Abstract
ObjectivesImpact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on individuals with arthritis has been highlighted whereas data on other rheumatic diseases, e.g., systemic lupus erythematosus (SLE), are scarce. Similarly to SLE, severe SARS-CoV-2 infection includes risks for thromboembolism, an unbalanced type I interferon response, and complement activation. Herein, SARS-CoV-2 antibodies in longitudinal samples collected prior to vaccination were analyzed and compared with SLE progression and antinuclear antibody (ANA) levels.MethodsOne hundred patients (83 women) with established SLE and a regular visit to the rheumatologist (March 2020 to January 2021) were included. All subjects donated blood and had done likewise prior to the pandemic. SARS-CoV-2 antibody isotypes (IgG, IgA, IgM) to the cell receptor-binding S1-spike outer envelope protein were detected by ELISA, and their neutralizing capacity was investigated. IgG-ANA were measured by multiplex technology.ResultsDuring the pandemic, 4% had PCR-confirmed infection but 36% showed SARS-CoV-2 antibodies of ≥1 isotype; IgA was the most common (30%), followed by IgM (9%) and IgG (8%). The antibodies had low neutralizing capacity and were detected also in prepandemic samples. Plasma albumin (p = 0.04) and anti-dsDNA (p = 0.003) levels were lower in patients with SARS-CoV-2 antibodies. Blood group, BMI, smoking habits, complement proteins, daily glucocorticoid dose, use of hydroxychloroquine, or self-reported coronavirus disease 2019 (COVID-19) symptoms (except fever, >38.5°C) did not associate with SARS-CoV-2 antibodies.ConclusionOur data from early 2021 indicate that a large proportion of Swedish SLE patients had serological signs of exposure to SARS-CoV-2 but apparently with a minor impact on the SLE course. Use of steroids and hydroxychloroquine showed no distinct effects, and self-reported COVID-19-related symptoms correlated poorly with all antibody isotypes.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic has caused disastrous effects worldwide and posed enormous challenges to healthcare
To gain an increased understanding of the immune response towards SARS-CoV-2 in patients with systemic lupus erythematosus (SLE), we focused on the following aims: (I) to assess to which extent well-characterized cases with established SLE have been exposed to, and managed to mount an IgG, IgA, or IgM antibody response to, SARS-CoV-2 during the first year of the pandemic; (II) to investigate the neutralizing capacity of the detected SARSCoV-2 antibodies; and to evaluate if the serological signs of COVID-19 were related to (III) progression of SLE or (IV) antinuclear antibody (ANA) levels and (V) the use of immunomodulatory drugs
The present study was primarily undertaken to extend our knowledge of the adaptive immune response against SARS-CoV2 in patients with established SLE, of which the great majority (92%) were taking immunosuppressive or immunomodulatory drugs
Summary
The coronavirus disease 2019 (COVID-19) pandemic has caused disastrous effects worldwide and posed enormous challenges to healthcare. COVID19 has been associated with activation of the complement system as well as the development of autoantibodies in hospitalized patients; manifest autoimmune disease related to these newfound autoantibodies and complement consumption has been observed [15,16,17,18]. Another feature of COVID-19, resembling SLE and antiphospholipid syndrome (APS), is the increased risk of thromboembolic events [15, 19]. In multiple sclerosis (MS), the use of rituximab (anti-CD20) is associated with a two to threefold higher risk for severe COVID-19, and the risk increases with the duration of rituximab therapy [20]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
