Arthritis and Clinical Rheumatology Program, Oklahoma Medical Research Foundation, 825 NE 13th Street, MS 22, Oklahoma City, OK, 73104, USA.
Departments of Pediatrics, Medicine, and Immunology, and Lupus Center of Excellence, University of Pittsburgh School of Medicine, 7123 Rangos Research Center, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA.
Curr Rheumatol Rep. 2021 Jan 28;23(2):8. doi: 10.1007/s11926-020-00973-w.
To summarize current knowledge of the impact of coronavirus disease 19 (COVID-19) on patients with systemic lupus erythematosus (SLE).
Several observational studies, including case series, patient surveys, and patient registries, have examined the incidence and severity of COVID-19 in patients with SLE. Due to methodologic limitations (focus on sicker patients, exclusion of asymptomatic or mild cases, limited or inaccurate viral testing), it is difficult to determine the risk and outcomes of COVID-19 in SLE patients. Corticosteroids might be associated with increased hospitalizations from COVID-19 in individuals with autoimmune rheumatic diseases. Some immune suppressive treatments do not appear to significantly increase the risk of contracting COVID-19 or poor subsequent outcomes; however, data on the safety of specific drugs remain scarce. Studies in non-autoimmune cohorts have shown more severe COVID-19 in ethnic and racial minorities, populations also more heavily impacted by SLE. Such results have been attributed to highly prevalent socioeconomic disparities and comorbidities. The complex interplay between SARS-CoV-2 and the host immunologic milieu may have particular implications for patients with SLE that remain to be explored. Concerns have been raised of COVID-19 heightening the risk of thromboembolic events in the presence of an SLE-induced procoagulant state. Limitations in epidemiologic data available to date do not allow for assessing the risk and severity of COVID-19 in patients with SLE. Other than corticosteroids, prior use of some immune suppressive medications does not appear to increase the risk for infection with SARS-CoV-2 however, more comprehensive studies are needed.
总结目前关于新型冠状病毒病（COVID-19）对系统性红斑狼疮（SLE）患者影响的知识。
一些观察性研究，包括病例系列、患者调查和患者登记，已经研究了 COVID-19 在 SLE 患者中的发病率和严重程度。由于方法学的限制（关注更严重的患者，排除无症状或轻度病例，有限或不准确的病毒检测），难以确定 SLE 患者 COVID-19 的风险和结局。皮质类固醇可能与自身免疫性风湿病患者因 COVID-19 住院增加有关。一些免疫抑制治疗似乎不会显著增加感染 COVID-19 或随后预后不佳的风险；然而，关于特定药物安全性的数据仍然很少。非自身免疫队列的研究表明，少数族裔和少数民族 COVID-19 更为严重，这些人群也受到 SLE 的严重影响。这些结果归因于普遍存在的社会经济差异和合并症。SARS-CoV-2 与宿主免疫环境之间的复杂相互作用可能对 SLE 患者具有特殊影响，有待进一步研究。人们担心在存在 SLE 诱导的促凝状态的情况下，COVID-19 会增加血栓栓塞事件的风险。迄今为止，流行病学数据的局限性不允许评估 COVID-19 在 SLE 患者中的风险和严重程度。除皮质类固醇外，先前使用某些免疫抑制药物似乎不会增加感染 SARS-CoV-2 的风险，但需要更全面的研究。
