian geographical areas with different prevalence of Covid-19 [high in north (Emilia Romagna), medium in central (Tuscany), and low in south (Calabria)] by means of telephone 6-week survey. Covid-19 was classified as (1) definite diagnosis of Covid-19 disease: presence of symptomatic Covid-19 infection, confirmed by positive oral/nasopharyngeal swabs; (2) highly suspected Covid-19 disease: presence of highly suggestive symptoms, in absence of a swab test. Results A significantly higher prevalence of patients with definite diagnosis of Covid-19 disease, or with highly suspected Covid-19 disease, or both the conditions together, was observed in the whole autoimmune systemic disease series, compared to “Italian general population” (p = .030, p = .001, p = .000, respectively); and for definite + highly suspected diagnosis of Covid-19 disease, in patients with autoimmune systemic diseases of the three regions (p = .000, for all comparisons with the respective regional general population). Moreover, significantly higher prevalence of definite + highly suspected diagnosis of Covid-19 disease was found either in patients with various “connective tissue diseases” compared to “inflammatory arthritis group” (p < .000), or in patients without ongoing conventional synthetic disease-modifying anti-rheumatic drugs treatments (p = .011). Conclusions The finding of a higher prevalence of Covid-19 in patients with autoimmune systemic diseases is particularly important, suggesting the need to develop valuable prevention/management strategies, and stimulates in-depth investigations to verify the possible interactions between Covid-19 infection and impaired immune-system of autoimmune systemic diseases. Key Points• Significantly higher prevalence of Covid-19 is observed in a large series of patients with autoimmune systemic diseases compared to the Italian general population, mainly due to patients’ increased susceptibility to infections and favored by the high exposure to the virus at medical facilities before the restriction measures on individual movement.• The actual prevalence of Covid-19 in autoimmune systemic diseases may be underestimated, possibly due to the wide clinical overlapping between the two conditions, the generally mild Covid-19 disease manifestations, and the limited availability of virological testing.• Patients with “connective tissue diseases” show a significantly higher prevalence of Covid-19, possibly due to deeper immune-system impairment, with respect to “inflammatory arthritis group”.• Covid-19 is more frequent in the subgroup of autoimmune systemic diseases patients without ongoing conventional synthetic disease-modifying anti-rheumatic drugs, mainly hydroxyl-chloroquine and methotrexate, which might play some protective role against the most harmful manifestations of Covid-19.

scholarly journals POS1246 COVID-19 IN ITALIAN PATIENTS WITH RHEUMATIC AUTOIMMUNE SYSTEMIC DISEASES: RESULTS OF A NATIONWIDE SURVEY STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 906-907
Author(s):  
C. Ferri ◽  
D. Giuggioli ◽  
V. Raimondo ◽  
L. Dagna ◽  
V. Riccieri ◽  
...  
Keyword(s):  
General Population ◽  
Connective Tissue ◽  
Surveillance System ◽  
Systemic Vasculitis ◽  
Connective Tissue Diseases ◽  
Survey Study ◽  
Systemic Diseases ◽  
Lung Involvement ◽  
National Surveillance ◽  
National Surveillance System

Background:SARS-CoV-2 infection poses a serious challenge for patients with rheumatic autoimmune systemic diseases (ASD), characterized by marked immune-system dysregulation and frequent visceral organ involvement.Objectives:To evaluate the impact of Covid-19 pandemic in a large series of Italian patients with ASD.Methods:Our multicenter telephone survey (8-week period, March-April 2020) included a large series of 2,994 patients (584 M, 2,410 F, mean age 58.9±13.4SD years) with ASD followed at 34 tertiary referral centers of 14 regions of northern, central, and southern Italian macro areas, characterized by different prevalence of SARS-CoV-2 infection. According to currently used criteria, Covid-19 was classified as definite Covid-19 (signs or symptoms of Covid-19 confirmed by positive oral/nasopharyngeal swabs at PCR testing) or highly suspected Covid-19 (signs or symptoms highly suggestive of Covid-19, but not confirmed by PCR testing due to limited availability of virological tests in that period). The results were analyzed performing the Odds Ratio by Java-Stat 2-way Contingency Table Analysis.Results:The main findings of the survey study revealed a significantly increased prevalence of Covid-19 in:a.the whole series of ASD patients (definite Covid-19: 22/2994, 0.73%; p=0.0007;definite Covid-19 plus highly suspected Covid-19: 74/2,994, 2.47%; p<0.0001) when compared to Italian general population of Covid-19 infected individuals (349/100000 = 0.34%; data from Italian Superior Institute of Health;https://www.epicentro.iss.it/en/coronavirus/sars-cov-2-national-surveillance-system).b.the subgroup of patients with connective tissue diseases or systemic vasculitis (n = 1,901) compared to the subgroup of inflammatory arthritis (n = 1,093), namely rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis (definite Covid-19: 19/1,901, 0.99%, vs 3/1,093, 0.27%; p=0.036; definite Covid-19 plus highly suspected Covid-19: 69/1,901, 3.6%, vs 5/1,093, 0.45%; p<0.0001)c.the subgroup of patients with pre-existing interstitial lung involvement (n = 526) compared to those without (n = 2,468) (definite Covid-19: 10/526, 1.90%, vs 12/2,468, 0.48%; p=0.0015; definite Covid-19 plus highly suspected Covid-19: 33/526, 6.27%, vs 41/2,468, 1.66%; p<0.0001).Of interest, the prevalence of Covid-19 did not correlate with presence/absence of different comorbidities, mainly diabetes, cardio-vascular and/or renal disorders, as well as of ongoing treatments with biological DMARDs; while patients treated with conventional DMARDs showed a significantly lower prevalence of Covid-19 compared to those without. Covid-19 was more frequently observed in the patients’ populations from northern and central compared to southern Italian macro area with lower diffusion of pandemic. Clinical manifestations of Covid-19, observed in 74 patients, were generally mild or moderate; 4/9 individuals requiring hospital admission died for severe pneumonia.Conclusion:The prevalence of Covid-19 observed in ASD patients during the first wave of pandemic was significantly higher than that observed in Italian general population; moreover, the actual prevalence of Covid-19 might be underestimated due to the high number of mild variants as well as the possible clinical overlapping between these two conditions. Patients with ASD should be invariably regarded as ‘frail patients’ during the pandemic course, considering the risk of worse outcome in the acute phase of Covid-19, as well as the potential long-term effects of viral infection.The statistically significant association of Covid-19 with connective tissue diseases/systemic vasculitis, as well as with pre-existing interstitial lung involvement, suggests the presence of distinct clinico-pathological ASD subsets, characterized by markedly different patients’ vulnerability to SARS-CoV-2 infection.Disclosure of Interests:None declared

Cutaneous vasculitis, connective tissue diseases, and urticaria

2010 ◽  
pp. 4626-4655
Author(s):  
Susan Burge ◽  
Graham S. Ogg
Keyword(s):  
Connective Tissue ◽  
Blood Vessels ◽  
Systemic Vasculitis ◽  
Vascular Inflammation ◽  
Systemic Disease ◽  
Connective Tissue Diseases ◽  
Vascular Occlusion ◽  
Clinical Findings ◽  
Cutaneous Vasculitis ◽  
Imaging Studies

Vasculitis (angiitis) denotes necrotizing inflammation of the blood vessels; occlusive vasculopathy implies vascular occlusion without significant vascular inflammation. A small-vessel cutaneous vasculitis is the most common vasculitis affecting the skin, and may be the first sign of a systemic vasculitis, but 50% of patients have no systemic disease. The clinical findings must be integrated with the results of serological, pathological, and imaging studies to reach a diagnosis....

Rehabilitation in joint and connective tissue diseases. 1. Systemic diseases

1995 ◽  
Vol 76 (5) ◽  
pp. S32-S40 ◽  
Author(s):  
Neal Alpiner ◽  
Terry H. Oh ◽  
Steven R. Hinderer ◽  
Victoria A. Brander
Keyword(s):  
Connective Tissue ◽  
Connective Tissue Diseases ◽  
Systemic Diseases

The TLRs and IFNs in patients with connective tissue diseases

2020 ◽  
Vol 7 ◽  
pp. 1-10
Author(s):  
Agnieszka Paradowska-Gorycka ◽  
Anna Wajda ◽  
Barbara Stypińska ◽  
Ewa Walczuk ◽  
Marcela Walczyk ◽  
...  
Keyword(s):  
Immune System ◽  
Connective Tissue ◽  
Immune Complexes ◽  
Connective Tissue Diseases ◽  
Serum Levels ◽  
Protective Role ◽  
Type I ◽  
Complement Components ◽  
Ifn Γ ◽  
Stimulation Of

Autoimmune connective tissue diseases (ACTD) are characterized by spontaneous stimulation of the immune system and the production of autoantibodies. Some autoantibodies may create an immune complex with DNA and/or RNA and promote tissue inflammation. Immune complexes that contain nucleic acids can act as ligands for endosomal Toll-like receptors (TLR), which activation induces secretion of the type I and type III interferons. The present study aimed to determine whether TLRs and IFNs genes could be considered as potential ACTD biomarkers. IFN-A and IFN-G showed a relationship with a predisposition to the development of SLE and MCTD, and IFN-B with a predisposition to the development of SLE. The TLR7 rs5743305 T allele and rs5743316 A allele may play a protective role against the development of MCTD, and the TLR7 rs1731479 T allele and TLR8 rs17256081 C allele may be predictors of MCTD development. mRNA expression of the IFN-α, IFN-β, IFN-γ, TLR3, TLR8 and TLR7 was significantly higher in patients with SLE compared to patients with MCTD and SSc. MCTD patients with anti-U1-70k (+) had higher IFN-γ and lower IFN-β serum levels than patients without this antibody. In patients with SLE, serum levels of IFN-α and IFN-γ correlate with the concentration of complement components, and serum levels of IFN-α with disease activity. The study confirmed that the TLR-IFN pathway may be considered as an important pathogenic mechanism for ACTD.

Imaging Features of the Juvenile Inflammatory Arthropathies

2018 ◽  
Vol 22 (02) ◽  
pp. 147-165
Author(s):  
Lennart Jans ◽  
Anne Jurik ◽  
Robert Hemke ◽  
Iris Eshed ◽  
Nathalie Boutry ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Connective Tissue ◽  
Lupus Erythematosus ◽  
Soft Tissues ◽  
Early Recognition ◽  
Systemic Disease ◽  
Connective Tissue Diseases ◽  
Disease Process ◽  
Imaging Features ◽  
Disease Modifying Drugs

AbstractWe discuss the imaging of several juvenile inflammatory arthropathies including juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, juvenile scleroderma, juvenile dermatomyositis, and chronic recurrent multifocal osteomyelitis. Juvenile idiopathic arthritis is the most common autoimmune chronic systemic disease of connective tissue in children. The remaining systemic juvenile connective tissue diseases are rare. However, they require early diagnosis and initiation of treatment to prevent injury, not only to the musculoskeletal system but also to the internal organs, and even death. Imaging of juvenile inflammatory arthropathies has relied for years on radiography. Recent advances in disease-modifying drugs have led to a greater emphasis on the detection of early inflammation not evident on plain radiography. Ultrasound examination allows for the early recognition of the disease process in the soft tissues. Magnetic resonance imaging detects early inflammatory changes involving the soft tissues, the subcortical bone of peripheral joints, the spine, and entheses.

Neuropathy of Connective Tissue Diseases and Other Systemic Diseases

2019 ◽  
Vol 39 (05) ◽  
pp. 651-668
Author(s):  
Peter H. Jin ◽  
Susan C. Shin
Keyword(s):  
Peripheral Neuropathy ◽  
Connective Tissue ◽  
Clinical Features ◽  
Connective Tissue Diseases ◽  
Chemotherapeutic Agents ◽  
Nutritional Deficiencies ◽  
Systemic Diseases ◽  
Monoclonal Gammopathies ◽  
Diagnosis And Management

AbstractPeripheral neuropathy is associated with numerous systemic diseases. It is often the heralding finding, which can lead to earlier diagnoses and better outcomes. An understanding of the epidemiology and clinical features of these diseases is paramount to their diagnosis and management. This article will focus on neuropathy associated with connective tissue diseases, monoclonal gammopathies, paraneoplastic disorders, medications including chemotherapeutic agents, nutritional deficiencies, alcohol, and toxins.

scholarly journals Pathological lesions in the oral cavity in the course of connective tissue diseases

2018 ◽  
Vol 31 (4) ◽  
pp. 209-212
Author(s):  
Daria Bednarek-Hatlinska ◽  
Anna Prymas ◽  
Marta Mrall-Wechta ◽  
Anna Surdacka
Keyword(s):  
Connective Tissue ◽  
Oral Cavity ◽  
Viral Infections ◽  
Dental Treatment ◽  
Systemic Disease ◽  
Connective Tissue Diseases ◽  
Interdisciplinary Approach ◽  
Pathological Changes ◽  
Tissue System ◽  
Relationship Of

Abstract Dentistry, is one of the intensively and rapidly growing branches of medicine. This prompts dentists to take an interdisciplinary approach to their patients. Thus, the dentist, being a general practitioner, can make significant contributions to the early diagnosis of systemic disease and the faster implementation of appropriate treatment. In view of the aforementioned, we undertook research on the relationship of pathological changes observed in the oral cavity with diseases of the connective tissue system. Collagenosis is a chronic autoimmune disease initiated by many factors, among which the genetic factor and viral infections are mentioned. The changes observed in the oral cavity may be a picture of the disease, a complication of the disease or a side effect of the treatment. The aim of the study is, thus, too present the pathological changes in the oral cavity which often accompany collagenosis, and to discuss the risk factors of connective tissue system diseases and methods of dental treatment.

scholarly journals Covid-19 And Rheumatic Autoimmune Systemic Diseases: Role of Pre-Existing Lung Involvement and Ongoing Treatments

2021 ◽  
Vol 27 ◽  
Author(s):  
Clodoveo Ferri ◽  
Dilia Giuggioli ◽  
Vincenzo Raimondo ◽  
Massimo L’Andolina ◽  
Lorenzo Dagna ◽  
...  
Keyword(s):  
Management Strategies ◽  
Connective Tissue Diseases ◽  
Chronic Arthritis ◽  
Targeted Prevention ◽  
Systemic Diseases ◽  
Lung Involvement ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Pandemic Wave

Background: The Covid-19 pandemic may have a deleterious impact on patients with autoimmune systemic diseases (ASD) due to their deep immune-system alterations. Objective: To investigate the prevalence of symptomatic Covid-19 and its correlations with both organ involvement and ongoing treatments in a large series of Italian ASD patients during the first wave of pandemic. Method: Our multicenter telephone 6-week survey included 3,029 unselected ASD patients enrolled at 36 tertiary referral centers of northern, central, and southern Italian macro-areas with different diffusion of pandemic. Symptomatic SARS-CoV-2 infection was classified as definite Covid-19 (presence of symptoms plus positive oral/nasopharyngeal swabs) or highly suspected Covid-19 (highly suggestive symptoms, in absence of a swab testing). Results: A significantly higher prevalence of definite plus highly suspected Covid-19 compared to Italian general population was detected in the whole ASD series (p=.000), as well as in patients from the three macro-areas (p=.000 in all). Statistically higher prevalence of Covid-19 was also found in connective tissue diseases compared to chronic arthritis subgroup (p=.000) and in ASD patients with pre-existing interstitial lung involvement (p=.000). Patients treated with either conventional disease modifying anti-rheumatic drugs (DMARDs) and/or biological DMARDs showed a significantly lower prevalence of Covid-19 (p=.000 in both). Finally, scleroderma patients undergoing low-dose aspirin showed significantly lower rate of Covid-19 compared to those without (p=0.003). Conclusion: The higher prevalence of Covid-19 in ASD patients along with the significant correlations with important clinical features and therapeutic regimens suggests the need to develop targeted prevention/management strategies during the current pandemic wave.

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