COVID-19 and the clinical course of rheumatic manifestations.

COVID-19 and the clinical course of rheumatic manifestations.
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DOI:
10.1007/s10067-021-05691-x
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发表时间:
2021-07
影响因子:
3.4
通讯作者:
Gasparyan AY
Gasparyan AY
中科院分区:
医学3区
文献类型:
--
作者:
Ahmed S;Zimba O;Gasparyan AY

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新冠肺炎的表现形式一直在随着时间的推移而演变。人们正在认识到各种后新冠肺炎综合症。各种病毒与自身免疫性疾病的发病机制有关,我们预计与严重急性呼吸综合征相关冠状病毒-2(SARS-CoV-2)的结果类似。SARS-CoV-2病毒穿透各种组织和器官,容易导致内皮炎,可能导致血管症状,包括血栓形成。SARS-CoV-2已被证明激活Toll样受体和补体系统。它使蚊虫增多症持续存在,并导致自身抗体的形成。这些都容易引发全身性自身免疫。新冠肺炎之后,报道了反应性关节炎和结缔组织疾病,如狼疮和炎症性肌炎。其他已报道的自身免疫性疾病包括溶血性贫血、免疫性血小板减少症、皮肤血管炎和类似格林-巴利的急性脱髓鞘疾病。儿童和成人的多系统炎症综合征是另一个后新冠肺炎的实体,表现为川崎病和葡萄球菌中毒性休克综合征的混合体。在SARS-CoV-2感染期间,既有风湿性疾病的患者可能会发作。它们还可能产生新的自身免疫特征。在急性新冠肺炎疾病期间使用的免疫抑制剂可能会混淆结果,而风湿病患者的并存可能会掩盖结果。迫切需要对COVID康复患者进行随访,并监测风湿症状背景下自身抗体的产生。
The manifestations of COVID-19 have been evolving over time. Various post-COVID-19 syndromes are being recognised. Various viruses have been implicated in the pathogenesis of autoimmune diseases, and we expect a similar outcome with the severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2). The SARS-CoV-2 virus penetrates various tissues and organs and has a predisposition to lead to endotheliitis that may cause vascular manifestations including thrombosis. SARS-CoV-2 has been shown to activate Toll-like receptors and the complement system. It perpetuates NETosis and leads to autoantibody formation. These predispose to systemic autoimmunity. Both reactive arthritis and connective tissue disorders such as lupus and inflammatory myositis have been reported after COVID-19. Other reported autoimmune disorders include haemolytic anaemia, immune thrombocytopenia, cutaneous vasculitis, and Guillain Barré–like acute demyelinating disorders. The multi-system inflammatory syndrome in children and its adult counterpart are another post-COVID-19 entity that presents as an admixture of Kawasaki disease and staphylococcal toxic shock syndrome. Patients with preexisting rheumatic diseases may flare during the SARS-CoV-2 infection. They may develop novel autoimmune features also. The immune-suppressants used during the acute COVID-19 illness may confound the outcomes whereas comorbidities present in patients with rheumatic diseases may mask them. There is an urgent need to follow-up patients recovering from COVID and monitor autoantibody production in the context of rheumatic manifestations.
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