Hot Topic: AOSD Diagnosis Post-COVID-19

A call to Action: Earlier Recognition, Research, & Treatment Options

by: Shalla Newton MSN, RN, NE-BC and David Maher

There’s a recent article in The Lancet Rheumatology by Bamidis et al. (2021) about a case of Still’s disease developed after COVID. We wanted to take a minute to share some highlights and bring attention to Still’s disease as a potential consequence of COVID-19 infection. Inflammatory syndromes post-viral infection are not new, but gaining broader mainstream media and research attention due to COVID-19. ‘Long-haulers’ or long-COVID-19 can mirror autoinflammatory and innate immune dysregulations like Still’s (AOSD/SJIA), with Macrophage Activation Syndrome (MAS) and lead to further complicated diagnosis of either disease (or both). If we were not complex enough, let’s throw in distinguishing autoinflammation from COVID-19!

While this is one case, we are certain there are more based on the incredible overlap in symptoms between COVID and Still’s disease pathology. Recently, experts from Cincinnati Children’s have a pre-printed article in The Lancet discussing the correlation between Multisystem Inflammatory Syndrome-Children (MIS-C), MAS, and Kawaski’s disease in relation to COVID-19 inflammatory responses.

However, Bamidis et al. (2021) also point out the following similarities between COVID-19 and AOSD:

AOSD and COVID-19 share several clinical and laboratory features, including systemic inflammation, unremitting fever, high serum ferritin, and a potentially life-threatening cytokine release syndrome.

Bamidis et al. (2021) also note that:

The case of this patient shows that long COVID can mimic AOSD and delay the time point of diagnosis.

Symptoms and pathology in long-COVID and MIS-C/MIS-A (MIS in Adults) overlap with Still’s and Macrophage Activation Syndrome. Subsequently, in collaboration with national experts, we’re currently working on an Op-ed piece focused on the importance of creating adult complex care clinics as sustainable healthcare models post-COVID-19 ‘long-hauler’ clinics.  ‘Long-hauler’ COVID-19 funded clinics and existing pediatric complex care healthcare models build from the concept of  metacognition or multidisciplinary huddles.

Evidence supports the best patient outcomes come for meta-collaboration on complex care which is also endorsed by the nation’s leading healthcare quality improvement agencies, such as the NQF, CMS, and AHRQ. Furthermore, the awareness of the similarities of COVID-19 and Still’s (AOSD/SJIA) will undoubtedly bring forth a call to action to further research and treatment options as well as potentially recognition of an under diagnosed disease.

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