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*Only for medical professionals to read for reference.
Let's vaccinate together, Miao Miao Miao Miao Miao! On May 20-22, 2021, the 25th Academic Conference of the Chinese Association of Rheumatology (CRA) in 2021 will be held in Shenzhen.
This conference can be described as a gathering of big names and bright spots.
Professor Dong Lingli from Tongji Hospital affiliated to Huazhong University of Science and Technology gave a high-profile report on the diagnosis and treatment of rheumatism under the epidemic situation.
The report discussed in detail the vaccination recommendations and management of rheumatism patients under the current epidemic situation.
The "medical community" is fortunate to invite Professor Dong Lingli to be a guest at the special site of the 2021 CRA "famous doctor Kung Fu tea" in the medical community, and call for doctors in the rheumatology and immunology department across the country.
The picture shows that Professor Dong Lingli is a guest in the live broadcast room, and patients with rheumatism are more likely to be infected with the new crown and have a worse prognosis? Professor Dong Lingli introduced the epidemiology of rheumatism patients with COVID-19 and the two parts of rheumatism and the new crown vaccine.
In the first part, Professor Dong Lingli introduced some of the work done by her team in response to COVID-19.
They followed up 15,697 patients with rheumatism by telephone, excluded gout, ankylosing spondylitis, osteoarthritis, and patients with ineffective follow-up, and enrolled 6,228 patients.
patient.
Taking the family as the research unit, it was found that 42 patients had a history of exposure to COVID-19 in their families, and further divided according to whether they had a history of rheumatism.
It was found that 27 cases of families with a history of rheumatism were diagnosed with new crowns, and 28 cases of families with no history of rheumatism were diagnosed with new crowns , Calculated that the infection rate of rheumatism patients is about 0.
43%, which is significantly higher than 0.
12% of the general population.Figure 1.
Susceptibility of patients with rheumatism to COVID-19 So how severe are rheumatism patients after being infected with COVID-19? A single-center study of patients with rheumatism and immune diseases in Tongji Hospital who are infected with COVID-19 shows that patients with rheumatism and immune diseases have a higher proportion of respiratory failure after being infected with the new crown than patients with non-rheumatic diseases.
More than 23 patients with rheumatism and immune diseases in Hubei have been infected with COVID-19.
The central study found that 100 of the 20,000 patients with new crowns had rheumatism, of which gout patients accounted for 59.
5%.
Further research found that patients with rheumatism and immune diseases suffered from new crowns and had a worse condition and a worse prognosis than the normal population.
Figure 2.
Multi-center study of COVID-19 in patients with rheumatism in Hubei.
Many drugs commonly used by patients with rheumatism include hormones and hydroxychloroquine (HCQ).
They further analyzed the previous telephone follow-up patients and found that rheumatism using HCQ Patients are less likely to be infected with COVID-19 than those who have not used HCQ, and a multi-center study found that taking HCQ and low-dose hormones (<15mg) has a smaller proportion of severe and critical illness.
Summarizing the status of COVID-19 in global rheumatism and immune diseases, we can find that most studies support that patients with rheumatism and immune diseases are at higher risk of COVID-19 infection and have a worse prognosis.
In terms of disease types, according to a single-center study of Hubei Tongji Hospital, rheumatoid arthritis is the most common.
In terms of global data, the proportion of psoriasis, spondyloarthritis, and vasculitis is not low.
Figure 3.
The incidence of COVID-19 in different rheumatic diseases.
In the main treatment of rheumatism and COVID-19, most of the current studies believe that the use of glucocorticoids may lead to an increase in hospitalization and infection rates, which is useful for improving the disease and fighting rheumatism.
Studies on DMARDs are controversial, and antimalarial drugs are generally believed to have little effect, and studies believe that some biological agents may increase the risk.
How to get vaccinated? A big summary of foreign guides! Next, Professor Dong Lingli elaborated on rheumatism and the new crown vaccine.
Most studies believe that patients with rheumatism are more susceptible to new crowns, so it is necessary for patients with rheumatism to be vaccinated. The 2019 European Union Against Rheumatism (EULAR) vaccination recommendations for adult patients with autoimmune inflammatory rheumatism recommends that patients with rheumatism are in stable condition to receive inactivated vaccines, and other guidelines/consensus such as the Portuguese guidelines and the French guidelines also recommend vaccination.
Simply put, the key to vaccinating patients with rheumatism is a stable and inactivated vaccine.
Figure 4.
2019 EULAR vaccination recommendations for adults with autoimmune inflammatory rheumatism.
Figure 5.
Other guidelines/consensus recommendations for vaccination for patients with rheumatism.
As of December 2020, 60 new crown vaccines worldwide have been approved for clinical trials, mainly divided into the following 6 different types: inactivated vaccines, nucleic acid vaccines, vector vaccines, subunit vaccines, virus-like particle vaccines, live attenuated vaccines.
To summarize all current views/consensus regarding COVID-19 vaccination for patients with rheumatism and musculoskeletal diseases (RMDs): Figure 6.
EULAR's view on COVID-19 vaccination for patients with RMDs in 2020 Figure 7.
ACR rheumatism and musculoskeletal Summary of Clinical Guidance for COVID-19 Vaccine for Patients with Diseases Figure 8.
APLAR's update of COVID-19 vaccination for rheumatism.
Figure 9.
Singapore Rheumatology Society's consensus on COVID-19 vaccine.
What does my country's guidelines say? In this context, the Rheumatology Branch of the Chinese Medical Association and the Infectious Diseases Branch jointly wrote the "Expert Recommendations for Immunity Impaired Adults New Coronavirus Vaccination (Patients with Chronic Liver Disease, Liver Cirrhosis, Tuberculosis and Rheumatology)", aiming to Provide practical reference opinions for patients with rheumatism and immune diseases to vaccinate COVID-19 vaccine.
Among them, for patients with rheumatism and immune diseases, the recommended points are as follows: 1.
The new crown vaccination decision-making for adult patients with rheumatism and immune diseases should fully consider personal and social factors and be implemented by rheumatologists, vaccination doctors, primary care doctors and patients; 2.
Adult patients with rheumatism and immunological diseases are in a stable period.
If there are no other contraindications, it is recommended to inoculate the new crown inactivated vaccine; 3.
The application of immunosuppressive agents may reduce the effectiveness of the vaccine; 4.
The vast majority of immunosuppressants, biological agents and small molecule targets The drug should continue to be applied without changing the time of immunotherapy and vaccination.
5.
For methotrexate, JAK inhibitors, abatacept, cyclophosphamide and rituximab, immunotherapy and vaccination time should be adjusted accordingly. The specific content includes: 1.
Types of vaccination: Adult rheumatism patients are recommended to receive inactivated vaccines.
Careful consideration should be given to vaccination of other types of vaccines, such as nucleic acid vaccines, recombinant subunit vaccines, and adenovirus recombinant vaccines.
2.
Indications: In addition to the contraindications listed below, adult patients with rheumatism who are in stable condition are advised to receive the new crown inactivated vaccine.
Whether to vaccinate during the active period of the disease needs to be weighed according to the pros and cons of the disease.
However, compared with healthy people, the expected effectiveness of the COVID-19 vaccine in patients with rheumatism who receive systemic immunosuppressive therapy may decrease.
3.
Contraindications: Those who are contraindicated in the general vaccine in the "Technical Guidelines for New Coronavirus Vaccination (First Edition)" cannot be vaccinated.
4.
Adjustment of immunosuppressive therapy and vaccination time: Most immunosuppressive agents, biological agents and small molecule targeted drugs should continue to be used without changing the immunosuppressive therapy and vaccination time.
However, when methotrexate and JAK are used When enzyme inhibitors, abatacept, cyclophosphamide, and rituximab are used for immunosuppressive therapy, the vaccination time is recommended to be adjusted accordingly (see Figure 10).
Figure 10.
The treatment adjustment and vaccination time recommendations in the "Expert Recommendations for Immunity Impaired Adults with New Coronavirus Vaccination" 5.
Special attention should be paid: (1) Rheumatologists should participate in the evaluation of adult patients with rheumatism and immunity COVID-19 Indications for vaccination.
The individualized vaccination plan should be explained to the patient by the rheumatologist immunologist, and jointly decided and implemented by the rheumatologist, vaccination doctor, primary care doctor and the patient.
(2) After vaccination with COVID-19, there may theoretically be a risk of recurrence or progression of rheumatic immune disease.
However, the benefits of COVID-19 vaccination for adult patients with rheumatic immune diseases outweigh the potential risk of recurrence of the original disease.
Patients with rheumatic immune diseases should continue to closely observe the underlying disease and monitor the disease activity after being vaccinated with the COVID-19 vaccine.
(3) Recently, AstraZeneca COVID-19 vaccine (adenovirus recombinant vaccine) has experienced complications of venous thrombosis after vaccination, especially thrombosis in rare parts (such as intracranial venous sinus thrombosis), which is called vaccine-induced promotor Thrombosis immune thrombocytopenia (VIPIT).
VIPIT is believed to be related to platelet antibody production caused by immune response after vaccination.
Although for patients with a history of thrombosis and/or known thrombosis (such as antiphospholipid syndrome), there is currently no evidence that the risk of intracranial veins or other rare sites of thrombotic complications increased after AstraZeneca COVID-19 vaccination , It is recommended that patients with rheumatism immune disease avoid vaccination of recombinant adenovirus vaccine.
(4) After receiving the COVID-19 vaccine, patients with rheumatism should continue to follow all other public health guidelines, maintain social distancing, and take personal protection.
(5) Family members and other close contacts of patients with rheumatic immune diseases should be vaccinated against COVID-19 if possible, which may help protect patients.
(6) In particular, since there is currently no sufficient high-quality evidence-based medicine for the above population, this proposal cannot replace the doctor's individualized advice to patients.
In addition, since the specific data of the new crown vaccination study for this special population is still being released one after another, this recommendation will be adjusted and revised accordingly based on the new clinical evidence.
Let's vaccinate together, Miao Miao Miao Miao Miao! On May 20-22, 2021, the 25th Academic Conference of the Chinese Association of Rheumatology (CRA) in 2021 will be held in Shenzhen.
This conference can be described as a gathering of big names and bright spots.
Professor Dong Lingli from Tongji Hospital affiliated to Huazhong University of Science and Technology gave a high-profile report on the diagnosis and treatment of rheumatism under the epidemic situation.
The report discussed in detail the vaccination recommendations and management of rheumatism patients under the current epidemic situation.
The "medical community" is fortunate to invite Professor Dong Lingli to be a guest at the special site of the 2021 CRA "famous doctor Kung Fu tea" in the medical community, and call for doctors in the rheumatology and immunology department across the country.
The picture shows that Professor Dong Lingli is a guest in the live broadcast room, and patients with rheumatism are more likely to be infected with the new crown and have a worse prognosis? Professor Dong Lingli introduced the epidemiology of rheumatism patients with COVID-19 and the two parts of rheumatism and the new crown vaccine.
In the first part, Professor Dong Lingli introduced some of the work done by her team in response to COVID-19.
They followed up 15,697 patients with rheumatism by telephone, excluded gout, ankylosing spondylitis, osteoarthritis, and patients with ineffective follow-up, and enrolled 6,228 patients.
patient.
Taking the family as the research unit, it was found that 42 patients had a history of exposure to COVID-19 in their families, and further divided according to whether they had a history of rheumatism.
It was found that 27 cases of families with a history of rheumatism were diagnosed with new crowns, and 28 cases of families with no history of rheumatism were diagnosed with new crowns , Calculated that the infection rate of rheumatism patients is about 0.
43%, which is significantly higher than 0.
12% of the general population.Figure 1.
Susceptibility of patients with rheumatism to COVID-19 So how severe are rheumatism patients after being infected with COVID-19? A single-center study of patients with rheumatism and immune diseases in Tongji Hospital who are infected with COVID-19 shows that patients with rheumatism and immune diseases have a higher proportion of respiratory failure after being infected with the new crown than patients with non-rheumatic diseases.
More than 23 patients with rheumatism and immune diseases in Hubei have been infected with COVID-19.
The central study found that 100 of the 20,000 patients with new crowns had rheumatism, of which gout patients accounted for 59.
5%.
Further research found that patients with rheumatism and immune diseases suffered from new crowns and had a worse condition and a worse prognosis than the normal population.
Figure 2.
Multi-center study of COVID-19 in patients with rheumatism in Hubei.
Many drugs commonly used by patients with rheumatism include hormones and hydroxychloroquine (HCQ).
They further analyzed the previous telephone follow-up patients and found that rheumatism using HCQ Patients are less likely to be infected with COVID-19 than those who have not used HCQ, and a multi-center study found that taking HCQ and low-dose hormones (<15mg) has a smaller proportion of severe and critical illness.
Summarizing the status of COVID-19 in global rheumatism and immune diseases, we can find that most studies support that patients with rheumatism and immune diseases are at higher risk of COVID-19 infection and have a worse prognosis.
In terms of disease types, according to a single-center study of Hubei Tongji Hospital, rheumatoid arthritis is the most common.
In terms of global data, the proportion of psoriasis, spondyloarthritis, and vasculitis is not low.
Figure 3.
The incidence of COVID-19 in different rheumatic diseases.
In the main treatment of rheumatism and COVID-19, most of the current studies believe that the use of glucocorticoids may lead to an increase in hospitalization and infection rates, which is useful for improving the disease and fighting rheumatism.
Studies on DMARDs are controversial, and antimalarial drugs are generally believed to have little effect, and studies believe that some biological agents may increase the risk.
How to get vaccinated? A big summary of foreign guides! Next, Professor Dong Lingli elaborated on rheumatism and the new crown vaccine.
Most studies believe that patients with rheumatism are more susceptible to new crowns, so it is necessary for patients with rheumatism to be vaccinated. The 2019 European Union Against Rheumatism (EULAR) vaccination recommendations for adult patients with autoimmune inflammatory rheumatism recommends that patients with rheumatism are in stable condition to receive inactivated vaccines, and other guidelines/consensus such as the Portuguese guidelines and the French guidelines also recommend vaccination.
Simply put, the key to vaccinating patients with rheumatism is a stable and inactivated vaccine.
Figure 4.
2019 EULAR vaccination recommendations for adults with autoimmune inflammatory rheumatism.
Figure 5.
Other guidelines/consensus recommendations for vaccination for patients with rheumatism.
As of December 2020, 60 new crown vaccines worldwide have been approved for clinical trials, mainly divided into the following 6 different types: inactivated vaccines, nucleic acid vaccines, vector vaccines, subunit vaccines, virus-like particle vaccines, live attenuated vaccines.
To summarize all current views/consensus regarding COVID-19 vaccination for patients with rheumatism and musculoskeletal diseases (RMDs): Figure 6.
EULAR's view on COVID-19 vaccination for patients with RMDs in 2020 Figure 7.
ACR rheumatism and musculoskeletal Summary of Clinical Guidance for COVID-19 Vaccine for Patients with Diseases Figure 8.
APLAR's update of COVID-19 vaccination for rheumatism.
Figure 9.
Singapore Rheumatology Society's consensus on COVID-19 vaccine.
What does my country's guidelines say? In this context, the Rheumatology Branch of the Chinese Medical Association and the Infectious Diseases Branch jointly wrote the "Expert Recommendations for Immunity Impaired Adults New Coronavirus Vaccination (Patients with Chronic Liver Disease, Liver Cirrhosis, Tuberculosis and Rheumatology)", aiming to Provide practical reference opinions for patients with rheumatism and immune diseases to vaccinate COVID-19 vaccine.
Among them, for patients with rheumatism and immune diseases, the recommended points are as follows: 1.
The new crown vaccination decision-making for adult patients with rheumatism and immune diseases should fully consider personal and social factors and be implemented by rheumatologists, vaccination doctors, primary care doctors and patients; 2.
Adult patients with rheumatism and immunological diseases are in a stable period.
If there are no other contraindications, it is recommended to inoculate the new crown inactivated vaccine; 3.
The application of immunosuppressive agents may reduce the effectiveness of the vaccine; 4.
The vast majority of immunosuppressants, biological agents and small molecule targets The drug should continue to be applied without changing the time of immunotherapy and vaccination.
5.
For methotrexate, JAK inhibitors, abatacept, cyclophosphamide and rituximab, immunotherapy and vaccination time should be adjusted accordingly. The specific content includes: 1.
Types of vaccination: Adult rheumatism patients are recommended to receive inactivated vaccines.
Careful consideration should be given to vaccination of other types of vaccines, such as nucleic acid vaccines, recombinant subunit vaccines, and adenovirus recombinant vaccines.
2.
Indications: In addition to the contraindications listed below, adult patients with rheumatism who are in stable condition are advised to receive the new crown inactivated vaccine.
Whether to vaccinate during the active period of the disease needs to be weighed according to the pros and cons of the disease.
However, compared with healthy people, the expected effectiveness of the COVID-19 vaccine in patients with rheumatism who receive systemic immunosuppressive therapy may decrease.
3.
Contraindications: Those who are contraindicated in the general vaccine in the "Technical Guidelines for New Coronavirus Vaccination (First Edition)" cannot be vaccinated.
4.
Adjustment of immunosuppressive therapy and vaccination time: Most immunosuppressive agents, biological agents and small molecule targeted drugs should continue to be used without changing the immunosuppressive therapy and vaccination time.
However, when methotrexate and JAK are used When enzyme inhibitors, abatacept, cyclophosphamide, and rituximab are used for immunosuppressive therapy, the vaccination time is recommended to be adjusted accordingly (see Figure 10).
Figure 10.
The treatment adjustment and vaccination time recommendations in the "Expert Recommendations for Immunity Impaired Adults with New Coronavirus Vaccination" 5.
Special attention should be paid: (1) Rheumatologists should participate in the evaluation of adult patients with rheumatism and immunity COVID-19 Indications for vaccination.
The individualized vaccination plan should be explained to the patient by the rheumatologist immunologist, and jointly decided and implemented by the rheumatologist, vaccination doctor, primary care doctor and the patient.
(2) After vaccination with COVID-19, there may theoretically be a risk of recurrence or progression of rheumatic immune disease.
However, the benefits of COVID-19 vaccination for adult patients with rheumatic immune diseases outweigh the potential risk of recurrence of the original disease.
Patients with rheumatic immune diseases should continue to closely observe the underlying disease and monitor the disease activity after being vaccinated with the COVID-19 vaccine.
(3) Recently, AstraZeneca COVID-19 vaccine (adenovirus recombinant vaccine) has experienced complications of venous thrombosis after vaccination, especially thrombosis in rare parts (such as intracranial venous sinus thrombosis), which is called vaccine-induced promotor Thrombosis immune thrombocytopenia (VIPIT).
VIPIT is believed to be related to platelet antibody production caused by immune response after vaccination.
Although for patients with a history of thrombosis and/or known thrombosis (such as antiphospholipid syndrome), there is currently no evidence that the risk of intracranial veins or other rare sites of thrombotic complications increased after AstraZeneca COVID-19 vaccination , It is recommended that patients with rheumatism immune disease avoid vaccination of recombinant adenovirus vaccine.
(4) After receiving the COVID-19 vaccine, patients with rheumatism should continue to follow all other public health guidelines, maintain social distancing, and take personal protection.
(5) Family members and other close contacts of patients with rheumatic immune diseases should be vaccinated against COVID-19 if possible, which may help protect patients.
(6) In particular, since there is currently no sufficient high-quality evidence-based medicine for the above population, this proposal cannot replace the doctor's individualized advice to patients.
In addition, since the specific data of the new crown vaccination study for this special population is still being released one after another, this recommendation will be adjusted and revised accordingly based on the new clinical evidence.
