Braunisch M C, Bachmann Q, Hammitzsch A, Lorenz G, Geisler F, Schmaderer C, Heemann U, Moog P
Sektion Rheumatologie, Abteilung für Nephrologie, II. Medizinische Klinik, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
II. Medizinische Klinik, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, München, Deutschland.
Z Rheumatol. 2021 Jun;80(5):408-417. doi: 10.1007/s00393-020-00935-8. Epub 2020 Nov 30.
In March 2020 the SARS-CoV‑2 pandemic disseminated initially especially in Bavaria. At that time data on patients with rheumatic diseases and immunomodulatory treatment was lacking.
The aim was to analyze the influence of the SARS-CoV‑2 pandemic on the clinical treatment strategy.
Between 16 March and 31 July 2020 all patients who consecutively presented at the rheumatology outpatient clinic of the Klinikum rechts der Isar of the Technical University of Munich were included in the study. Individual treatment adjustments were based on clinical judgment and the recommendations for action of the German Society for Rheumatology (DGRh).
A total of 322 patients were included. The most frequent diagnosis was rheumatoid arthritis with 17%, ANCA-associated vasculitis (AAV) with 14% and SLE with 12%. Of the patients 262 were on DMARD treatment and 77 received oral glucocorticoids. There were 5 cases of suspected SARS-CoV‑2 infection; however, no patient verifiably became ill due to COVID-19. In 40 patients, treatment adjustments were done due to the pandemic, whereby 3 patients developed a flare of the underlying disease. In retrospect, treatment de-escalation occurred most frequently in AAV, IgG4-related disease, immunosuppressive treatment with rituximab and the simultaneous presence of malignant diseases.
The total lack of confirmed SARS-CoV‑2 infections in an otherwise strongly affected region could indicate that the infection risk for SARS-CoV‑2 is not substantially increased for patients with inflammatory rheumatic diseases. A continuation of most immunosuppressive medications therefore seems reasonable during the ongoing pandemic.
2020年3月，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行最初在巴伐利亚州尤其迅速传播。当时，缺乏关于风湿病患者和免疫调节治疗的数据。
旨在分析SARS-CoV-2大流行对临床治疗策略的影响。
2020年3月16日至7月31日期间，所有连续就诊于慕尼黑工业大学伊萨尔河右岸医院风湿病门诊的患者均纳入本研究。个体治疗调整基于临床判断和德国风湿病学会（DGRh）的行动建议。
共纳入322例患者。最常见的诊断为类风湿关节炎（17%）、抗中性粒细胞胞浆抗体相关性血管炎（AAV，14%）和系统性红斑狼疮（SLE，12%）。262例患者接受改善病情抗风湿药（DMARD）治疗，77例接受口服糖皮质激素治疗。有5例疑似SARS-CoV-2感染；然而，没有患者被证实因2019冠状病毒病（COVID-19）而患病。40例患者因大流行进行了治疗调整，其中3例患者出现基础疾病病情复发。回顾性分析发现，治疗降级在AAV、IgG4相关性疾病、利妥昔单抗免疫抑制治疗以及同时患有恶性疾病的患者中最为常见。
在一个受影响严重的地区，完全没有确诊的SARS-CoV-2感染病例，这可能表明炎症性风湿病患者感染SARS-CoV-2的风险并未大幅增加。因此，在当前大流行期间，继续使用大多数免疫抑制药物似乎是合理的。
