Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
MSK Research Unit, NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Lupus. 2020 Nov;29(13):1661-1672. doi: 10.1177/0961203320961848. Epub 2020 Oct 15.
Severe acute respiratory syndrome coronavirus (SARS-CoV-2), the virus causing Coronavirus disease 2019 (COVID-19), has had a huge impact on health services with a high mortality associated with complications including pneumonia and acute respiratory distress syndrome. Historical evidence suggests that Lupus patients have a higher incidence of several viral infections. This is likely due to a combination of immune dysfunction, immunosuppressive therapy and excess co-morbidities. In this context there has been concern that Lupus patients may be at a higher risk of developing COVID-19 and suffering a severe disease course. As a result, many Lupus patients have been advised to 'shield' by isolating from social contact in the hope that this will reduce the likelihood of infection. Early clinical data does not appear to show that the incidence of COVID-19 is higher in Lupus patients. Reassuringly, the clinical course of COVID-19 in Lupus does not generally seem to be more severe than in the general population. There has been huge interest in repurposing existing drugs as potential treatments, including several used to treat Lupus. Of these, corticosteroids and hydroxychloroquine are the most well researched so far. The current evidence suggests that the corticosteroid dexamethasone improves outcome for the sickest COVID-19 patients requiring respiratory support. Initial reports suggested that hydroxychloroquine could have a positive impact on the course of COVID-19, however larger prospective studies have not supported this. Janus kinase inhibitors, currently being investigated for efficacy in lupus, have been shown to have anti-viral effects in vitro and inhibiting the JAK-STAT pathway may dampen down the host hyper-inflammatory response. Several trials are ongoing to assess the outcome of the use of JAK inhibitors in COVID-19 positive patients. For most patients continuing with their existing therapies to prevent a lupus flare or adverse events associated with sudden corticosteroid withdrawal is important whilst an Individualised risk assessment remains vital.
严重急性呼吸综合征冠状病毒（SARS-CoV-2）是导致 2019 年冠状病毒病（COVID-19）的病毒，它对卫生服务系统造成了巨大影响，其死亡率与肺炎和急性呼吸窘迫综合征等并发症相关。历史证据表明，狼疮患者发生多种病毒感染的几率更高。这可能是由于免疫功能障碍、免疫抑制治疗和合并症过多的综合作用。在这种情况下，人们担心狼疮患者患 COVID-19 的风险更高，并且疾病病程更为严重。因此，许多狼疮患者被建议通过与社会隔离来“隔离”，希望以此降低感染的可能性。早期临床数据似乎并未表明狼疮患者 COVID-19 的发病率更高。令人欣慰的是，狼疮患者 COVID-19 的临床病程似乎通常并不比普通人群更为严重。人们对重新利用现有药物作为潜在治疗方法产生了浓厚的兴趣，包括几种用于治疗狼疮的药物。在这些药物中，皮质类固醇和羟氯喹是迄今为止研究最多的药物。目前的证据表明，皮质类固醇地塞米松可改善需要呼吸支持的最病重 COVID-19 患者的预后。最初的报告表明，羟氯喹可能对 COVID-19 病程有积极影响，但更大的前瞻性研究并未支持这一点。目前正在研究用于狼疮疗效的 Janus 激酶抑制剂，已在体外显示出抗病毒作用，抑制 JAK-STAT 通路可能会减轻宿主的过度炎症反应。正在进行几项试验，以评估在 COVID-19 阳性患者中使用 JAK 抑制剂的结果。对于大多数患者，继续使用现有的治疗方法来预防狼疮发作或与突然停用皮质类固醇相关的不良事件很重要，而个体化风险评估仍然至关重要。
