Minireviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2020; 8(17): 3669-3678
Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3669
Complexities of diagnosis and management of COVID-19 in autoimmune diseases: Potential benefits and detriments of immunosuppression
Tsvetoslav Georgiev, Alexander Krasimirov Angelov
Tsvetoslav Georgiev, Clinic of Rheumatology, University Hospital "St. Marina", First Department of Internal Medicine, Medical University - Varna, Varna 9010, Bulgaria
Alexander Krasimirov Angelov, Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical University - Sofia, Sofia 1612, Bulgaria
Author contributions: Georgiev T and Angelov AK contributed equally to the article by taking part in the conception and design of the study, literature search and review, and logical interpretation; Georgiev T drafted the introduction, search methodology, and diagnostic sections, while Angelov AK – the abstract, management and conclusion sections; both authors revised the manuscript critically for important intellectual content and approved the final version.
Conflict-of-interest statement: No conflict of interest to declare for both authors.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tsvetoslav Georgiev, MD, PhD, Assistant Professor, Doctor, Clinic of Rheumatology, University Hospital "St. Marina", First Department of Internal Medicine, Medical University - Varna, 1 Hristo Smirnenski str, Varna 9010, Bulgaria. tsetso@medfaculty.org
Received: May 16, 2020
Peer-review started: May 16, 2020
First decision: June 7, 2020
Revised: June 12, 2020
Accepted: August 26, 2020
Article in press: August 26, 2020
Published online: September 6, 2020
Processing time: 110 Days and 16.8 Hours
Abstract

Recent advances in our understanding of coronavirus disease 2019 (COVID-19) and the associated acute respiratory distress syndrome might approximate the cytokine release syndrome of severe immune-mediated disease. Importantly, this presumption provides the rationale for utilization of therapy, until recently reserved mostly for autoimmune diseases (ADs), in the management of COVID-19 hyperinflammation condition and has led to an extensive discussion for the potential benefits and detriments of immunosuppression. Our paper intends to examine the available recommendations, complexities in diagnosis and management when dealing with patients with ADs amidst the COVID-19 crisis. Mimicking a flare of an underlying AD, overlapping pathological lung patterns, probability of higher rates of false-positive antibody test, and lack of concrete data are only a part of the detrimental and specific characteristics of COVID-19 outbreak among the population with ADs. The administration of pharmaceutical therapy should not undermine the physical and psychological status of the patient with the maximum utilization of telemedicine. Researchers and clinicians should be vigilant for upcoming research for insight and perspective to fine-tune the clinical guidelines and practice and to weigh the potential benefits and detrimental effects of the applied immunomodulating therapy.

Keywords: Autoimmune diseases; Autoimmunity; COVID-19; Coronavirus; Serologic Tests; Cross reactions

Core tip: It is of utmost importance to differentiate coronavirus disease 2019 (COVID-19) manifestations from a relapse of the autoimmune disease. COVID-19 lung disease and interstitial lung disease may share similar pathological patterns. False positivity may complicate the serodiagnostics of COVID-19 in patients with autoimmune diseases. Maximum utilization of tele-medicine should be made when appropriate. Suspected COVID-19 patients should be treated by a multidisciplinary team with robust knowledge of immunosuppressive medication to carefully weigh the benefits and potential detrimental effects of the applied therapy.