I’ve just stumbled across an article about another of the odd features of coronovirus illness. I thought it was quite interesting that the infection can cause a temporary loss of the sense of smell, which could happen in a number of different ways, but the covid infection feature that really fascinates me right now is “covid toes” This feature, which can also affect hands, has been identified as an atypical form of perniosis or chilblains that is not triggered by cold as is typical of perniosis/chilblains. These discomforts of the extremities fascinate me because they seem to have a lot in common with a cluster of inter-related medical conditions involving small blood vessels and typically affecting the hands and feet that are often associated with autoimmune diseases, including Sjogren’s syndrome, and Sjogren’s syndrome itself could be viewed as having many features in common with the coronovirus illness.
Both Sjogren’s and COVID-19 infection can cause lung damage that creates “ground-glass” CT images, inflammation in the lungs and lung conditions that sound pneumonia-ey. One of the many lung diseases that can be caused by Sjogren’s is bronchiolitis, an inflammatory lung disease that “is almost always caused by a virus”, except when it is caused by Sjogren’s syndrome, of course.
Sjogren’s can be associated with Raynaud’s phenomenon and erythromelalgia; two related conditions of “dysfunctional vascular dynamics” reacting to temperature, affecting sensation and typically affecting the hands and feet. COVID-19 is associated with the “covid toe” phenomenon, affecting the hands and feet, resembling perniosis/chilblains which is normally triggered by cold temperature and “may be an abnormal blood vessel response” and can co-occur with Raynaud’s. The bluishly discoloured extremities shown in photos of covid toes and hands looks a lot like Raynaud’s. Covid toes can be painful and “have a hot burning sensation”, which sounds a lot like erythromelalgia, the evil twin of Raynaud’s which hurts like a bitch and is worsened by heat and can sometimes be relieved by cooling.
The “covid toes” phenomenon can involve a rash, which maybe isn’t surprising considering how common rashes are in bacterial and viral infections. Sjogren’s can also come with a rash, a rash that can last not just days or weeks, but decades. Like Raynaud’s and erythromelalgia this autominnune rash involves stupid things happening to or inside blood vessels. It typically affects the feet and lower legs, and sometimes the hands and other parts of the body. This rash that can go on forever also has a name of impressive length; hypergammaglobulinemic purpura of Waldenström, or HGP for short.
Like the coronavirus illness, Sjogren’s affects the blood vessels, parts of the head, the lungs and sometimes the extremities, and typically causes tiredness or fatigue. Sjogren’s can affect the nose area, in addition to it’s more well-known autoimmune attacks on the tear and saliva glands in the face, and like the coronavirus illness, Sjogren’s can impair the sense of smell.
As I’ve explained already, Sjogren’s can damage the lungs in the same way that a virus might. I think it is also quite interesting that one of the vascular diseases that can co-occur with Sjogrens, erythromelalgia, was, according to one report, once caused by infection of humans with a virus that is typically found in small mammalian animals. Can you guess which country those humans and little animals lived in? Yes, China.
I have not been able to find any evidence one way or the other as to whether the COVID-19 illness can directly damage the foetus of an infected pregnant woman. I’m interested in any research or observations about this possibility because if there are non-trivial commonalities between this illness and Sjogren’s some unusual and distinctive problems in babies born of infected mothers might occur. Antibodies characteristically found in Sjogren’s cases can cause congential heart block in the foetus in utero or “neonatal lupus”, a strange solid red rash around the baby’s eyes, but even among pregnancies of women with at least one of these antibodies, these rare conditions are found at a rate of only one or two percent.
If it is true that there are non-trivial commonalities between COVID-19 illness and Sjogren’s syndrome, that might suggest a general explanation of the much-pondered question of why coronavirus kills more men than women. Sjogren’s syndrome, Raynaud’s phenomenon and erythromelalgia are all more commonly found in women than in men. Maybe this indicates that the normal, healthy female body is generally more likely to manifest the kinds of immunological/vascular shenanigans that happen in these three related conditions. Maybe the normal male body rarely has these things happening, and has not adjusted to or accommodated these abnormal processes, so when male bodies encounter COVID-19, which apparently causes wierd vascular events to happen, the male body is less able to cope with these processes. Just a theory. Women have babies and men do not. Lots of interesting things happen during pregnancy to the vasular and blood systems that the male body will never have to deal with. Notice that I haven’t once mentioned the word “hormones” during this explanation? I so much hate it when boffins glibly explain differences in sex ratios for diseases and social problems as due to “hormones”. That is a non-explanation. That is inexcusably lame.
As long-time readers of this blog might have noticed, I have quite a fascination for rare and autoimmune diseases. I was the original author in 2012, at this blog, of two hypotheses, one speculating that a rare form of dementia might be caused by high levels of a type of chemical that plays a part in both synaptic pruning and the immune system, and a twin hypothesis that the psychological/neurological developmental variation synaesthesia might be caused by low levels of one or more of the same group of immune chemicals. The latter novel hypothesis was later published in a peer-reviewed neuroscience journal, unfortunately without me listed as an author. Even though I’m pretty interested in a bit of amateur immunology (more than the average housewife), before tonight it had not occurred to me how much a cluster of inter-related autoimmune diseases could be similar to a virus.
So I guess the world-shaking, worth-a-million-bucks-to-someone-else, super-important question is whether established scientific knowledge about Sjogren’s syndrome and related autoimmune diseases could provide any useful insights into a vaccine or treatment or prevention of the COVID-19 illness. I think probably not, because I don’t think medical science knows terribly much about Sjogren’s or any of the other diseases that I’ve just wasted my time writing about here. It’s the same old story about rare diseases being the orphans of the world of disease research. Erythromelalgia can be a horribly painful disease, once treated by amputation before doctors had any insight into how it works, and has been written about under a variety of names since 1878, but your GP has probably never heard of it. Like Raynaud’s phenomenon, there is apparently no blood/pathology test known to be useful for diagnosing erythromlalgia. Has any researcher even bothered to search for pathology or autoimmune abnormalities in either of these diseases? If you Google Sjogren’s syndrome you will probably read that it is dry eyes and a dry mouth, then the details of symptomatic treatment. I guess that’s the level of interest and trivialisation that one might expect from the world of medical science for a mostly non-fatal disease affecting mostly middle-aged women. Outlines of Sjogren’s in medical literature and patient info might also give you the impression that Sjogren’s always coincides with rheumatoid joint problems, and the only pathology results associated with it are antinuclear antibodies, rheumatoid factors and SSA and SSB. None of this is true.
Does medicine understand how Sjogren’s syndrome works? No. Is there a unequivocally safe and effective treatment for it? Of course, no. Apparently “Hydroxychloroquine (Plaquenil), a drug designed to treat malaria, is often helpful in treating Sjogren’s syndrome.” I have no idea whether that is a useful insight in relation to COVID-19. So often prescription drugs are worse in the side effects than the disease, or don’t really work at all, but I guess in April 2020 we are all grasping at straws. I guess there’s one positive thing that might come out of my thoughts and speculations; maybe I’ve just discovered what triggers the development of Sjogren’s syndrome? A coronavirus?
If medical science had taken diseases like Sjogren’s syndrome and associated vascular and autoimmune disorders seriously before now, would we now understand how COVID-19 kills and sickens people, and would science have already developed a safe and effective treatment for it?
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Am I a super-recognizer? 