Autoimmune rheumatic manifestations in a cohort of Egyptian COVID-19 patients

The coronavirus disease 2019 (COVID-19) pandemic had significant global health impact. Like systemic autoimmune diseases, COVID-19 may manifest with systemic and heterogenous clinical presentations. This study aimed to evaluate the prevalence of autoimmune rheumatic manifestations among a cohort of Egyptian patients with COVID-19 infection. The study included 90 adult confirmed COVID-19 patients as determined by the polymerase chain reaction test. They were subjected to the following assessments: detailed medical history, full clinical and rheumatological examination, routine laboratory investigations, a panel of autoimmune markers, and high-resolution computed tomography chest. Then the patients studied were divided according to the positivity of autoimmune markers into positive and negative groups. According to the COVID-19 disease severity, patients were divided into mild, moderate, severe, and critical groups. The mean age of the study population was 54.60 ± 10.72 years, and 53.3% of them were females and 46.7% males. Of the patients studied 13.3% had positive antinuclear antibodies (ANA), 15.6% positive for rheumatoid factor (RF), 8.9% positive for anticardiolipin (ACL) IgM, and 5.6% positive for ACL IgG. The autoimmune markers were not statistically different however, all cases with positive ANA were present among severe and critical COVID-19 cases. All cases with positive RF, ACL IgM, or ACL IgG were found among moderate, severe, and critical patients. In conclusion, COVID-19 disease is associated with variable autoimmune manifestations. Autoimmune rheumatic manifestations, either clinical or autoimmune markers, are more evident in severe and critical COVID-19 cases. COVID-19 patients with positive ANA or RF are more likely to develop cutaneous, musculoskeletal, and vascular manifestations.