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Emily Oakes

Pronouns

She/Her/Hers

Job Title

Research Assistant II

Academic Rank

Department

Rheumatology

Authors

Emily G. Oakes, Jack Ellrodt, Roberta Vezza Alexander, John Conklin, May Choi, Hongshu Guan, Sara Tedeschi, Jeffrey Sparks, Siobhan Case, Tiffany Hsu, Daniel H. Solomon, A. Helena Jonsson, Karen H. Costenbader

Principal Investigator

Karen H. Costenbader, MD, MPH

Research Category: Allergy, Immunology, Inflammation, and Infectious Diseases

Tags

Autoimmune Serologies, Cell-Bound Complement Activation Products, and Autoimmune Rheumatic Disease Symptoms after COVID-19 Infection

Scientific Abstract

Background: We examined common autoimmune rheumatic disease symptoms, serologies, and complement activation arising after COVID-19 infection.

Methods: We conducted a cross-sectional prospective study. Patients ≥3 months post-infection received the CTD Screening Questionnaire (CSQ). Subjects with evidence of new-onset CTD symptoms and no CTD diagnosis (CSQ+) completed a physician exam and blood draw testing autoimmune serologies and CB-CAPs. We invited age- and sex-matched subjects who had COVID-19, negative CSQs, and no CTD (CSQ-) for blood collection. Associations were tested by Fisher exact test.

Results: 19 CSQ+ and 22 CSQ- subjects were enrolled. Age and sex were well-matched. At infection, 4.9% of subjects were vaccinated and 14.6% were hospitalized (Table 1). Joint pain (36.8%), shortness of breath (36.8%), and non-malar rash (42.1%) were common symptoms (Table 2). On exam, 4 cases of joint pain and 4 cases of non-malar rash were found. There was low prevalence of autoantibodies and no positive CB-CAPs. No significant associations were identified between new symptoms and autoantibodies, CB-CAPs, or MAP (Table 3).

Conclusion: We found overall low prevalence of CTD symptoms and CTD-related autoantibodies, and no associations between symptoms or exam findings and CTD autoantibodies/CB-CAPs. CSQ positivity post-COVID-19 may not be associated with CB-CAPs or CTD-associated autoantibodies.

Lay Abstract

Background: We examined common autoimmune rheumatic disease symptoms and autoantibodies arising post-COVID-19 infection.

Methods: We conducted a cross-sectional prospective study comparing matched individuals with and without connective tissue disease (CTD) symptoms post COVID-19 infection. All symptoms were self-reported by questionnaire. Patients with new-onset CTD symptoms and no history of CTD (CSQ+) received a physician exam and blood draw for autoantibodies associated with CTD. Patients without symptoms who had no history of CTD (CSQ-) received a blood draw only. Associations were tested by Fisher exact test.

Results: 19 CSQ+ and 22 CSQ- subjects were enrolled. Age and sex were well-matched. At infection, 4.9% of subjects were vaccinated and 14.6% were hospitalized (Table 1). Joint pain (36.8%), shortness of breath (36.8%), and non-malar rash (42.1%) were common new-onset symptoms (Table 2). On exam, 4 cases of joint pain and 4 cases of non-malar rash were found. There was low prevalence of autoantibodies. No significant associations were identified between new symptoms and autoantibodies (Table 3).

Conclusion: We found overall low prevalence of CTD symptoms and CTD-related autoantibodies, and no associations between symptoms or exam findings and CTD autoantibodies. CSQ positivity post-COVID-19 may not be associated with CTD-associated autoantibodies.

Clinical Implications

To our knowledge, this is the first study of CB-CAPs, a novel complement-based biomarker for SLE, in the context of COVID-19, which is thought to activate complement. These findings suggest that CSQ symptom positivity post-infection may not be associated with CB-CAPs or CTD-associated autoantibodies.