PDF(Pubmed)
Abstract：
BACKGROUND: Vaccines are a crucial component of the global efforts to control the spread of COVID-19. Very little is known about COVID-19 vaccine responses in patients living with autoimmune rheumatic conditions in Africa. We examined the clinical reaction to COVID-19 vaccinations in Ghanaians diagnosed with autoimmune rheumatic disease.
METHODS: This was a hospital-based interventional cohort study of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients recruited via regular face-to-face clinic visits. The systemic lupus erythematosus disease activity index Selena modification (SELENA-SLEDAI) and the disease activity score 28-joint count-erythrocyte sedimentation rate (DAS28-ESR) were used to measure changes in disease activity levels.
RESULTS: Thirty-eight (38) patients of which 21 (55.3%) were diagnosed with SLE and 17 (44.7%) with RA contributed data for analyses. Most (89.5%) of the patients were females, with a mean age of 37.4 years. The SLE patients experienced a notable increase in severe flares during weeks three and six, as well as the third and sixth months, followed by subsequent decreases in the twelfth month, while remission levels increased throughout the same period. Among RA patients, high disease activity decreased during weeks three and six, as well as the third, sixth, and twelfth months, with remission levels increasing during the same time. A low dose (≥ 50 < 75 mg) dose of azathioprine was at some point associated with having a severe flare among SLE patients. After both vaccine doses, SLE patients were the majority having experienced both local and systemic reactions, all resolving within 24 h. Approximately 73.7% of the patients were COVID-19 negative at baseline. During post-vaccination visits, this increased to 100% by week six, with no positives thereafter.
CONCLUSIONS: This study explores COVID-19 vaccine responses in Ghanaian autoimmune rheumatic disease patients, revealing disease activity levels in RA patients improved after vaccination compared to SLE patients. Our findings identify a potential link between low-dose azathioprine and severe flares in SLE patients, particularly evident in the third-week post-vaccination. Further research is warranted to clarify these findings and guide tailored treatment approaches in this medically significant population during pandemics and vaccination efforts.
METHODS: This was a hospital-based interventional cohort study of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients recruited via regular face-to-face clinic visits. The systemic lupus erythematosus disease activity index Selena modification (SELENA-SLEDAI) and the disease activity score 28-joint count-erythrocyte sedimentation rate (DAS28-ESR) were used to measure changes in disease activity levels.
RESULTS: Thirty-eight (38) patients of which 21 (55.3%) were diagnosed with SLE and 17 (44.7%) with RA contributed data for analyses. Most (89.5%) of the patients were females, with a mean age of 37.4 years. The SLE patients experienced a notable increase in severe flares during weeks three and six, as well as the third and sixth months, followed by subsequent decreases in the twelfth month, while remission levels increased throughout the same period. Among RA patients, high disease activity decreased during weeks three and six, as well as the third, sixth, and twelfth months, with remission levels increasing during the same time. A low dose (≥ 50 < 75 mg) dose of azathioprine was at some point associated with having a severe flare among SLE patients. After both vaccine doses, SLE patients were the majority having experienced both local and systemic reactions, all resolving within 24 h. Approximately 73.7% of the patients were COVID-19 negative at baseline. During post-vaccination visits, this increased to 100% by week six, with no positives thereafter.
CONCLUSIONS: This study explores COVID-19 vaccine responses in Ghanaian autoimmune rheumatic disease patients, revealing disease activity levels in RA patients improved after vaccination compared to SLE patients. Our findings identify a potential link between low-dose azathioprine and severe flares in SLE patients, particularly evident in the third-week post-vaccination. Further research is warranted to clarify these findings and guide tailored treatment approaches in this medically significant population during pandemics and vaccination efforts.
摘要：
背景：疫苗是全球控制COVID-19传播努力的关键组成部分。关于非洲自身免疫性风湿病患者的COVID-19疫苗反应知之甚少。我们检查了被诊断为自身免疫性风湿病的加纳人对COVID-19疫苗接种的临床反应。
方法：这是一项针对系统性红斑狼疮（SLE）和类风湿性关节炎（RA）患者的基于医院的干预队列研究，通过定期面对面门诊就诊招募。使用系统性红斑狼疮疾病活动指数Selena修饰（SELENA-SLEDAI）和疾病活动评分28-关节计数-红细胞沉降率（DAS28-ESR）来测量疾病活动水平的变化。
结果：38例患者，其中21例（55.3%）被诊断为SLE，17例（44.7%）被诊断为RA。大多数（89.5%）的患者是女性，平均年龄37.4岁.SLE患者在第3周和第6周经历了严重耀斑的显着增加，以及第三和第六个月，随后在第十二个月出现下降，而同期缓解水平增加。在RA患者中，高疾病活动在第3周和第6周期间下降，以及第三个，第六，第十二个月，缓解水平在同一时间增加。低剂量（≥50<75mg）剂量的硫唑嘌呤在某些时候与SLE患者的严重耀斑有关。两种疫苗剂量后，SLE患者大多数经历了局部和全身反应，全部在24小时内消退。基线时，约73.7%的患者为COVID-19阴性。在疫苗接种后的访问中，到第六周增加到100%，此后没有积极因素。
结论：本研究探讨了加纳自身免疫性风湿性疾病患者的COVID-19疫苗反应，与SLE患者相比,RA患者接种疫苗后疾病活动水平改善.我们的发现确定了低剂量硫唑嘌呤与SLE患者严重耀斑之间的潜在联系。在疫苗接种后的第三周尤其明显。需要进一步的研究来澄清这些发现，并指导在大流行和疫苗接种工作期间在这个医学上重要的人群中量身定制的治疗方法。
方法：这是一项针对系统性红斑狼疮（SLE）和类风湿性关节炎（RA）患者的基于医院的干预队列研究，通过定期面对面门诊就诊招募。使用系统性红斑狼疮疾病活动指数Selena修饰（SELENA-SLEDAI）和疾病活动评分28-关节计数-红细胞沉降率（DAS28-ESR）来测量疾病活动水平的变化。
结果：38例患者，其中21例（55.3%）被诊断为SLE，17例（44.7%）被诊断为RA。大多数（89.5%）的患者是女性，平均年龄37.4岁.SLE患者在第3周和第6周经历了严重耀斑的显着增加，以及第三和第六个月，随后在第十二个月出现下降，而同期缓解水平增加。在RA患者中，高疾病活动在第3周和第6周期间下降，以及第三个，第六，第十二个月，缓解水平在同一时间增加。低剂量（≥50<75mg）剂量的硫唑嘌呤在某些时候与SLE患者的严重耀斑有关。两种疫苗剂量后，SLE患者大多数经历了局部和全身反应，全部在24小时内消退。基线时，约73.7%的患者为COVID-19阴性。在疫苗接种后的访问中，到第六周增加到100%，此后没有积极因素。
结论：本研究探讨了加纳自身免疫性风湿性疾病患者的COVID-19疫苗反应，与SLE患者相比,RA患者接种疫苗后疾病活动水平改善.我们的发现确定了低剂量硫唑嘌呤与SLE患者严重耀斑之间的潜在联系。在疫苗接种后的第三周尤其明显。需要进一步的研究来澄清这些发现，并指导在大流行和疫苗接种工作期间在这个医学上重要的人群中量身定制的治疗方法。
