COVID-19 Symptoms & Treatments in Autoimmune Disease Patients

May 30, 2023

A recent paper published in the Virology Journal reviewed what is currently known about COVID-19 and autoimmune diseases. Authors of this article state that patients with most autoimmune conditions are generally at a higher risk of covid 19 infection. That being said, those with multiple sclerosis, psoriasis, vasculitis, and type 1 diabetes in particular may not have a higher risk of serious infection or hospitalization. Those with systemic lupus erythematosus, rheumatoid arthritis, myasthenia gravis, or scleroderma are thought to have an increased risk of serious infection, hospitalization, and mortality. For Type 1 diabetes, there is conflicting evidence as to the risk or protective nature of the autoimmune condition.

Drugs used to treat COVID-19 can impact autoimmune disease patients differently than the general population. In diabetic patients, Hydroxychloroquine decreases the rate of insulin degradation and can lead to hypoglycemia, while medications such as glucocorticoids and antivirals like Ritonavir and Lopinavir can lead to hyperglycemia. Hydroxychloroquine and Azithromycin have both been shown to increase the risk of myasthenic crisis in patients with myasthenia gravis. 

Most treatments for autoimmune diseases have not been found to increase hospitalization rates following a COVID-19 infection nor are they associated with negative outcomes post-infection. Some treatments have even been shown to decrease hospitalization rates: TNF-inhibitors in vasculitis patients, Apremilast in psoriasis patients, and Tocilizumab in scleroderma patients. However with B-cell depleting therapies, Prednisone and Rituximab have all been implicated in higher hospitalization rates and/or negative outcomes. 

The COVID-19 pandemic decreased the access to medical care for those with autoimmune conditions due to lockdowns and an over-stretched healthcare system. This negatively impacted many patients and led to missed diagnoses of autoimmune conditions during this time. Those with autoimmune diseases are known to be at higher risk of mental health problems and pandemic isolation, illness, and fear of infection have exacerbated the issue.