Response to: 'Correspondence on 'What comes after the lockdown? Clustering of ANCA-associated vasculitis: single-centre observation of a spatiotemporal pattern'' by Hocevar et al.
TL;DR: Hocevar et al. as mentioned in this paper reported an incidence shift with a post-lockdown clustering and an increased incidence rate of AAV diagnoses between February and August 2020 compared with previous years.
Abstract: In our previous report on antineutrophil cytoplasm antibodies (ANCA)-associated vasculitides (AAV) during the current COVID-19 pandemic, we described our observation of both an incidence-shift with a post-lockdown clustering and an increased incidence rate of AAV diagnoses between February and August 2020 compared with previous years.1
In correspondence to our article, Hocevar et al report how COVID-19 pandemic affected management of patients with vasculitides at their centre. The in-depth analysis examined symptom duration (ie, time eclipsed to final diagnosis), disease activity/severity and seasonal changes of patients presenting with giant cell arteritis, and IgA vasculitis and AAV during 2020 and in the previous decade. No significant differences were found in incidence rates or indications for deferrals; that is, symptoms were experienced for a longer length of time before a diagnosis was made or a more severe presentation occurred.2
As the COVID-19 pandemic remains ongoing, six patients with AAV treated at …
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TL;DR: In this article, a review summarizes a recent educational forum and a recent virtual meeting of the European Vasculitis Society (EUVAS) focusing on the COVID-19 pandemic influenced the management of patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis.
15 citations
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University of California1, Boston University2, University of Ferrara3, McMaster University4, Brigham and Women's Hospital5, HealthPartners6, Harvard University7, University of Alcalá8, Manchester Academic Health Science Centre9, Institute of Chartered Accountants of Nigeria10, University of Otago11, University of Giessen12, Royal Brisbane and Women's Hospital13, University of Queensland14
TL;DR: In this paper, the authors determined factors associated with COVID-19-related death in people with rheumatic diseases, including age, sex, smoking status, comorbidities, diagnosis, disease activity and medications.
Abstract: OBJECTIVES: To determine factors associated with COVID-19-related death in people with rheumatic diseases. METHODS: Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category. RESULTS: Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death. CONCLUSION: Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.
405 citations
TL;DR: There is no evidence based research to support the notion that the stress-triggered neuroendocrine hormones lead to immune dysregulation, which ultimately results in autoimmune disease by altering or amplifying cytokine production, but Nonetheless, stress reactions should be discussed with autoimmune patients.
188 citations
Johannes Kepler University of Linz1, Linköping University2, Karolinska University Hospital3, Veterans Health Administration4, Loyola University Chicago5, National Institutes of Health6, Agency for Science, Technology and Research7, McMaster University8, University of Cambridge9, Innsbruck Medical University10
Abstract: Patients with kidney diseases should be prioritized for COVID-19 vaccination and the available data suggest that replication-defective viral-vectored vaccines and mRNA vaccines are safe to use. As vaccine responses are likely to be lower in patients with kidney diseases than in the general population, highly potent vaccines should be preferred.
74 citations
TL;DR: The relatively uniform and distinctive clinical features of the disease after the Great Earthquake, in conjunction with a high morbidity, suggest a relationship between disease development and this urban type of earthquake.
62 citations
TL;DR: In this article, the authors discuss thirteen frequently-asked questions regarding safety and efficacy of the most promising vaccine candidates, including BNT162b2, mRNA-1273 or Gam-COVID-Vac.
Abstract: Coronavirus Disease 19 (COVID-19) vaccine platforms are becoming available and are the most promising strategy to curb the spread of SARS-CoV-2 infections. However, numerous uncertainties exist regarding the pros and cons of vaccination, especially in patients with (immune-mediated) kidney diseases on immunosuppressive drugs. Here, members of the Immunonephrology Working Group (IWG) of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) discuss thirteen frequently-asked questions regarding safety and efficacy of the most promising vaccine candidates. Post-marketing surveillance should be performed to estimate the rate of vaccine response (humoral and cellular) of different vaccine platforms, and surveillance of disease activity following administration of COVID-19 vaccines. Some of the candidates induce signaling pathways which also promote autoimmune kidney diseases, e.g. type I interferons in systemic lupus erythematosus. Efficacy estimates would thus far favor the use of selected COVID-19 vaccines, such as BNT162b2, mRNA-1273 or Gam-COVID-Vac. Humoral immune response after vaccination should be monitored using appropriate assays. Even in the absence of neutralizing antibodies patients might be protected by a sufficient cellular immune response capable to reduce severity of COVID-19. A reduced vaccine response after the use of CD20-depleting agents is anticipated, and it is particularly important to discuss strategies to improve vaccine response with these patients. Distancing and shielding measures remain important as not all vaccines fully protect from coronavirus infection. In-depth information about the most pressing vaccine questions is essential to reduce vaccine hesitancy of patients.
31 citations