الفهرس 
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Abstract
S
UMMARY
OVID-19 is a novel pandemic that has had significant global health consequences. Similar to systemic autoimmune diseases, COVID-19 can present with heterogeneous and systemic clinical manifestations.
To some extent, there are similarities in the immune response in both disease conditions, and organ damage in COVID-19 appears to be largely immune-mediated, similar to autoimmune diseases. The SARS-CoV-2 virus can disturb self-tolerance of host antigens at least in part through molecular mimicry, bystander activation, cytokines release and autoantibodies formation.
In this study we aimed to assess the prevalence of autoimmune rheumatic manifestations in a cohort of Egyptian COVID-19 patients.
Ninety adult COVID-19 patients confirmed with PCR test,were enrolled in the current study.They were recruited during the 2nd wave in late 2021 and early 2022. All were subjected to the following; a full history taking with special emphasis on history of COVID-19 and autoimmune manifestations, through clinical and musculoskeletal examination and laboratory investigations: CBC, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)with titer, liver functions, kidney functions, Serum Ferritin, D-dimer, LDH, CK T, CK MB, HCV antibodies
C
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and autoimmune markers such as (ANA, ACL IgG, IgM, RF), HRCT chest. The studied patients then were divided according to the positivity of autoimmune markers into positive and negative groups and according to severity of COVID-19 disease into mild, moderate, severe and critical groups.
In the present study the age of patients ranged from 21-65 years, with female to male ratio of about 8:7.Most of the patients 80% had multiple co-morbidities; (DM(43.3%), HTN (53.3%), CKD (6.7%), ISHD (14.3%), COPD (3.3%), Asthma (4.4%), AF (8.9%), HF(4.4%)) and 20% had no comorbidities.
As regard laboratory data this study revealed that (96.7%) of the studied patients had high CRP, (82.2%) of patients had lymphopenia, (78.9%) of patients had hyperferritenemia, (76.7%) of patients had high level of LDH, (72.2%) showed high D-dimer and (32.2%) had high creatinine level.Anemia, thrombocytopenia and leukopenia were reported in (45.6%), (31.1%), (16, 7%) respectively.
By comparing laboratory data in all severity groups, our study exhibited statistically significant higher percentages of COVID-19 patients that developed thrombocytopenia (45.2%) and high creatinine level (45.2%) among critical group than in mild, moderate, and severe groups.
Regarding autoimmune rheumatic manifestations of COVID-19, it’s noteworthy that this study revealed that
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(77.8%) developed myalgia, (57.8%) developed arthralgia, (20%) developed arthritis, (40%) developed skin rash especially malar rash with a percentage of (14.4%), (20%) developed chilblain, (10%) developed vasculitic rash and (11.1%) developed urticarial rash.
As we compared all severity groups of COVID-19 disease as regard clinical data, our novel study showed statistically significant higher percentages of COVID-19 patients that developed sore throat (78.6%), orthopnea (21.4%), hemoptysis (31%), chest pain (52.4%), hematuria (21.4%), oliguria (21.4), bleeding per orifices (26.2%), ecchymosis (64.3%), venous thrombosis (19%), abdominal pain (42.9%), oral ulcers (31%), dry eye and dry mouth (45.2%), skin rash (57.1%) and arthritis (33.3%) among critical group than in mild, moderate and severe groups.
Regarding the results of the autoimmune markers: (13.3%) of the studied patients had positive ANA, (15.6%) had positive RF, with (8.9%) and (5.6%) had positive ACL IgM and IgG respectively.There was no statistically significant difference between different severity groups as regard results of all autoimmune markers, however all cases with positive ANA were present among severe and critical COVID-19 cases and all cases with positive RF, ACL IgM, or ACL IgG were among moderate, severe, and critical cases.
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Severe and critical groups of COVID-19 patients were dealt as one group and compared statistically to mild and moderate groups as regard autoimmune markers, we found that there was a statistically significant higher percentage of COVID-19 with positive ANA among severe/critical group (20.3%) than in mild (0%) and moderate groups (0%).
Comparing positive and negative ANA groups as regard inflammatory markers, the current study showed statistically significant higher percentages of COVID-19 patients that developed thrombocytopenia (66.7%), elevated ALT (58.3%) in the positive ANA group than negative group but WBCs, Hemoglobin, PLTs, AST, serum creatinine, CRP, D-dimer and ferritin were non significant.
We found statistically significant higher percentages of COVID-19 patients with positive ANA that developed headache (91.%), nasal discharge (33.3%), loss of taste and smell (83.3%), chest pain (66.7%) pulmonary embolism (25%), hemorrhagic stroke (8.3%), oral ulcers (41.7%), genital ulcers (16.7%), photosensitivity (33.3%), skin rash (91.7%)especially malar rash (50%), arthralgia (100%)and arthritis (50%).
By comparing positive and negative ACL IgM and IgG groups as regard inflammatory markers there was no statistically significant difference.
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By comparing autoimmune rheumatic manifestations in positive and negative ACL IgM and IgG groups we found a statistically significant higher percentage that developed myocardial infarction (12.5%), maculopapular rash (25%), dry eye and dry mouth (62.5%), genital ulcers (25%) and arthritis (50%) being among positive ACL IgM group, and statistically significant higher percentages with positive ACL IgG that developed lower limp claudications (20%), myocardial infarction (20%), bloody diarrhea (20%) and genital ulcers (40%).
By comparing positive and negative RF groups as regard inflammatory markers there was no statistically significant difference.
By comparing autoimmune rheumatic manifestations in positive and negative RF groups the present novel study demonstrated that there was statistically significant higher percentages of COVID-19 patients that developed sore throat (85.7%), chest pain (64.3%), acute kidney injury (50%), lower limp claudications (14.3%), hemorrhagic stroke (7.1%) in the positive RF group than negative group.
The current novel study showed no statistically significant difference between patients with negative and positive ANA, ACL IgM, ACL IgG, RF groups as regard HRCT(CORADs) grade.