Dey Dzifa, Katso Bright, Amoako Emmanuella, Manu Aida, Bediako Yaw
Department of Medicine and Therapeutics, University of Ghana Medical School, Legon, Accra, Ghana.
Rheumatology Unit, Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana.
BMC Rheumatol. 2024 Jun 17;8(1):25. doi: 10.1186/s41927-024-00396-5.
Vaccines are a crucial component of the global efforts to control the spread of COVID-19. Very little is known about COVID-19 vaccine responses in patients living with autoimmune rheumatic conditions in Africa. We examined the clinical reaction to COVID-19 vaccinations in Ghanaians diagnosed with autoimmune rheumatic disease.
This was a hospital-based interventional cohort study of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients recruited via regular face-to-face clinic visits. The systemic lupus erythematosus disease activity index Selena modification (SELENA-SLEDAI) and the disease activity score 28-joint count-erythrocyte sedimentation rate (DAS28-ESR) were used to measure changes in disease activity levels.
Thirty-eight (38) patients of which 21 (55.3%) were diagnosed with SLE and 17 (44.7%) with RA contributed data for analyses. Most (89.5%) of the patients were females, with a mean age of 37.4 years. The SLE patients experienced a notable increase in severe flares during weeks three and six, as well as the third and sixth months, followed by subsequent decreases in the twelfth month, while remission levels increased throughout the same period. Among RA patients, high disease activity decreased during weeks three and six, as well as the third, sixth, and twelfth months, with remission levels increasing during the same time. A low dose (≥ 50 < 75 mg) dose of azathioprine was at some point associated with having a severe flare among SLE patients. After both vaccine doses, SLE patients were the majority having experienced both local and systemic reactions, all resolving within 24 h. Approximately 73.7% of the patients were COVID-19 negative at baseline. During post-vaccination visits, this increased to 100% by week six, with no positives thereafter.
This study explores COVID-19 vaccine responses in Ghanaian autoimmune rheumatic disease patients, revealing disease activity levels in RA patients improved after vaccination compared to SLE patients. Our findings identify a potential link between low-dose azathioprine and severe flares in SLE patients, particularly evident in the third-week post-vaccination. Further research is warranted to clarify these findings and guide tailored treatment approaches in this medically significant population during pandemics and vaccination efforts.
疫苗是全球控制新冠病毒传播努力的关键组成部分。对于非洲自身免疫性风湿疾病患者的新冠疫苗反应，人们了解甚少。我们研究了被诊断患有自身免疫性风湿疾病的加纳人对新冠疫苗接种的临床反应。
这是一项基于医院的干预性队列研究，通过定期面对面门诊招募系统性红斑狼疮（SLE）和类风湿关节炎（RA）患者。采用系统性红斑狼疮疾病活动指数的塞莱娜修正版（SELENA - SLEDAI）和28关节计数 - 红细胞沉降率疾病活动评分（DAS28 - ESR）来衡量疾病活动水平的变化。
38名患者参与了分析，其中21名（55.3%）被诊断为SLE，17名（44.7%）被诊断为RA。大多数患者（89.5%）为女性，平均年龄37.4岁。SLE患者在第三周和第六周以及第三个月和第六个月时严重病情加重明显增加，随后在第十二个月下降，而缓解水平在同一时期有所上升。在RA患者中，高疾病活动度在第三周和第六周以及第三个月、第六个月和第十二个月时下降，同时缓解水平在同一时期上升。低剂量（≥50＜75毫克）硫唑嘌呤在某些时候与SLE患者的严重病情加重有关。在接种两剂疫苗后，SLE患者是经历局部和全身反应的主要群体，所有反应均在24小时内消退。大约73.7%的患者在基线时新冠病毒检测呈阴性。在接种疫苗后的随访中，到第六周时这一比例增至100%，此后无阳性病例。
本研究探讨了加纳自身免疫性风湿疾病患者对新冠疫苗的反应，发现与SLE患者相比，RA患者接种疫苗后疾病活动水平有所改善。我们的研究结果确定了低剂量硫唑嘌呤与SLE患者严重病情加重之间的潜在联系，在接种疫苗后的第三周尤为明显。有必要进行进一步研究以阐明这些发现，并在大流行和疫苗接种期间为这一具有医学重要性的人群指导量身定制的治疗方法。
