Department of Medicine, University of Otago Wellington, Wellington, New Zealand; Hutt Valley District Health Board, Lower Hutt, Wellington, New Zealand.
Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, United Kingdom; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, United Kingdom.
Best Pract Res Clin Rheumatol. 2021 Mar;35(1):101657. doi: 10.1016/j.berh.2020.101657. Epub 2020 Dec 23.
There is concern that people with rheumatic disease, often treated with immunosuppressive or immunomodulatory medication, may be at an increased risk of poor outcomes of novel coronavirus disease-2019 (COVID-19). However, hyperinflammation is a major cause of morbidity and mortality in COVID-19 and treatment with glucocorticoids has been shown to improve outcomes in patients with severe COVID-19. Therefore, uncertainty exists about continuing or withholding immune therapies with the risk of infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review covers the current knowledge with respect to the risk of infection and outcomes and risk factors for poor outcomes in patients with rheumatic disease. We also discuss data from other immune-mediated diseases and its relevance to patients with rheumatic disease. In addition, we cover the limitations of the research efforts to date and how the current knowledge translates into practice guidance. Finally, we discuss our vision of the future research agenda.
人们担心患有风湿性疾病的人(这些人常接受免疫抑制或免疫调节药物治疗)可能面临新型冠状病毒病 2019(COVID-19)不良结局的风险增加。然而,COVID-19 患者的高炎症反应是导致发病率和死亡率增加的主要原因,并且糖皮质激素治疗已被证明可改善重症 COVID-19 患者的结局。因此,在感染严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)的风险与继续或停用免疫治疗之间存在不确定性。这篇综述涵盖了目前关于风湿性疾病患者感染和结局风险以及不良结局的危险因素的知识。我们还讨论了来自其他免疫介导性疾病的数据及其与风湿性疾病患者的相关性。此外,我们还介绍了迄今为止研究工作的局限性以及这些知识如何转化为临床实践指南。最后,我们讨论了我们对未来研究议程的看法。