First flare of ACPA-positive rheumatoid arthritis after SARS-CoV-2 infection.
First flare of ACPA-positive rheumatoid arthritis after SARS-CoV-2 infection.
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DOI：
10.1016/s2665-9913(20)30396-9
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发表时间：
2021-01
期刊：
影响因子：
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通讯作者：
Balandraud N
中科院分区：
文献类型：
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作者：
Perrot L;Hemon M;Busnel JM;Muis-Pistor O;Picard C;Zandotti C;Pham T;Roudier J;Desplat-Jego S;Balandraud N
评论：柳叶刀。COM/风湿学第三卷2021年1月E7在临床症状出现之前；以及人类白细胞抗原(HLA)-DR等位基因的存在，这些等位基因表达与发生类风湿性关节炎的高风险相关的所谓共同表位。2为什么一些有这些因素的人会出现临床多发性关节炎尚不清楚，但外部因素，如病毒感染，可能是触发因素。事实上，尽管病毒和诱导自身反应之间的确切机制联系还远未建立，但在人类和动物中的一些研究表明，病毒可以诱导或保护宿主免受自身免疫性疾病的影响，这取决于几个因素，包括宿主的遗传背景、对感染的免疫反应、病毒株系、病毒载量和感染的时间。3 2019年开始的新冠肺炎大流行是由感染严重急性呼吸综合征冠状病毒2型引起的，这种病毒会引起各种流感样症状，以及嗅觉障碍、腹泻、骨关节疾病，在严重的情况下，可能会出现细胞因子风暴。4在这里，我们描述了一例SARS-CoV-2感染后立即发生的ACPA阳性类风湿性关节炎病例，并讨论了SARS-CoV-2作为临床类风湿性关节炎激活剂的可能性。一名来自法国马赛的60岁妇女，身体质量指数(20公斤/平方米)健康，无明显病史(无关节体征或症状)，于2020年4月27日开始咳嗽，并伴有异常虚弱、肌肉痛、腹痛和头痛，当时法国新冠肺炎患病率很高。2020年5月1日，她咨询了马赛大学传染病医院。SARS-CoV-2的RT-PCR检测呈阳性，胸部CT扫描显示结节状凝聚，伴磨砂玻璃面，本质上累及胸膜下，支持SARS-CoV-2轻度感染的诊断。患者用羟氯喹和氮杂霉素治疗5天，用葡萄糖酸锌治疗10天。她的症状在5-6天内得到改善，重复的SARS-CoV-2聚合酶链式反应检测(在第一次症状出现后11天做)为阴性。2020年5月21日，也就是第一次感染迹象后25天，患者的右手开始疼痛，特别是第五指的掌指和指间关节，并有肿胀。3-5天后，关节炎扩散到左手食指的掌指关节和右手的第二、三指，也有持续性的
Comment www. thelancet. com/rheumatology Vol 3 January 2021 e7 before the onset of clinical symptoms; and the presence of human leukocyte anti gen (HLA)-DR alleles that express the so-called shared epitope that is associated with a high risk of developing rheuma toid arthritis. 2 Why clinical polyarthritis occurs in some individuals with these elements is unknown, but external factors such as viral infection could act as a trigger. Indeed, although a definitive mechanistic link between viruses and the induction of autoreactivity is far from established, several studies in humans and animals have shown that viruses can induce or protect the host from autoimmune disease, depending on several factors including genetic background of the host, immune responses to infection, virus strain, viral load, and the timing of infection. 3 The COVID-19 pandemic that began in 2019 is caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which induces various influenza-like symptoms, as well as anosmia, diarrhoea, osteo articular disorders, and, in severe cases, a possible cytokine storm. 4 Here, we describe a case of ACPA-positive rheumatoid arthritis that occurred immediately after SARS-CoV-2 infection and discuss the potential for SARS-CoV-2 to act as an activator of clinical rheuma toid arthritis. A 60-year-old woman from Marseille, France, with a healthy body-mass index (20 kg/m²) and no notable medical history (includ ing no articular signs or symptoms) began to have cough with unusual asthenia, myalgia, abdominal pain, and headaches on April 27, 2020, when the COVID-19 case rate was very high in France. On May 1, 2020, she consulted the University Hospital for Infectious Diseases in Marseille. An RT-PCR for SARS-CoV-2 was positive, and a chest CT scan showed the presence of a nodular condensation with a frosted glass aspect, and essentially subpleural involvement, support ing a diagnosis of a mild SARS-CoV-2 infection. The patient was treated with hydroxychloroquine and azithro mycin for 5 days and effizinc (zinc gluconate) for 10 days. Her symptoms improved in within 5–6 days, and a repeat SARS-CoV-2 PCR test (done 11 days after the first symptoms) was negative.On May 21, 2020, 25 days after the first signs of infection, the patient began to have pain in her right hand, particularly the metacarpophalangeal and inter phalangeal joints of the fifth finger, with swelling. 3–5 days later, arthritis had spread to the metacarpophalangeal joints of the first finger on her left hand and the second and third fingers on her right hand; she also had persistent