The intersection of COVID-19 and autoimmunity: What is our current understanding?

Abstract

Viral infections have historically had a complex relationship with autoimmune diseases. For patients with preexisting autoimmune disorders, often complicated by immunosuppressive therapies, there are numerous potential effects of COVID-19, a disease of complex immunobiology, including the potential to alter the natural history when infected. In addition, individuals without recognized autoimmune disease may be vulnerable to virally induced autoimmunity in the forms of autoantibody formation, as well as the development of clinical immune mediated inflammatory diseases. Until quite recently in the pandemic this relationship between COVID-19 and autoimmune diseases has been relatively under- explored, yet such investigation offers potential insights into immunopathogenesis as well as for the development of new immune based therapeutics. This review examines this relationship through exploration of a series of questions with relevance to both immunopathogenic mechanisms as well as some clinical implications.