Flare of rheumatoid arthritis after COVID-19 vaccination.
Flare of rheumatoid arthritis after COVID-19 vaccination.
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DOI：
10.1016/s2665-9913(21)00108-9
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发表时间：
2021-07
期刊：
影响因子：
--
通讯作者：
Tan FK
中科院分区：
文献类型：
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作者：
Terracina KA;Tan FK
随着新冠肺炎的大流行，鉴于感染会导致免疫系统过度激活，人们对该病毒是否会加剧类风湿关节炎等自身免疫性疾病存在很大的不确定性，而免疫系统被认为在普通人群中的严重病例中起到了一定作用。1、2对文献的回顾表明，到目前为止，已经有一例感染SARS-CoV-2后出现类风湿性关节炎的病例报告。3到目前为止，美国已批准三种新冠肺炎疫苗紧急使用。4其中两种疫苗，BNT162b2(BioNTech-Pfizer)和mRNA1273(莫德纳)，是通过脂质纳米粒递送的新型mRNA疫苗。这些疫苗的临床试验允许风湿病患者参与试验的后期阶段，但排除了服用免疫抑制剂的患者。5、6因此，目前尚不完全清楚这些疫苗是否会由于免疫激活或非特异性佐剂作用而引发潜在风湿性疾病的爆发。有报道称，其他疫苗，如针对破伤风、风疹、乙肝和流感的疫苗，会引发类风湿性关节炎，但因果关系从未得到证实，也从未在大型对照研究中再现过这种联系。分子模仿被认为是发生自身免疫的一种机制，其中病毒多肽和自体多肽之间的相似性可以刺激免疫激活，但这在类风湿性关节炎中尚未得到证实。美国风湿病学会于2021年2月8日发布了关于新冠肺炎疫苗接种的指导意见，并以适度的共识承认了接种后自身免疫性疾病爆发的理论风险。9.
With the COVID-19 pandemic, there has been great uncertainty about whether the virus could exacerbate autoimmune diseases such as rheumatoid arthritis given that infection can lead to an overactivation of the immune system, which is thought to play a part in severe cases in the general population. 1, 2 A review of the literature shows there has been one case report so far of a flare of rheumatoid arthritis after infection with SARS-CoV-2. 3Three COVID-19 vaccines have been approved for emergency use in the USA so far. 4 Two of the vaccines, BNT162b2 (BioNTech-Pfizer) and mRNA-1273 (Moderna), are novel mRNA-based vaccines delivered via lipid nanoparticles. The clinical trials of these vaccines allowed for patients with rheumatic disease to participate in the later stages of the trials, but excluded patients on immunosuppressive agents. 5, 6 Therefore, it is not fully known whether these vaccines might provoke flares of underlying rheumatic conditions as a result of immune activation or non-specific adjuvant effects. There are reports of other vaccines, such as those against tetanus, rubella, hepatitis B, and influenza, triggering rheumatoid arthritis, but causality has never been proven and an association has never been reproduced in large, controlled studies. 7 Molecular mimicry is thought to be one mechanism by which autoimmunity can occur, in which similarities between viral peptides and self-peptides can stimulate immune activation, but this has not been proven in rheumatoid arthritis. 8 The American College of Rheumatology issued guidance regarding COVID-19 vaccination on Feb 8, 2021, and acknowledged a theoretical risk of flare of autoimmune disease after vaccination with moderate consensus. 9