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COVID-19 shares clinical features with anti-melanoma differentiation-associated protein 5 positive dermatomyositis and adult Still’s disease


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13

 

  1. Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
  2. Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan. ykaneko.z6@keio.jp
  3. Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
  4. Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
  5. Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
  6. Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan.
  7. Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.
  8. Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan.
  9. Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
  10. Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.
  11. Center for Infection Diseases and Infection Control, Keio University School of Medicine, Tokyo, Japan.
  12. Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
  13. Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.

for the Keio Donner Project

CER14295
2021 Vol.39, N°3
PI 0631, PF 0638
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PMID: 33886458 [PubMed]

Received: 04/12/2020
Accepted : 23/02/2021
In Press: 08/04/2021
Published: 21/05/2021

Abstract

OBJECTIVES:
To 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.
METHODS:
We 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.
RESULTS:
The 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.
CONCLUSIONS:
COVID-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.

Rheumatology Article

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