Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 020022 Bucharest, Romania.
Neuromuscular Rehabilitation Clinic Division, Teaching Emergency Hospital "Bagdasar-Arseni", 041915 Bucharest, Romania.
Int J Mol Sci. 2024 Oct 17;25(20):11149. doi: 10.3390/ijms252011149.
Rheumatoid arthritis (RA) patients face different health challenges when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) than the general population, due to both their immunocompromised state and the immunosuppressive therapies they receive. This systematic literature review, which follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) paradigm, explores the interactions between RA and SARS-CoV-2 infection, focusing on immunologic issues, disease management, vaccination, and adverse outcomes. In order to obtain the most relevant information, we systematically reviewed the specific literature from 1 January 2021 to 31 December 2023, based on the PRISMA method, by which we eventually selected 35 eligible articles, to which we added other ISI-indexed studies to enrich our results further. Consequently, we performed a funnel analysis to evaluate the potential for publication bias. Firstly, the data collected revealed the impact of the pandemic on RA diagnoses and the fear of face-to-face medical consultations that delayed adequate treatment. Secondly, cardiovascular and metabolic comorbidities increase the risk of prolonged COVID-19 symptoms, hospitalization, and severe COVID-19 outcomes for RA patients. With respect to immunosuppressive treatment used to control RA, it was observed that glucocorticoids (especially high-dose usage) and Rituximab (RTX) predispose the patients to poor SARS-CoV-2 outcomes, as opposed to Baricitinib and interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) inhibitors. COVID-19 vaccination has proven effective and generally safe for RA patients in some studies, although therapies with Methotrexate (MTX), Abatacept (ABA), and RTX have been associated with impaired vaccine immune response. This systematic literature review brings updated and thorough information with respect to the immunological, clinical, and management of a complex immune-mediated inflammatory disease (IMID) like RA in the setting of COVID-19 and underlines the challenges faced by this group of patients. The lessons learned can be extended beyond the pandemic in shaping a more informed and compassionate healthcare system and offering long-term medical care for patients with RA.
类风湿关节炎（RA）患者在感染严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）时面临着与普通人群不同的健康挑战，这是由于他们的免疫功能低下状态和接受的免疫抑制治疗。本系统文献综述遵循系统评价和荟萃分析的首选报告项目（PRISMA）范式，探讨了 RA 与 SARS-CoV-2 感染之间的相互作用，重点关注免疫问题、疾病管理、疫苗接种和不良结局。为了获得最相关的信息，我们根据 PRISMA 方法，从 2021 年 1 月 1 日至 2023 年 12 月 31 日系统地回顾了特定的文献，最终选择了 35 篇合格的文章，并添加了其他 ISI 索引的研究来进一步丰富我们的结果。因此，我们进行了漏斗分析以评估发表偏倚的可能性。首先，收集的数据揭示了大流行对 RA 诊断的影响以及对面对面医疗咨询的恐惧，这延迟了充分的治疗。其次，心血管和代谢合并症增加了 RA 患者 COVID-19 症状延长、住院和严重 COVID-19 结局的风险。关于用于控制 RA 的免疫抑制治疗，观察到糖皮质激素（尤其是高剂量使用）和利妥昔单抗（RTX）使患者易患不良的 SARS-CoV-2 结局，而巴利昔单抗和白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）抑制剂则相反。在一些研究中，COVID-19 疫苗已被证明对 RA 患者有效且通常安全，尽管 MTX、ABA 和 RTX 等疗法与疫苗免疫反应受损有关。本系统文献综述提供了有关 COVID-19 背景下 RA 等复杂免疫介导的炎症性疾病（IMID）的免疫、临床和管理的最新和全面的信息，并强调了这群患者所面临的挑战。所吸取的经验教训不仅可以在大流行之外扩展，还可以塑造一个更明智和富有同情心的医疗保健系统，并为 RA 患者提供长期医疗护理。
