Life | Special Issue : Clinical Manifestations and Treatment of Autoimmune Diseases

Research

18 pages, 2524 KiB

Open AccessArticle

A Real-Life Study in Patients Newly Diagnosed with Autoimmune Hashimoto’s Thyroiditis: Analysis of Asthenia as Admission Complaint

by Ana Valea, Mihai Costachescu, Mihaela Stanciu, Claudiu Nistor, Oana-Claudia Sima, Mara Carsote, Tiberiu Vasile Ioan Nistor, Denisa Tanasescu, Florina Ligia Popa and Mihai-Lucian Ciobica

Life 2024, 14(11), 1380; https://doi.org/10.3390/life14111380 - 27 Oct 2024

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Abstract

Background: Amid the large panel of autoimmune thyroid diseases, Hashimoto’s thyroiditis (HT) represents a major point across multidisciplinary daily practice. When it comes to the clinical picture, particularly in regard to asthenia (also described as “fatigue” or “decreased energy”), the differential diagnosis is [...] Read more.

Background: Amid the large panel of autoimmune thyroid diseases, Hashimoto’s thyroiditis (HT) represents a major point across multidisciplinary daily practice. When it comes to the clinical picture, particularly in regard to asthenia (also described as “fatigue” or “decreased energy”), the differential diagnosis is challenging, and a meticulous anamnesis should be backed up by focused lab investigations. Our objective was to analyze the thyroid panel in newly diagnosed patients with HT in relationship with the presence of asthenia as an admission complaint. Methods: This was a retrospective, multi-centric, real-life study conducted in secondary endocrine units (university hospitals) from July 2022 to July 2023. The exclusion criteria were COVID-19 infection; an active malignancy, etc. Results: The cohort (N = 120) included an asthenia group (AS, 49.2%) and a non-AS group of a similar age (49.3 ± 14.7 vs. 47.1 ± 14.8 y, p = 0.426). Headache was more frequent in the AS group (35.6% vs. 18%, p = 0.03). Thyroid function and HT-related antibodies assays were similar between the groups and show no correlation with serum total cholesterol and triglycerides, respectively. TSH levels did not vary among the age sub-groups (p = 0.701). One third of the studied population was affected by hypothyroidism (TSH > 4.5 μIU/mL), being seen at a higher rate in the AS (39%) vs. non-AS group (23%). Total cholesterol positively correlated with the patients’ age (r = 0.180, p = 0.049) and triglycerides (N = 120; r = 0.324, p < 0.001), as found only in the non-AS group (r = 0.246, p = 0.006, respectively, r = 0.319, p < 0.001). Conclusions: The analysis of the AS vs. non-AS group pinpointed the fact that, in regard to daily practice, asthenia as an admission complaint seems less of an indicator of an underlying thyroid dysfunction or a higher level of serum antibodies against thyroid in patients without a full clinical picture of thyrotoxicosis or myxoedema. Full article

(This article belongs to the Special Issue Clinical Manifestations and Treatment of Autoimmune Diseases)

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11 pages, 2013 KiB

Open AccessArticle

Impact of Plasminogen Activator Inhibitor-1 Serum Levels and the -675 4G/5G Variant in the SERPINE1 Gene on Systemic Sclerosis in a Mexican Population

by José Alvaro Lomelí-Nieto, José Francisco Muñoz-Valle, José Eduardo Navarro-Zarza, Christian Johana Baños-Hernández, Jesús Alberto Gutierrez-Brito, Valeria Renteria-Cabrera, Eduardo Arturo Horta-Chávez, José Javier Morales-Núñez, Samuel García-Arellano, Isela Parra-Rojas and Jorge Hernández-Bello

Life 2024, 14(9), 1056; https://doi.org/10.3390/life14091056 - 23 Aug 2024

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Abstract

Systemic sclerosis (SSc) is characterized by a complex interplay of vascular damage, inflammation, and fibrosis, affecting the skin and internal organs. Plasminogen activator inhibitor-1 (PAI-1), a protein encoded by the SERPINE1 gene, is a potential biomarker of SSc because it is primarily involved [...] Read more.

Systemic sclerosis (SSc) is characterized by a complex interplay of vascular damage, inflammation, and fibrosis, affecting the skin and internal organs. Plasminogen activator inhibitor-1 (PAI-1), a protein encoded by the SERPINE1 gene, is a potential biomarker of SSc because it is primarily involved in fibrinolysis and is associated with the severity of some autoimmune diseases. This study aimed to determine the association between SERPINE1 variant -675 4G/5G and soluble PAI-1 (sPAI-1) levels with the clinical characteristics and risk of SSc in a Mexican population. This cross-sectional study included 56 SSc patients and 114 control subjects (CSs). The variant was genotyped via the PCR–RFLP method and the levels of sPAI-1 were determined using enzyme-linked immunosorbent assays (ELISAs). The -675 4G/5G variant was not associated with SSc risk or sPAI-I levels. However, higher sPAI-1 levels were observed in SSc patients than in CSs (p = 0.045); these levels were significantly correlated with age, platelets, glucose, and serum levels of transforming growth factor (TGF)-β1, 2, and 3. The SERPINE1 -675 4G/5G variant did not show any association with SSc risk or sPAI-I levels. However, our study shows a possible alteration of sPAI-1 in this disease, which could be associated with the fibrotic and thrombotic processes in SSc. Full article

(This article belongs to the Special Issue Clinical Manifestations and Treatment of Autoimmune Diseases)

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14 pages, 1142 KiB

Open AccessArticle

Sociodemographic and Clinical Determinants of Fatigue in Multiple Sclerosis

by Smaranda Maier, Zoltán Bajkó, Ruxandra Roșescu, Laura Bărcuțean, Emanuela Sărmășan, Septimiu Voidăzan and Rodica Bălașa

Life 2023, 13(11), 2132; https://doi.org/10.3390/life13112132 - 29 Oct 2023

Cited by 5 | Viewed by 1444

Abstract

Fatigue is the most common and disabling symptom in patients with multiple sclerosis (PwMS), representing one of the main determinants of reduced quality of life among PwMS due to its interference with social activities and work capacity. This study aimed to identify the [...] Read more.

Fatigue is the most common and disabling symptom in patients with multiple sclerosis (PwMS), representing one of the main determinants of reduced quality of life among PwMS due to its interference with social activities and work capacity. This study aimed to identify the sociodemographic determinants of fatigue in a cohort of 150 PwMS and 100 healthy controls (HCs). Fatigue was assessed using one of the most suitable and appropriate tools for measuring the degree of fatigue: the Modified Fatigue Impact Scale (MFIS). By comparing the median scores for the MFIS, we observed that the PwMS group had significantly higher MFIS scores than the HCs (p = 0.0001). In PwMS, MFIS scores correlated positively with age, total number of relapses, total disease duration, disability status, and Beck Depression Inventory-II score and negatively with cognitive performance. Patients with relapsing-remitting MS had significantly lower fatigue levels than those with secondary progressive MS (p = 0.0010). Fatigue levels were significantly lower among male than female PwMS (p = 0.0120). Other determinant factors of fatigue in our study proved to be the marital and occupational status, as well as the presence of children, but in a linear multivariate regressions analysis with MFIS score as the dependent variable, the fatigue levels were influenced only by sex, occupational status, marital status, children status, and BDI-II test results. Considering the significant impact of fatigue on the quality of life of PwMS, clinicians must diagnose fatigue as early as possible, identify its modifiable determinants, and manage it effectively to increase their quality of life. Full article

(This article belongs to the Special Issue Clinical Manifestations and Treatment of Autoimmune Diseases)

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8 pages, 254 KiB

Open AccessCommunication

Significance of Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) for the Monitoring of Treatment Response to Cyclosporine in Patients with Psoriasis

by Aleksandra Frątczak, Bartosz Miziołek, Agnieszka Łupicka-Słowik, Marcin Sieńczyk, Karina Polak and Beata Bergler-Czop

Life 2023, 13(9), 1873; https://doi.org/10.3390/life13091873 - 6 Sep 2023

Cited by 2 | Viewed by 1430

Abstract

Neutrophil gelatinase-associated lipocalin (NGAL) may promote development of inflammation in psoriasis, whereas proprotein convertase subtilisin/kexin type 9 (PCSK9) may account for dyslipidemia in some psoriatic patients. The aim of the study was to analyze the influence of cyclosporine therapy on serum levels of [...] Read more.

Neutrophil gelatinase-associated lipocalin (NGAL) may promote development of inflammation in psoriasis, whereas proprotein convertase subtilisin/kexin type 9 (PCSK9) may account for dyslipidemia in some psoriatic patients. The aim of the study was to analyze the influence of cyclosporine therapy on serum levels of NGAL and PCSK9 in patients with psoriasis vulgaris. Methods: Serum samples were obtained before and after three months cyclosporine therapy. Patients were grouped into responders and non-responders to cyclosporine depending on whether they achieved at least 50% reduction of Psoriatic Activity Score Index (PASI), or not. Serum levels of PCSK9 and NGAL were assayed using commercially available ELISA tests. Lipid levels were measured with an enzymatic method. Results: There were 40 patients enrolled. A significant decrease in serum NGAL level was seen in cyclosporine responders. No similar dependance was found for PCSK9. Serum PCSK9 concentration correlated with total cholesterol (TChol) and LDL at baseline and after three month treatment. Conclusions: Cyclosporine therapy contributes to the reduction of the NGAL serum but not the PCSK9 concentration. Correlation between the PCSK9 serum level and TChol as well as LDL concentration may help to understand drug induced dyslipidemia after cyclosporine. Full article

(This article belongs to the Special Issue Clinical Manifestations and Treatment of Autoimmune Diseases)

Review

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27 pages, 2930 KiB

Open AccessReview

Navigating Adult-Onset IgA Vasculitis-Associated Nephritis

by Ming Ying Gan, Freda Zhi Yun Chua, Zi Yun Chang, Yan Ting Chua and Gek Cher Chan

Life 2024, 14(8), 930; https://doi.org/10.3390/life14080930 - 25 Jul 2024

Cited by 1 | Viewed by 1219

Abstract

Purpose of Review: IgA vasculitis (IgAV), formerly Henoch–Schonlein purpura, is the most common systemic vasculitis in childhood. In adults, however, this condition is poorly understood, yet associated with more severe disease and poorer outcomes. This necessitates the need for early diagnosis and management. [...] Read more.

Purpose of Review: IgA vasculitis (IgAV), formerly Henoch–Schonlein purpura, is the most common systemic vasculitis in childhood. In adults, however, this condition is poorly understood, yet associated with more severe disease and poorer outcomes. This necessitates the need for early diagnosis and management. Scope of Review: We describe the pathophysiology, clinical manifestations, and diagnosis of IgAV in adults. Poor outcomes are often due to the high frequency of glomerulonephritis in IgAV-IgA vasculitis-associated nephritis (IgAVN). We hence also aim to summarize the latest clinical data regarding treatment strategies in IgAVN. The diagnosis and differentiation in histology between IgAVN and IgA nephropathy (IgAN) remain a challenge. Review of treatment therapies: Pathological mechanisms between IgAVN and IgAN appear to be consistent between the two, and data from IgAN are often extrapolated to IgAVN. The role of various immunosuppression therapies remains controversial, and in this review, we will discuss immunosuppression use and highlight evidence surrounding emerging and promising novel therapies in IgAVN/IgAN. Our aim for this review is to guide future treatment strategies and direct future studies. Full article

(This article belongs to the Special Issue Clinical Manifestations and Treatment of Autoimmune Diseases)

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30 pages, 1499 KiB

Open AccessReview

Crosstalk between Inflammation and Atherosclerosis in Rheumatoid Arthritis and Systemic Lupus Erythematosus: Is There a Common Basis?

by Marta Chiara Sircana, Gian Luca Erre, Floriana Castagna and Roberto Manetti

Life 2024, 14(6), 716; https://doi.org/10.3390/life14060716 - 31 May 2024

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Abstract

Cardiovascular disease is the leading cause of morbidity and mortality in patients with rheumatoid arthritis and systemic lupus erythematosus. Traditional cardiovascular risk factors, although present in lupus and rheumatoid arthritis, do not explain such a high burden of early cardiovascular disease in the [...] Read more.

Cardiovascular disease is the leading cause of morbidity and mortality in patients with rheumatoid arthritis and systemic lupus erythematosus. Traditional cardiovascular risk factors, although present in lupus and rheumatoid arthritis, do not explain such a high burden of early cardiovascular disease in the context of these systemic connective tissue diseases. Over the past few years, our understanding of the pathophysiology of atherosclerosis has changed from it being a lipid-centric to an inflammation-centric process. In this review, we examine the pathogenesis of atherosclerosis in systemic lupus erythematosus and rheumatoid arthritis, the two most common systemic connective tissue diseases, and consider them as emblematic models of the effect of chronic inflammation on the human body. We explore the roles of the inflammasome, cells of the innate and acquired immune system, neutrophils, macrophages, lymphocytes, chemokines and soluble pro-inflammatory cytokines in rheumatoid arthritis and systemic lupus erythematosus, and the roles of certain autoantigens and autoantibodies, such as oxidized low-density lipoprotein and beta2-glycoprotein, which may play a pathogenetic role in atherosclerosis progression. Full article

(This article belongs to the Special Issue Clinical Manifestations and Treatment of Autoimmune Diseases)

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17 pages, 692 KiB

Open AccessReview

Sarcoidosis and Autoimmune Inflammatory Syndrome Induced by Adjuvants

by Anna Starshinova, Yulia Zinchenko, Anna Malkova, Dmitriy Kudlay, Igor Kudryavtsev and Piotr Yablonskiy

Life 2023, 13(4), 1047; https://doi.org/10.3390/life13041047 - 19 Apr 2023

Cited by 7 | Viewed by 3815

Abstract

Currently, sarcoidosis remains one of the diseases with unknown etiology, which significantly complicates its diagnosis and treatment. Various causes of sarcoidosis have been studied for many years. Both organic and inorganic trigger factors, provoking the development of granulomatous inflammation are considered. However, the [...] Read more.

Currently, sarcoidosis remains one of the diseases with unknown etiology, which significantly complicates its diagnosis and treatment. Various causes of sarcoidosis have been studied for many years. Both organic and inorganic trigger factors, provoking the development of granulomatous inflammation are considered. However, the most promising and evidence-based hypothesis is the development of sarcoidosis as an autoimmune disease, provoked by various adjuvants in genetic predisposed individuals. This concept fits into the structure of the autoimmune/inflammatory syndrome, induced by adjuvants (ASIA) that was proposed in 2011 by Professor Shoenfeld Y. In this paper, the authors reveal the presence of major and minor ASIA criteria for sarcoidosis, propose a new concept of the course of sarcoidosis within the framework of ASIA, and point out the difficulties in creating a model of the disease and the selection of therapy. It is obvious that the data obtained not only bring us closer to understanding the nature of sarcoidosis, but also potentiate new studies confirming this hypothesis by obtaining a model of the disease. Full article

(This article belongs to the Special Issue Clinical Manifestations and Treatment of Autoimmune Diseases)

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Other

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8 pages, 1912 KiB

Open AccessCase Report

Fractionated CO₂ Laser in Combination with Topical Tacrolimus for Chronic Alopecia Areata: A Case Series Study

by Giulio Rizzetto, Edoardo De Simoni, Helena Gioacchini, Elisa Molinelli, Annamaria Offidani and Oriana Simonetti

Life 2024, 14(9), 1128; https://doi.org/10.3390/life14091128 - 7 Sep 2024

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Abstract

Alopecia areata (AA) is a non-scarring autoimmune disease requiring long-term treatments. Topical, intralesional or systemic corticosteroids are the first option. However, considering the risk of skin atrophy and the possible lack of clinical response, new treatment options are urgently needed. A fractional carbon [...] Read more.

Alopecia areata (AA) is a non-scarring autoimmune disease requiring long-term treatments. Topical, intralesional or systemic corticosteroids are the first option. However, considering the risk of skin atrophy and the possible lack of clinical response, new treatment options are urgently needed. A fractional carbon dioxide laser (FCL) has been proven to be effective alone or in combination with other drugs. However, no study has ever evaluated the association between FCL and topical tacrolimus. We report three cases of AA resistant to corticosteroids for at least 12 months, treated with topical tacrolimus 0.1% ointment and FCL on some patches. After 16 weeks from the beginning of treatment, all patients showed improvement in clinical and trichoscopic parameters in the areas treated in combination. FCL and tacrolimus may represent a new therapeutic option, but further studies are needed for confirmation. Full article

(This article belongs to the Special Issue Clinical Manifestations and Treatment of Autoimmune Diseases)

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12 pages, 1107 KiB

Open AccessCase Report

Unveiling the Mystery of Adult-Onset Still’s Disease: A Compelling Case Report

by Daniele Sola, Carlo Smirne, Francesco Bruggi, Chiara Bottino Sbaratta, Aubin Cardin Tamen Njata, Guido Valente, Maria Cristina Pavanelli, Rosetta Vitetta, Mattia Bellan, Lorenzo De Paoli and Mario Pirisi

Life 2024, 14(2), 195; https://doi.org/10.3390/life14020195 - 29 Jan 2024

Cited by 2 | Viewed by 2266

Abstract

Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder. Diagnosis can take a long time, especially in the presence of confounding factors, and it is, to some extent, a process of exclusion. AOSD has life-threating complications ranging from asymptomatic to severe, such [...] Read more.

Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder. Diagnosis can take a long time, especially in the presence of confounding factors, and it is, to some extent, a process of exclusion. AOSD has life-threating complications ranging from asymptomatic to severe, such as macrophage activation syndrome (MAS), which is also referred to as hemophagocytic lymphohistocytosis (HLH). This condition is correlated with cytokine storm production and monocyte/macrophage overactivation and typically occurs with rash, pyrexia, pancytopenia, hepatosplenomegaly and systemic involvement. Exitus occurs in approximately 10% of cases. For the treatment of MAS-HLH, the Histiocyte Society currently suggests high-dose corticosteroids, with the possible addition of cyclosporine A, anti-interleukin (IL)-1, or IL-6 biological drugs; the inclusion of etoposide is recommended for the most severe conditions. In all cases, a multidisciplinary collaboration involving the resources and expertise of several specialists (e.g., rheumatologist, infectiologist, critical care medicine specialist) is advised. Herein, we provide a detailed description of the clinical case of a previously healthy young woman in which MAS developed as a dramatic onset manifestation of AOSD and whose diagnosis posed a real clinical challenge; the condition was finally resolved by applying the HLH-94 protocol (i.e., etoposide in combination with dexamethasone). Full article

(This article belongs to the Special Issue Clinical Manifestations and Treatment of Autoimmune Diseases)

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7 pages, 227 KiB

Open AccessCase Report

A Case of Polymyositis Associated with Cytomegalovirus Infection in a Patient with Hashimoto’s Thyroiditis

by Ergeta Ktona, Blerta Budani, Ioannis Kostas-Agnantis and Alma Idrizi

Life 2023, 13(12), 2331; https://doi.org/10.3390/life13122331 - 12 Dec 2023

Viewed by 1287

Abstract

Polymyositis is a rare condition with an unknown etiology occurring more frequently in adult women. There is a lack of evidence on the coexistence of PM and CMV infection in a patient with hypothyroidism due to Hashimoto’s Thyroiditis. However, the growing occurrence of [...] Read more.

Polymyositis is a rare condition with an unknown etiology occurring more frequently in adult women. There is a lack of evidence on the coexistence of PM and CMV infection in a patient with hypothyroidism due to Hashimoto’s Thyroiditis. However, the growing occurrence of both CMV infection and the simultaneous occurrence of autoimmune diseases points out a relationship, while the association direction remains unclear. Case outline: A 32-year-old woman recently treated for HT hypothyroidism was admitted to the hospital two weeks after being treated for common flu by the family doctor, complaining about a worsening condition with muscle pain, weakness, frequent falls, and fatigue. The first tests showed a normalized thyroid function, with elevated values of troponin and serum creatinine kinase (CK). The immunological tests revealed the presence of a high titer of CMV IgG antibodies and raised levels of CMV DNA. Pelvis MRI images demonstrated markedly elevated signals on the STIR sequences in the pelvis, thighs, and calves, indicating active and severe multifocal myositis. The diagnosis of PM was confirmed with the muscle biopsy on day 7 of hospitalization. The patient showed significant improvements within two weeks after the medical therapy and physiotherapy. Full article

(This article belongs to the Special Issue Clinical Manifestations and Treatment of Autoimmune Diseases)

11 pages, 4827 KiB

Open AccessCase Report

Co-Occurrence of Rheumatoid Arthritis and Lung Cancer—Coincidence or Not?

by Ioana Munteanu, Constantin Gheorghevici, Catalin Constantin Coca, George Alexandru Diaconu, Alexandra Emilia Sandru, Nicolae Feraru, Andreea Popa, Roxana Nemes and Beatrice Mahler

Life 2023, 13(10), 2089; https://doi.org/10.3390/life13102089 - 20 Oct 2023

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Abstract

Bronchopulmonary cancer is the leading cause of cancer deaths globally. Rheumatoid arthritis is one of the risk factors for lung cancer, and those who use methotrexate have a higher risk of developing lung cancer. We present the case of an 80-year-old patient who [...] Read more.

Bronchopulmonary cancer is the leading cause of cancer deaths globally. Rheumatoid arthritis is one of the risk factors for lung cancer, and those who use methotrexate have a higher risk of developing lung cancer. We present the case of an 80-year-old patient who is a former smoker and is known to have rheumatoid arthritis, being treated using methotrexate; they were brought by ambulance to the emergency room for coughing with ineffective expectoration, dyspnea on slight exertion, and right-lateral chest pain with onset about one month prior and progressive worsening. Imaging showed a 7 cm/6 cm LID tumorous lung formation with parietal invasion and C7 rib lysis, as well as diffuse fibrotic interstitial changes predominantly in the lower lobes. An ultrasound-guided transthoracic lung biopsy was performed, and histopathological examination established the diagnosis of invasive squamous cell lung carcinoma, G2. In conclusion, the chest pain interpreted by the patient as rheumatic pain delayed the diagnosis of lung cancer; the patient presented rather late to the hospital once respiratory failure set in. Full article

(This article belongs to the Special Issue Clinical Manifestations and Treatment of Autoimmune Diseases)

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11 pages, 1336 KiB

Open AccessStudy Protocol

Prevalence of Long COVID Symptoms Related to SARS-CoV-2 Strains

by Teresita Aloè, Federica Novelli, Gianfranco Puppo, Valentina Pinelli, Emanuela Barisione, Elisa Trucco, Roberta Costanzo, Maria Grazia Covesnon, Federica Grillo, Patrizia Zoccali, Manlio Milanese, Sara Maniscalco, Elena Tagliabue, Ines Maria Grazia Piroddi, Simonetta Venturi, Maria Serra, Francesca Scordamaglia, Marta Ferrari and Antonella Serafini

Life 2023, 13(7), 1558; https://doi.org/10.3390/life13071558 - 13 Jul 2023

Cited by 3 | Viewed by 2936

Abstract

Background: Few studies have assessed the differences of patterns of Long COVID (L-COVID) with regards to the pathogenetic SARS-CoV-2 strains. Objectives: To investigate the relationship between demographic and clinical characteristics of acute phase of infection and the persistence of L-COVID symptoms and clinical [...] Read more.

Background: Few studies have assessed the differences of patterns of Long COVID (L-COVID) with regards to the pathogenetic SARS-CoV-2 strains. Objectives: To investigate the relationship between demographic and clinical characteristics of acute phase of infection and the persistence of L-COVID symptoms and clinical presentation across different SARS-CoV-2 strains. Methods: In this observational-multicenter study we recorded all demographic and clinical characteristics, severity of infection, presence/persistence of symptoms of fatigue, dyspnoea and altered quality of life (QoL) at baseline and after 6 months, in a sample of Italian patients from Liguria between March 2020 and March 2022. Results: 308 patients (mean age 63.2 years; 55.5% men) with previous COVID were enrolled. Obese patients were 21.2% with a significant difference in obesity prevalence across the second and third wave (p = 0.012). Treatment strategies differed between waves (p < 0.001): more patients required invasive mechanical ventilation in the first wave, more patients were treated with high-flow nasal cannula/non-invasive ventilation in the in the second and more patients were treated with oxygen-therapy in the fourth wave. At baseline, a high proportion of patients were symptomatic (dyspnoea and fatigue), with impairment in some QoL indicators. A higher prevalence of patients with pain, were seen in the first wave compared to later infections (p = 0.01). At follow-up, we observed improvement of dyspnoea, fatigue and some dimensions of QoL scale evaluation such as mobility, usual activities, pain evaluations; instead there was no improvement in remaining QoL scale indicators (usual care and anxiety-depression). Conclusions: There were no significant differences in the prevalence of the most frequent L-COVID symptoms, except for QoL pain domain that was especially associated with classical variant. Our results show substantial impact on social and professional life and usual care activities. These findings highlight the importance of multidisciplinary post COVID follow-up care including mental health support and rehabilitation program. Full article

(This article belongs to the Special Issue Clinical Manifestations and Treatment of Autoimmune Diseases)

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