Rheumatic Diseases & Covid 19

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Rheumatic Diseases & Covid 19

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Study shows low incidence of COVID-19 infection in people with rheumatic diseases

11/6/20


https://www.news-medical.net/news/20201 ... eases.aspx


A new study shows that the COVID-19 infection incidence has been low in people with rheumatic diseases, and most of those infected experience a mild course of illness. Additionally, fatalities have been low among rheumatic disease patients infected with COVID-19. Details of this research was presented at ACR Convergence, the American College of Rheumatology's annual meeting (ABSTRACT #0008).

COVID-19 is the infectious disease caused by the novel coronavirus SARS-CoV-2. As the COVID-19 pandemic surged worldwide in early 2020, the risk of serious infection, complications or fatality was unknown for people with rheumatic disease. Many patients with rheumatic disease are treated with immunosuppressant medications that leave them more susceptible to infection.

As the pandemic began, it was unclear how people with rheumatic diseases, on immunosuppressant therapy, were affected by a COVID-19 infection. Some early studies even suggested that these drugs could have a protective effect, but concerns remained about the vulnerability of this patient population. To learn more, researchers conducted a systematic review of studies that reported outcomes of COVID-19 infection among patients with rheumatic diseases who were taking biologic and targeted therapies.


" When the pandemic started, there was concern on whether to continue or hold immune therapies among patients with rheumatic diseases because they are at increased risk for infection. We were interested to see if these patients are at an increased risk for COVID-19 infection. If they were to become infected, we wanted to know the severity of their clinical course. This can help us to determine whether it is safe to continue or hold immune therapies in setting of COVID-19 infection."

- Akhil Sood, MD, study's co-author, internal medicine resident in rheumatology, University of Texas Medical Branch in Galveston

The researchers systematically searched PubMed/Medline and Scopus to identify relevant studies from January to June 2020 that reported the outcomes of COVID-19 among patients with rheumatic disease. They extracted demographic information and patients' use of biologics or targeted therapy with Janus kinase (JAK) inhibitors. They measured the following COVID-19 outcomes: hospitalization, admission to an ICU and death. Based on their clinical symptoms, patients were split into two groups: severe, or having increased risk of respiratory failure or life-threatening complications or non-severe.

The final review included 6,095 patients with rheumatic diseases from eight observational cohort studies, with 28% having rheumatoid arthritis (RA) and 7% having psoriatic arthritis (PsA). Of the 6,095 patients, only 123 or 2% were positive or highly suspicious for COVID-19. Across all the studies used for the review, 68% of COVID-19 patients were taking biologics, with 31% taking anti-TNF drugs and 6% taking JAK inhibitors. Among those patients who were infected with the coronavirus, 91 or 73% were never hospitalized. Thirteen patients who were hospitalized required admission to an ICU and four patients died.

"In our analysis, there was a small number of patients on biologic and targeted therapies to make definite conclusions on whether to continue or hold therapies," says Dr. Sood. "We are waiting for additional extensive studies that include more patients with rheumatic disease on biologic and targeted therapies. Another area of interest for us is examining risk factors for severe COVID-19 infection in patients with rheumatic disease. We hope this can help us identify which patients to closely monitor and possibly develop precautions to mitigate their risk."

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American College of Rheumatology
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People of color with rheumatic disease have worse COVID-19 outcomes

11/6/20


https://www.news-medical.net/news/20201 ... comes.aspx


New research at ACR Convergence, the American College of Rheumatology's annual meeting, reveals that people of color with rheumatic disease have worse health outcomes from COVID-19 infection, are more likely to be hospitalized to treat their coronavirus infection, and are more likely to require invasive ventilator treatment (ABSTRACT #0006).

COVID-19 is the disease caused by the novel SARS-CoV-2 coronavirus. As part of the response to the global pandemic, the rheumatology community launched the COVID-19 Global Rheumatology Alliance physician registry, an international collection of data on patients with rheumatic diseases who have been diagnosed with COVID-19. These data have been used for a number of studies that clarify how people with rheumatic diseases, many of whom take immunosuppressant drugs to control their conditions, are affected by COVID-19.

People with rheumatic disease, particularly those on immunosuppressants, are may be at higher risk for severe infections. What doctors and their patients do not know is why.. This new study used the data collected in the registry to determine if patients are more likely to experience more severe outcomes from COVID-19, and to learn if COVID-19 health outcomes vary by race and ethnicity for patients in the United States (U.S.).


" At the time we were examining data from the registry, there was growing attention on the disproportionate impact of COVID-19 among racial/ethnic minorities in the U.S. We know that racial/ethnic minority rheumatic disease patients experience higher risk and disease severity in general. We were interested in examining whether the inordinate burden of COVID-19 also affected this susceptible population. Understanding disparities in COVID-19 outcomes can help us identify vulnerable populations and ensure that patients at high risk are adequately tested and treated."

- Milena Gianfrancesco, PhD, MPH, Study Co-Author, Assistant Adjunct Professor at the University of California, San Francisco School of Medicine

The study included 694 U.S. patients who were defined as white, Black, Latinx or other race/ethnicity from the global rheumatology registry from March 24 to May 22, 2020. The researchers examined COVID-19 outcomes, including whether patients were hospitalized, required ventilation support such as supplementary oxygen and/or invasive ventilation, and if they died or survived their coronavirus infection. They controlled the data for age, sex, smoking status and rheumatic disease diagnoses (including rheumatoid arthritis, lupus, psoriatic arthritis, ankylosing spondylitis and others). They also controlled data for other common health problems that affect people with rheumatic diseases, such as cardiovascular disease, hypertension, lung disease, diabetes, and chronic renal insufficiency or end-stage renal disease. They also looked at arthritis medications that patients used, including immunosuppressants. The study's data also included each patient's level of rheumatic disease activity, or if their inflammatory arthritis was in remission, low, moderate or high.

According to the study's findings, people with rheumatic disease who are of racial or ethnic minorities were more likely to experience poor health outcomes from COVID-19 infection, including hospitalization and necessary ventilation support, compared to white patients. Black and Latinx patients had 2.7 and 1.98 higher odds, respectively, of needing hospitalization for COVID-19 compared to whites. Black and Latinx patients had threefold increased odds of needing ventilation support compared to whites. The study found no differences in mortality rates based on race or ethnicity.

"Bringing these results to light will hopefully lead to actionable changes within the rheumatology community and beyond," says Dr. Gianfrancesco. "We need to be sure that patients who are at high risk of severe COVID-19 outcomes have access to testing, treatment and a vaccine when one is eventually available. I would also add that rheumatology providers can be advocates and trusted allies for their patients. They can ensure that patients are aware of disease risks by providing materials in multiple languages."

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American College of Rheumatology
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Survey: Only few children with rheumatic diseases report contracting COVID-19

11/6/20


https://www.news-medical.net/news/20201 ... ID-19.aspx


Results from a large, international survey shows that only a small fraction of children with rheumatic diseases reported contracting COVID-19. Those who did become infected with COVID-19 all had benign outcomes and did not develop significant complications, despite the fact that most children were taking immunosuppressive medications. The research was presented at ACR Convergence, the American College of Rheumatology's annual meeting (ABSTRACT #1685).

The most common pediatric rheumatic disease is juvenile idiopathic arthritis (JIA), which is a group of chronic conditions that cause arthritis (joint swelling and inflammation) affecting children and teenagers. JIA may involve one or many joints, may also affect the eyes, and cause other symptoms, such as fevers or rash.

As the COVID-19 pandemic surged worldwide in early 2020, the risk of COVID-19 and serious complications or death was unknown for children with rheumatic diseases. Many of these patients are treated with immunosuppressive medications that leave them more susceptible to infections.

" At the time, parents and physicians did not know whether to continue a child's immunosuppressive medications to prevent COVID-19 and related complications."

- Jonathan S. Hausmann, MD, Study's Co-Author, Instructor in Medicine at Harvard Medical School and a pediatric rheumatologist at Boston Children's Hospital

To learn more about the impact of COVID-19 on children with rheumatic diseases, Dr. Hausmann and his fellow researchers analyzed data from the international COVID-19 Global Rheumatology Alliance Patient Experience Survey, a global patient registry. They sent surveys to parents of children with rheumatic diseases through patient support organizations and social media. Parents provided information on their child's rheumatic disease diagnosis, medications, whether or not the child ever developed COVID-19 and any outcomes they experienced if they were infected.

The study collected data from April 3 to May 8, 2020 and includes 427 children under age 18. Most of the children in the study lived in the Americas, and were white, female and between 5 and 14 years old. Most had JIA, and they were taking either conventional synthetic or biologic disease-modifying antirheumatic drugs (DMARDs). Both classes of drugs suppress the immune system and help to control the arthritis, while also making children at increased risk of infection. The survey also included children with other pediatric rheumatic diseases such as lupus, dermatomyositis, and autoinflammatory diseases.

Among the 427 children in the study, only five, or 1.2%, were diagnosed with COVID-19, none of whom required hospitalization or had severe outcomes. Because the study is based on self-reported responses from parents who were engaged in social media or who were willing to fill out a survey, it may not fully represent all children with pediatric rheumatic diseases, and it may be more likely to include a healthier population, the researchers say.

"These findings are important as policymakers and educators contemplate reopening schools with the pandemic still ongoing, and with parents and physicians struggling to make decisions of whether to send their children back to school," says Dr. Hausmann. "Our study suggests that children with rheumatic disease should continue their immunosuppressive drugs during the pandemic, as it does not appear to place them at increased risk of COVID-19 related complications. Our findings support the recent ACR guidelines for managing immunosuppression during the pandemic."

Next, this research group plans to develop a prospective, international registry of people with rheumatic disease of all ages to assess long-term outcomes of the COVID-19 pandemic, explore the willingness to receive and assess the efficacy of a vaccine, assess the impact of the environment on COVID-19, and track the effects of the pandemic on the physical and mental health of participants over time, he adds.

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American College of Rheumatology
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Re: Rheumatic Diseases & Covid 19

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Patients with rheumatic diseases reported antimalarial drug shortages during COVID-19

11/6/20


https://www.news-medical.net/news/20201 ... ID-19.aspx


A new study shows that patients with rheumatic diseases across Africa, Southeast Asia, the Americas and Europe had trouble filling their prescriptions of antimalarial drugs, including hydroxychloroquine, during the 2020 global coronavirus pandemic, when antimalarials were touted as a possible COVID-19 treatment. Patients who could not access their antimalarial drugs faced worse physical and mental health outcomes as a result. Details of the research was presented at ACR Convergence, the American College of Rheumatology's annual meeting (ABSTRACT #0007).

Systemic lupus erythematosus, also called lupus or SLE, is a chronic (long-term) disease that causes systemic inflammation which can affect multiple organs: the skin, joints, kidneys, the tissue lining the lungs (pleura), heart (pericardium) and brain. Many patients experience fatigue, weight loss and fever. Antimalarial drugs are taken regularly by most people with lupus, as well as many with rheumatoid arthritis (RA) and other rheumatic diseases.


" In the early weeks of the global SARS-CoV-2 (COVID-19) pandemic, two antimalarial drugs often used to treat lupus and RA, hydroxychloroquine and chloroquine, were touted to potentially prevent or treat COVID-19 infections. Both drugs were suddenly repurposed as COVID-19 treatments despite a lack of data to support this use, leading to worldwide shortages of both. A team of international researchers launched this study to assess the effects of antimalarials on COVID-19 infection and the impact of drug shortages on people with rheumatic disease. The COVID-19 Global Rheumatology Alliance's Patient Experience Survey was launched in April 2020 during the early days of the pandemic, when the scientific and research communities were under extraordinary pressure to identify safe and effective treatments for SARS-CoV-2. Since hydroxychloroquine is an essential treatment for RA and lupus, reported drug shortages of antimalarials became a major concern,. The aims of this study were to assess the prevalence and impact of drug shortages during the COVID-19 pandemic, and whether the use of antimalarials in patients with rheumatic disease was associated with a lower risk of COVID-19 infection."

- Emily Sirotich, study's lead author, a doctoral student at McMaster Centre for Transfusion Research in Hamilton, Ontario. and Patient Engagement Lead of the COVID-19 Global Rheumatology Alliance

Data for the new study was collected using the COVID-19 Global Rheumatology Alliance Patient Experience Survey. The survey was distributed online through patient support organizations and social media. Both patients with rheumatic diseases and parents of pediatric patients anonymously completed the surveys with information on their rheumatic disease diagnosis, medications they take, COVID-19 status and any disease outcomes. The researchers evaluated the impact of antimalarial drug shortages on patients' disease activity, as well as their mental health and physical health.

Of the 9,393 people who responded to the survey, 3,872 were taking antimalarial drugs and 230 said they were unable to continue taking their medications because of a lack of supply at their pharmacy. Antimalarial shortages were worse for people in Africa and Southeast Asia: 26.7% of respondents in Africa and 21.4% of respondents in Southeast Asia reported inadequate supplies at local pharmacies. Patients in the Americas (6.8%) and Europe (2.1%) also reported being unable to fill their prescriptions at their pharmacy due to lack of supply.

The study found that patients on antimalarials and those who did not take these drugs had similar rates of COVID-19 infection. A total of 28 patients with COVID-19, who were also taking antimalarials, were hospitalized. Of 519 patients diagnosed with COVID-19 in the survey, 68 reported that they were prescribed an antimalarial for their coronavirus infection. Patients who could not fill their antimalarial prescriptions experienced higher levels of disease activity and also experienced worse mental and physical health symptoms, the study found.

"The findings from this study highlight the harmful consequences of repurposing antimalarials, without adequate evidence for benefit, on patients who rely on access to their hydroxychloroquine or chloroquine prescriptions for their rheumatic diseases," says Ms. Sirotich. "It is necessary to maintain scientific rigor even in the context of a pandemic and recognize the potential impacts of drug shortages. It is also important to address regional disparities in access to medications, to ensure all people, particularly those living in developing countries, receive fair and equitable access to their essential medications."

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American College of Rheumatology
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Lupus patients receiving prophylactic therapy are at high risk for adverse reactions

11/6/20


https://www.news-medical.net/news/20201 ... tions.aspx


New research shows that adults with systemic lupus erythematosus, who receive trimethoprim-sulfamethoxazole (TMP-SMX), a prophylactic therapy to help prevent pneumocystis pneumonia, are at high risk for adverse reactions to the drug, particularly if they are also positive for anti-Smith (anti-Sm) antibodies. Details of the study was presented at ACR Convergence, the American College of Rheumatology's annual meeting (ABSTRACT #1830).

Systemic lupus erythematosus, referred to as SLE or lupus, is a chronic (long-term) disease that causes systemic inflammation which affects multiple organs. In addition to affecting the skin and joints, it can affect other organs in the body such as the kidneys, the pleura tissue lining the lungs, or the heart and brain. Many patients with lupus experience fatigue, weight loss and fever.

Pneumocystis pneumonia, is an infection that can be life-threatening for people whose immune systems are suppressed by medications for autoimmune diseases, including connective tissue diseases. These patients may be treated with drugs like steroids or other immunosuppressants. One way to help prevent pneumocystis pneumonia infection is prophylactic treatment with the drug TMP-SMX, which is an antibiotic used to treat a variety of bacterial infections. It is effective but can cause adverse drug reactions in people with connective tissue diseases, and past research shows that people with SLE are at especially high risk for these serious reactions to the drug.


" Patients with moderate to severe SLE usually require a high dose of corticosteroid and various types of immunosuppressants, creating a risk of developing pneumocystis pneumonia. Unlike patients with HIV, who are also at high risk of pneumocystis pneumonia, patients with connective tissue diseases such as SLE are at risk for fatality when developing this infection so prophylaxis is important. Moreover, due to the COVID-19 pandemic, it is important to prevent pneumocystis pneumonia for patients on immunosuppressants, because the symptoms and image findings are similar to COVID-19. Fortunately, TMP-SMX can prevent pneumocystis pneumonia effectively."

- Shinji Izuka, MD, study's co-author, rheumatologist and researcher, National Centre for Global Health and Medicine in Tokyo

Because past studies suggested that lupus patients were at higher risk of adverse reactions to the drug, Dr. Izuka's group launched this study to confirm the risk and discover any specific risk factors. among people with SLE and other connective tissue diseases.

The researchers examined their hospital's in-patient database for records of patients with connective tissue diseases who were administered TMP-SMX as a prophylactic agent against pneumocystis pneumonia between January 2009 and April 2020. The baseline data was obtained at the time that TMP-SMX was started. They excluded patients with HIV and anyone who did not suffer adverse drug reactions within one month. They compared adverse reaction prevalence between people with lupus and those with other connective tissue diseases and also analyzed the data for any specific risk factors in lupus patients.

The 427 patients in the study included 164 with lupus, while the rest had another connective tissue disease, such as polymyositis or dermatomyositis, Sjögren's syndrome, systemic sclerosis, mixed connective tissue disease and different forms of vasculitis. Forty, or 9.4%, of patients developed an adverse drug reaction to TMP-SMX, including 10 with thrombocytopenia, nine with skin rash, seven with a liver function test abnormality, seven with fever, and 12 with other reactions.

People with lupus were more likely to have an adverse drug reaction: 13.4% compared to 6.9% in the control group patients. Their odds ratio of developing an adverse drug reaction was 2.12. When the researchers performed univariate analysis to look for risk factors, they found that lupus patients with anti-Sm, anti-RNP and anti-Ro/SS-A antibodies were significantly associated with higher risk of an adverse drug reaction. Then, they performed multivariate analysis and found that only anti-Sm antibodies was significantly associated with higher risk in people with lupus.

Due to these increased risks, patients with SLE who receive prophylactic TMP-SMX should be carefully monitored for any adverse reaction to the drug, especially those with anti-Sm antibodies, the researchers concluded.

"In these cases, it might be better to choose other options," says Dr. Izuka. "The important thing is, however, that there were no patients in our study who developed severe conditions, such as Stevens-Johnson syndrome, due to adverse drug reactions to TMP-SMX. We should not hesitate to initiate TMP-SMX for those who require it. The mechanisms of the association between adverse drug reactions and anti-Sm antibody remains unclear. Further study to identify them and other unrevealed factors is needed. Also, we should clarify the best way to prevent pneumocystis pneumonia for SLE patients with anti-Sm antibody and other autoantibodies for safety and efficacy."

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American College of Rheumatology
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Re: Rheumatic Diseases & Covid 19

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Study: Hydroxychloroquine has no effect on abnormal heart rhythm in lupus patients with CKD

11/9/20

https://www.news-medical.net/news/20201 ... h-CKD.aspx


New research shows that adults with lupus who take the antimalarial drug, hydroxychloroquine, do not have any differences in their corrected QT (QTc) intervals, an electrocardiogram (EKG) measurement of the heart's electrical signals, even if they have chronic kidney disease (CKD), a complication of lupus that can be associated with increased levels of the medication.

The study was presented at ACR Convergence, the American College Rheumatology's annual meeting (ABSTRACT #1844).

The systemic lupus erythematosus (SLE or lupus) is a chronic (long-term) disease that causes systemic inflammation which affects multiple organs. In addition to affecting the skin and joints, it can affect other organs in the body such as the kidneys, the tissue lining the lungs, heart, and brain. Many patients experience fatigue, weight loss, and fever.

Current lupus treatment recommendations include hydroxychloroquine for all patients. It is well tolerated and considered low risk for side effects.

The drug can produce a delay in the heart's electrical conduction system, but prior studies found no association with symptoms or a serious risk of abnormal heart rhythm. However, one concern is that in lupus patients with decreased kidney function, higher levels of hydroxychloroquine may be more likely to affect the heart.

One way to assess the heart's electrical signaling is the QTc interval measurement on an EKG. It measures how long it takes the heart to contract and relax on each heartbeat. People with prolonged QT intervals are at higher risk for heart arrhythmias, which are irregular heartbeats, that could be life-threatening.

This new study compared QTc intervals in adults with lupus based on their use of hydroxychloroquine, and if they did or did not have chronic kidney disease.

" Hydroxychloroquine use increased during the COVID-19 pandemic, with some contradictory reports regarding its cardiac safety. It is important to provide reassurance to lupus patients who need to take this medication regularly and for long periods that it is generally safe and without consequential risk for serious heart toxicity."

- H. Michael Belmont, MD, Study Co-Author and Co-Director, Professor of Medicine, NYU Grossman School of Medicine, NYU Langone Health's Lupus Center, New York University

There were 194 patients with lupus included in the study, which used retrospective data from the electronic medical records database at NYU Langone Health from March 2012 through May 2020.

The researchers collected data on patients' EKG results, including the QTc intervals from their first and last EKGs. Prolonged QTc intervals are more than 450 milliseconds for males and more than 470 milliseconds for females. Severe prolongation is more than 500 milliseconds.

The researchers also looked at patients' creatinine levels and demographics, and whether or not they had CKD.

Only 90 people in the study had taken at least one EKG during this period, and of these, 91% were female, 32.2% were African American, 6.6% were Asian, 28.8% were white, 20% were Hispanic, and 2.2% were of other races. Seventy-five were taking hydroxychloroquine, while 15 were not on the drug. Eight out of 75 patients who were on hydroxychloroquine had prolonged QTc intervals, and only one of the 15 people not taking the drug had a prolonged interval.

There was no significant difference in mean QTc intervals based on hydroxychloroquine treatment.

What about lupus patients with CKD? The 23 patients with chronic kidney disease in the study did not have any significant differences in their mean QTc intervals either, whether or not they were taking hydroxychloroquine.

None of these patients had any documented tachyarrythmia, or more rapid than normal heart rate, or Torsades de pointes (Tdp), a potentially life-threatening arrhythmia.

"The findings of this study can provide some comfort to lupus patients including those with CKD that hydroxychloroquine is not likely to produce serious heart arrhythmias," says Dr. Belmont. "Future studies could investigate these observations in even larger numbers of patients and include a prospective examination of QTc intervals in patients before and after starting the medication to provide even further assurance of drug safety."

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American College of Rheumatology
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Re: Rheumatic Diseases & Covid 19

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Juvenile inflammatory rheumatic disease associated with higher antibody responses to seasonal coronaviruses

2/19/21


https://www.news-medical.net/news/20210 ... ruses.aspx


The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogen behind the current coronavirus disease 2019 (COVID-19) pandemic is a coronavirus of the betacoronavirus family. However, there are other human seasonal coronaviruses that cause endemic human infection, with mild common cold symptoms. The spectrum of SARS-CoV-2 infection also ranges from mild symptoms like a runny nose, nasal congestion or mild fever, to severe gastrointestinal or respiratory disease, sometimes terminating in multi-organ failure.

SARS-CoV-2 vs HCoV-OC43 infection


The complications of COVID-19 are observed in less than a tenth of patients, with risk factors for these including male sex, advanced age, ethnic background, lack of healthcare access, and pre-existing conditions. The majority of infections are asymptomatic.

Children are more likely to be asymptomatic. In contrast, they are at higher risk of harboring one of the seasonal human coronaviruses (HCoVs) and are more likely to have pre-existing antibodies and memory B cells.

Children have also been found to develop the multisystem inflammatory syndrome (MIS), thought to be a little-understood inflammatory complication reflecting the dysregulation of the antibody response following COVID-19.

Risk of COVID-19 in juvenile inflammatory conditions

Children with inflammatory rheumatic disorders, such as juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM) and juvenile systemic lupus erythematosus (JSLE), were thought to be at high risk of COVID-19 because of uncontrolled antibody and inflammatory responses, as well as the fact that they were often on immunosuppressive treatment. However, specific information was lacking.

A new study released on the bioRxiv* server compared the antibodies produced in young patients with these three conditions against the two immunodominant coronavirus antigens, the spike and the nucleocapsid antigens. The researchers chose to study patients with infection to one of the seasonal HCoVs, HCoV-OC43, which is quite common in this group, where SARS-CoV-2 infections are rare due to shielding.

The underlying premise is that HCoV-OC43 can elicit not only antibodies specific to its antigens, but also cross-reactive antibodies to SARS-CoV-2. The study aims to understand this antibody response as a proxy for the humoral response against coronavirus infections, in general.

It is thought that the currently circulating SARS-CoV-2 virus will likely become an endemic infection, similar to current HCoVs. In fact, HCoV-OC43 has a history of mutations that suggests it recently jumped the species barrier to infect humans. In that case, it would indicate the possibility that this virus did initially cause a major epidemic.

For this reason, the current study could help uncover the response to SARS-CoV-2 as well when this becomes endemic.

Antibody responses to HCoV-OC43 spike

The study shows that IgG was the primary antibody response to the spike antigen, making up almost 70% and 60% of all antibodies to HCoV-OC43 and SARS-CoV-2, respectively. The remainder was made up of IgM antibodies, with IgA being the least abundant.

Most healthy children and adolescents had IgGs to the HCoV-OC43 spike, but the proportion with detectable SARS-CoV-2 spike antibodies was small, and the titer was much lower. The same profile was found in patients with JIA, JDM and JSLE.

However, the proportion of JDM and JSLE patients with IgGs against HCoV-OC43 spike was much higher than controls. JSLE patients also had a higher prevalence of IgGs against SARS-CoV-2 spike compared to healthy controls.

After classifying JSLE by age into those 1-12 years old and 13-18 years, the researchers found that younger patients with JIA and JDM had higher anti-HCoV-OC43 spike IgGs relative to older patients and controls. Even though patients with JSLE were typically older than pediatric patients with the other two conditions, they also had higher total and IgG anti- HCoV-OC43 spike antibodies.

IgA anti- HCoV-OC43 spike antibodies increased in all JSLE patients and the older JIA patients.

Antibodies against SARS-CoV-2 spike

All three classes of patients showed antibodies to the SARS-CoV-2 spike, though the titer was lower and the correlation with HCoV-OC43 spike antibodies low. JSLE patients, and younger patients with JIA, had higher IgG titers against the SARS-CoV-2 spike. Older JIA patients had below average anti-SARS-CoV-2 antibody titers.

After adjusting for the female sex, older age, steroid use and the year of collection, HCoV-OC43 spike antibodies were still higher in JSLE patients, and IgG HCoV-OC43 spike in younger patients with any of the three conditions.

Females and those on steroids had higher antibody titers. Steroid use may indicate more severe rheumatic disease but may also indicate immune dysregulation, especially in patients with JSLE.

After adjusting for confounding factors, total antibodies to SARS-CoV-2 spike were lower in JDM, but IgG levels were higher in JSLE patients. Both total and IgG SARS-CoV-2 spike antibodies were higher in younger patients and those who had autoantibodies.

Association with autoantibodies

The association between SARS-CoV-2 spike and HCoV-OC43 spike antibodies, with the presence of autoantibodies, gains significance when the presence of a comparable association between these spike antibodies and antibodies to HERV-encoded envelope glycoproteins, also essentially autoantibodies, is taken into account. This could indicate that the higher spike antibody levels in these patients reflect a fundamental overactivity of adaptive immunity.

Neutralizing titers were similar for all three conditions when assessed in most sera with cross-reactive SARS-CoV-2 IgGs. Neutralizing capacity bore a weak relation to antibodies to the SARS-CoV-2 spike but not IgGs against the HCoV-OC43 spike.

“Our findings suggest that inflammatory rheumatic diseases do not impede humoral immunity to a seasonal HCoV in this age group and may even enhance it.”

Coronavirus nucleoproteins stimulate mostly IgM responses


Younger patients with any of these conditions had higher IgG responses to the spike protein, which could be the result of exaggerated immune responses or a higher viral load because of immunosuppressive therapy. To explore this, the researchers measured antibodies to the nucleoprotein (N), which typically does not produce neutralizing antibodies. This would therefore provide a clearer idea of viral replication.

They found that most anti-N antibodies belonged to the IgM subclass, at 82% and 67% of total antibodies to the HCoV-OC43 and SARS-CoV-2 N proteins, respectively. In contrast, healthy adult controls produced both IgG (30%) and IgM (62%) antibodies to the HCoV-OC43 N protein.

Healthy pediatric controls, conversely, produced only 9% IgG, but 85% IgM to the HCoV-OC43 N protein. This shows that the coronavirus N protein stimulates an IgM-dominated response with a slow class-switching to IgG with increasing age.

In younger patients with JDM and JIA, both total and IgM antibodies to the N protein were reduced.

These findings show the difference in the antibody response in younger patients exposed to the coronavirus spike and N protein. The two are not correlated strongly. This could mean that either could be immunodominant in each individual patient.

However, with all disease groups, spike antibodies were at a higher ratio to N antibodies, irrespective of the virus tested (HCoV-OC43 or SARS-CoV-2). This was more likely with females and steroid treatment but less with old age. This indicated lower viral exposure and less risk of an adverse outcome.

What are the implications?


This study looks at the differences in the antibody response to coronaviruses in adults and children and the impact of underlying immunosuppression. The researchers found that in younger patients with JIA, JDM and JSLE, the antibody responses were similar or stronger than in healthy controls.

With HCoV-OC43 spike, IgGs were dominant, but there were also cross-reactive IgGs against SARS-CoV-2. However, antibody production against these two virus nucleoproteins showed a slow class-switching that occurred with age, and was not elevated from the baseline in patients with these conditions.

This indicates that the reason for the higher antibody response in these patients was not increased exposure. The outcome was a favorable ratio of spike to nucleoprotein antibodies.


" If the response to SARS-CoV-2 or vaccination can be inferred from the response to HCoV-OC-43, together with the presence of pre-existing cross-reactive antibodies to SARS-CoV-2, the data suggest that pediatric and adolescent patients with the most common inflammatory rheumatic diseases would mount a highly effective humoral response against SARS-CoV-2 infection or vaccination.”

*Important Notice

bioRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:

Deakin, C. et al. (2021). Favourable antibody responses to human coronaviruses in children and adolescents with autoimmune rheumatic diseases. bioRxiv preprint. doi: https://doi.org/10.1101/2021.02.15.431291, https://www.biorxiv.org/content/10.1101 ... 5.431291v1
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