The Relationship between post COVID-19 Rheumatological Manifestations and Angiotensin Converting Enzyme 2 Level in Patients with Type 2 Diabetes

Abstract

Background: Coronavirus disease (Covid-19) causes a systemic inflammatory syndrome with pulmonary involvement. Rheumatological involvement in patients with mild clinical forms of Covid-19 is uncertain. Diabetes mellitus (DM) is known to increase susceptibility to viral infections. Also, patients with DM have a reduced Angiotensin converting enzyme 2 (ACE2) expression that might contribute to the increased predisposition to severe lung injury. The aim of the work is to study the rheumatological manifestations with assessment of ACE2 level in post COVID patients with and without diabetes mellitus (DM).

Methods: We included a total of 160 consecutive patients in Covid-19 convalescent phase (after clinical recovery), all of them diagnosed with a positive PCR test. All participants were divided into two categories: 80 patients with COVID-19 and DM and another 80 patients with COVID-19 without DM. All patients subjected to history taking, clinical assessment, laboratory investigations (including serum ALT, AST, Albumin, Urea, Creatinine, FBG, HBA1c, Procalcitonin, CRP, Hemoglobin, WBC, Platelet count, Neutrophile count, Lymphocyte count, D-Dimer and ACE2).

Results: Patients with DM have a higher significant mean serum level of ACE2 (43.90 ± 20.04). Regarding post COVID rheumatological manifestation, patients with DM have a higher significant severe arthralgia and arthritis with higher significant serum level of anti-nuclear antibody (ANA), rheumatoid factor (RF) and Anti-citrullinated protein (CCP) (p < 0.05).

Conclusions: We found that COVID-19 patients with D.M have a higher risk of rheumatological complications with higher level of ACE2 than COVID-19 patients without D.M.