COVID-19 in patients with Systemic Lupus Erythematosus and the antiphospholipid syndrome

ABSTRACT

In patients with Systemic Lupus Erythematosus (SLE) and Antiphospholipid Syndrome (APS), the dysregulated immune response together with the use of immunosuppressive drugs has raised some concerns about the increased susceptibility to SARS-CoV-2 infection and the efficacy of anti-SARS-CoV-2 vaccines. Moreover, COVID-19, SLE, and APS share pathogenic pathways that may be responsible of common clinical and laboratory features and may explain why some drugs approved for SLE treatment were considered as potential treatment for COVID-19 disease. Another concern relies on "post-COVID syndrome” (the persistence of debilitating symptoms such as fatigue, dyspnea, and cognitive dysfunction) that could be confused with signs of SLE or APS. This chapter describes the common pathogenic mechanisms and clinical manifestations of COVID-19, SLE, and APS. Management strategies and immunogenicity and safety of COVID-19 vaccines are addressed. A focus on pregnant patients is also provided. Finally, similarities and differences between post-COVID syndrome and SLE/APS manifestations are described. © 2023 Elsevier Inc. All rights reserved.