Particularities regarding Clinical-biological and Evolutive Parameters of Immune-mediated Rheumatic Diseases in Patients with COVID-19 – systematic literature review
Authors: Trandafir Andreea Iulia , Onose Gelu , Munteanu Constantin , Băila Mihai , Saglam Ali-Osman , Mandu Mihaela , Săulescu Ioana , Grădinaru Elena , Bojincă Violeta-Claudia 
Published: July 2023

Background: Since its outbreak in 2019, Coronavirus disease 2019 (COVID-19)/Severe Acu-te Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was a serious medical threat and was declared Global Pandemic, triggering fear, panic and uncertainty for people around the Globe. Among those individuals, there is a specific category of patients – the ones with immune-mediated rheumatic diseases (IMIDs) – whose mantra from the diagnosis was to avoid infections at all costs because of the additional negative impact on the immune sys-tem and overall reactivity. Objective: Considering the aforementioned, our objective is to understand the in-depth relation of the immune system of patients with IMIDs in the set-ting of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and the real bur-den of the disease and vaccination against COVID-19. Materials and Methods: In this res-pect, we have conducted a thoroughly systematic literature review according to the “Prefer-red Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” concept. Following its five-steps algorithm, we first selected 745 articles that were published in re-putable international medical databases, ISI-indexed, for the period 1 January, 2021–31 December, 2022. After consequent elimination of duplicates, of articles that were not En-glish-written and “open access” and then applying PEDro classification/scoring-inspired, only 58 articles were selected for in-depth full qualitative reading. In the last stage,20 arti-cles were “excluded with reasons”, because they didn’t offer significant information. The-refore, in our systematic literature review, 38 articles were included.Results: In the data gathered in this review we described the molecular pathways of activation of the immune system triggered by COVID-19, with significance on the clinical and paraclinical aspects of IMID patients infected with the new Coronavirus. Patients with IMIDs are at higher risk for hospitalization if diagnosed with SARS-CoV2 and more prone to severe outcomes and death. Risk factors associated with severe outcomes and death are: age, comorbidities, un-derlying disease activity, therapies used (“the good” being anti-tumor necrosis factor α, “the bad” – Methotrexate, Sulfasalazine, Azathioprine and “the ugly” – anti CD20 mono-clonal antibodies). There were several reports of flares and new-onset of IMIDs after CO-VID-19 and after vaccination against this disease, but data from larger studies and registri-es do not confirm higher incidence of flare-ups or new-onset IMIDs. Regarding vaccination, of mounting importance is the timing between immunomodulatory and immunosuppres-sive agents and the administration of the vaccine. And last but not the least, we discussed about Long COVID and the role of artificial intelligence in the pandemic and related-drug development. Discussion and Conclusion: The data in our systematic literature review is consistent with the expertise from our clinical practice. This article is the first part of the doctoral study that is centralized on the same topics, with the current objective of deepe-ning the knowledge about the intersection of COVID-19/SARS-CoV2 and immune-mediated rheumatic diseases and a future objective: to compare information we have synthetized here with our database of almost 170 Romanian patients with a IMID and COVID-19/SARS-CoV2. The next objective is to extend the study to a multicenter control one.
Keywords: SARS-CoV2, COVID-19, Immune Mediated Rheumatic Diseases, Rheumatoid Arthri-tis, Systemic Lupus Erythematosus, COVID-19 Vaccine, Long COVID