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Rheumatologists' perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets.

风湿病学家对冠状病毒病 19 (新型冠状病毒肺炎) 和潜在治疗靶点的观点。

  • 影响因子:2.26
  • DOI:10.1007/s10067-020-05073-9
  • 作者列表:"Misra DP","Agarwal V","Gasparyan AY","Zimba O
  • 发表时间:2020-07-01

:The ongoing pandemic coronavirus disease 19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a matter of global concern. Environmental factors such as air pollution and smoking and comorbid conditions (hypertension, diabetes mellitus and underlying cardio-respiratory illness) likely increase the severity of COVID-19. Rheumatic manifestations such as arthralgias and arthritis may be prevalent in about a seventh of individuals. COVID-19 can result in acute interstitial pneumonia, myocarditis, leucopenia (with lymphopenia) and thrombocytopenia, also seen in rheumatic diseases like lupus and Sjogren's syndrome. Severe disease in a subset of patients may be driven by cytokine storm, possibly due to secondary hemophagocytic lymphohistiocytosis (HLH), akin to that in systemic onset juvenile idiopathic arthritis or adult-onset Still's disease. In the absence of high-quality evidence in this emerging disease, understanding of pathogenesis may help postulate potential therapies. Angiotensin converting enzyme 2 (ACE2) appears important for viral entry into pneumocytes; dysbalance in ACE2 as caused by ACE inhibitors or ibuprofen may predispose to severe disease. Preliminary evidence suggests potential benefit with chloroquine or hydroxychloroquine. Antiviral drugs like lopinavir/ritonavir, favipiravir and remdesivir are also being explored. Cytokine storm and secondary HLH might require heightened immunosuppressive regimens. Current international society recommendations suggest that patients with rheumatic diseases on immunosuppressive therapy should not stop glucocorticoids during COVID-19 infection, although minimum possible doses may be used. Disease-modifying drugs should be continued; cessation may be considered during infection episodes as per standard practices. Development of a vaccine may be the only effective long-term protection against this disease.Key Points• Patients with coronavirus disease 19 (COVID-19) may have features mimicking rheumatic diseases, such as arthralgias, acute interstitial pneumonia, myocarditis, leucopenia, lymphopenia, thrombocytopenia and cytokine storm with features akin to secondary hemophagocytic lymphohistiocytosis.• Although preliminary results may be encouraging, high-quality clinical trials are needed to better understand the role of drugs commonly used in rheumatology like hydroxychloroquine and tocilizumab in COVID-19.• Until further evidence emerges, it may be cautiously recommended to continue glucocorticoids and other disease-modifying antirheumatic drugs (DMARDs) in patients receiving these therapies, with discontinuation of DMARDs during infections as per standard practice.


: 由新型冠状病毒肺炎冠状病毒 2 (新型冠状病毒) 引起的正在发生的大流行性冠状病毒疾病 19 (SARS-CoV-2) 是全球关注的问题。环境因素,如空气污染、吸烟和合并症 (高血压、糖尿病和潜在的心肺疾病) 可能会增加新型冠状病毒肺炎的严重程度。风湿性表现如关节痛和关节炎可能在大约七分之一的个体中普遍存在。新型冠状病毒肺炎可导致急性间肺炎、心肌炎、白细胞减少 (伴有淋巴细胞减少) 和血小板减少,也见于狼疮和干燥综合征等风湿性疾病。一部分患者的严重疾病可能由细胞因子风暴驱动,可能是由于继发性噬血细胞淋巴组织细胞增生症 (HLH),类似于全身发病的幼年特发性关节炎或成人发病的Still病。在这种新兴疾病缺乏高质量证据的情况下,了解发病机制可能有助于假设潜在的治疗方法。血管紧张素转换酶 2 (ACE2) 对病毒进入肺细胞似乎很重要; ACE抑制剂或布洛芬引起的ACE2 平衡失调可能易患严重疾病。初步证据表明氯喹或羟氯喹有潜在的益处。抗病毒药物如洛匹那韦/利托那韦、法匹拉韦和雷米西韦也在探索中。细胞因子风暴和继发性HLH可能需要提高免疫抑制方案。目前的国际社会建议,风湿性疾病患者在接受免疫抑制治疗时,尽管可以使用最小剂量,但不应在新型冠状病毒肺炎感染时停用糖皮质激素。应继续使用疾病修饰药物; 根据标准实践,感染发作期间可考虑停止。疫苗的开发可能是对这种疾病的唯一有效的长期保护。要点 • 冠状病毒病患者 19 (新型冠状病毒肺炎) 可能具有类似风湿性疾病的特征,如关节痛、急性间质肺炎、心肌炎、白细胞减少、淋巴细胞减少、血小板减少和细胞因子风暴,特征类似于继发性噬血细胞淋巴组织细胞增生症。虽然初步结果可能令人鼓舞,但需要高质量的临床试验来更好地了解常用于风湿病的药物,如羟氯喹和托珠单抗在新型冠状病毒肺炎中的作用。• 在进一步证据出现之前,可能会谨慎建议继续使用糖皮质激素和其他改变病情的抗风湿药物(DMARDs) 在接受这些治疗的患者中,按照标准实践在感染期间停用DMARDs。



作者列表:["Lim J","Jeon S","Shin HY","Kim MJ","Seong YM","Lee WJ","Choe KW","Kang YM","Lee B","Park SJ"]

METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.

作者列表:["Zhang W","Du RH","Li B","Zheng XS","Yang XL","Hu B","Wang YY","Xiao GF","Yan B","Shi ZL","Zhou P"]

METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.

翻译标题与摘要 下载文献
作者列表:["Cheng ZJ","Shan J"]

METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.