Nune Arvind, Durkowski Victor, Pillay S Sujitha, Barman Bhupen, Elwell Helen, Bora Kaustubh, Bilgrami Syed, Mahmood Sajid, Babajan Nasarulla, Venkatachalam Srinivasan, Ottewell Lesley, Manzo Ciro
Department of Rheumatology, Southport and Ormskirk NHS Trust, Southport PR8 6PN, UK.
Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L9 7AL, UK.
Vaccines (Basel). 2023 Oct 8;11(10):1571. doi: 10.3390/vaccines11101571.
A comprehensive, up-to-date systematic review (SR) of the new-onset rheumatic immune-mediated inflammatory diseases (R-IMIDs) following COVID-19 vaccinations is lacking. Therefore, we investigated the demographics, management, and prognosis of new R-IMIDs in adults following SARS-CoV-2 vaccinations. A systematic literature search of Medline, Embase, Google Scholar, LitCovid, and Cochrane was conducted. We included any English-language study that reported new-onset R-IMID in adults following the post-COVID-19 vaccination. A total of 271 cases were reported from 39 countries between January 2021 and May 2023. The mean age of patients was 56 (range 18-90), and most were females (170, 62.5%). Most (153, 56.5%) received the Pfizer BioNTech COVID-19 vaccine. Nearly 50% of patients developed R-IMID after the second dose of the vaccine. Vasculitis was the most prevalent clinical presentation (86, 31.7%), followed by connective tissue disease (66, 24.3%). The mean duration between the vaccine's 'trigger' dose and R-IMID was 11 days. Most (220, 81.2%) received corticosteroids; however, 42% (115) received DMARDs such as methotrexate, cyclophosphamide, tocilizumab, anakinra, IV immunoglobulins, plasma exchange, or rituximab. Complete remission was achieved in 75 patients (27.7%), and 137 (50.6%) improved following the treatment. Two patients died due to myositis. This SR highlights that SARS-CoV-2 vaccines may trigger R-IMID; however, further epidemiology studies are required.
目前缺乏对新冠疫苗接种后新发性风湿免疫介导的炎症性疾病（R-IMIDs）的全面、最新的系统评价（SR）。因此，我们调查了成人接种SARS-CoV-2疫苗后新发R-IMIDs的人口统计学特征、管理情况和预后。我们对Medline、Embase、谷歌学术、LitCovid和Cochrane进行了系统的文献检索。我们纳入了任何报告成人在新冠疫苗接种后新发R-IMID的英文研究。2021年1月至2023年5月期间，来自39个国家共报告了271例病例。患者的平均年龄为56岁（范围18 - 90岁），大多数为女性（170例，62.5%）。大多数（153例，56.5%）接种了辉瑞BioNTech新冠疫苗。近50%的患者在接种第二剂疫苗后发生R-IMID。血管炎是最常见的临床表现（86例，31.7%），其次是结缔组织病（66例，24.3%）。从疫苗“触发”剂量到R-IMID的平均间隔时间为11天。大多数（220例，81.2%）接受了皮质类固醇治疗；然而，42%（115例）接受了甲氨蝶呤、环磷酰胺、托珠单抗、阿那白滞素、静脉注射免疫球蛋白、血浆置换或利妥昔单抗等改善病情抗风湿药（DMARDs）治疗。75例患者（27.7%）实现完全缓解，137例患者（50.6%）治疗后病情改善。两名患者因肌炎死亡。本系统评价强调SARS-CoV-2疫苗可能引发R-IMID；然而，还需要进一步的流行病学研究。
