Favalli Ennio Giulio, Gobbini Andrea, Bombaci Mauro, Maioli Gabriella, Biggioggero Martina, Pesce Elisa, Favalli Andrea, Martinovic Martina, Fabbris Tanya, Marchisio Edoardo, Bandera Alessandra, Gori Andrea, Abrignani Sergio, Grifantini Renata, Caporali Roberto
Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milan, Italy.
Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy.
Front Med (Lausanne). 2022 Mar 11;9:850858. doi: 10.3389/fmed.2022.850858. eCollection 2022.
Given the high occurrence of asymptomatic subsets, the true prevalence of SARS-CoV-2 infection in rheumatic patients is still underestimated. This study aims to evaluate the seroprevalence of SARS-CoV-2 antibodies in rheumatic musculoskeletal diseases (RMD) patients receiving immunomodulatory drugs.
All consecutive patients with rheumatoid arthritis or spondyloarthritis receiving disease-modifying antirheumatic drugs (DMARDs) evaluated between 4th May and 16th June 2020 were included. All participants were tested for anti-SARS-CoV-2 antibodies (IgG, IgM, IgA) by ELISA and were questioned about previous COVID-19 symptoms and clinical course. Results were compared with healthy population from the same region and with a control group of healthy subjects diagnosed with confirmed COVID-19.
The study population includes 358 patients. The overall prevalence of anti-SARS-CoV-2 antibodies (18.4%) was higher than prevalence rate based on swab-positivity (1.12%) or clinically suspected cases (10.6%), but consistent with seroprevalence observed in the healthy population. Among seropositive patients 58% were asymptomatic. Mean anti-SARS-CoV-2 titer was comparable with the control group. No differences in seroprevalence were observed according to age, sex, rheumatic disease and treatment with conventional, biologic or targeted synthetic DMARDs, whereas glucocorticoids and comorbidities resulted in higher seroprevalence rate.
The results of this study are reassuring about the low impact of RMDs and immunomodulatory therapies on the risk and clinical course of COVID-19 and on humoral immune response to SARS-CoV-2 infection.
鉴于无症状亚组的高发生率，风湿性疾病患者中SARS-CoV-2感染的真实患病率仍被低估。本研究旨在评估接受免疫调节药物治疗的风湿性肌肉骨骼疾病（RMD）患者中SARS-CoV-2抗体的血清阳性率。
纳入2020年5月4日至6月16日期间接受抗风湿药物（DMARDs）治疗的所有连续性类风湿关节炎或脊柱关节炎患者。所有参与者均通过酶联免疫吸附测定法（ELISA）检测抗SARS-CoV-2抗体（IgG、IgM、IgA），并询问其既往COVID-19症状和临床病程。将结果与来自同一地区的健康人群以及确诊为COVID-19的健康对照人群进行比较。
研究人群包括358名患者。抗SARS-CoV-2抗体的总体患病率（18.4%）高于基于拭子阳性率（1.12%）或临床疑似病例（10.6%）的患病率，但与健康人群中观察到的血清阳性率一致。在血清阳性患者中，58%无症状。抗SARS-CoV-2平均滴度与对照组相当。根据年龄、性别、风湿性疾病以及使用传统、生物或靶向合成DMARDs进行治疗，未观察到血清阳性率的差异，而糖皮质激素和合并症导致血清阳性率更高。
本研究结果令人放心，即RMDs和免疫调节疗法对COVID-19的风险和临床病程以及对SARS-CoV-2感染的体液免疫反应影响较小。
