Коронавирусная болезнь 2019 (COVID-19): вклад ревматологии - Журнал Терапевтический архив №5 Вопросы ревматологии 2021

Коронавирусная болезнь 2019 (COVID-19): вклад ревматологии

Насонов Е.Л. Коронавирусная болезнь 2019 (COVID-19): вклад ревматологии. Терапевтический архив. 2021; 93 (5): 537–550. DOI: 10.26442/00403660.2021.05.200799

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Nasonov EL. 2019 Coronavirus disease (COVID-19): contribution of rheumatology. Terapevticheskii Arkhiv (Ter. Arkh.). 2021; 93 (5): 537–550. DOI: 10.26442/00403660.2021.05.200799

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Аннотация

Пандемия коронавирусной болезни 2019 (coronavirus disease, COVID-19) явилась серьезным вызовом человечеству и уникальной возможностью составить представление о реальных достижениях современной биологии и медицины. В процессе развития пандемии вскрылось большое число новых фундаментальных и медицинских проблем, касающихся взаимоотношений вирусной инфекции и многих распространенных хронических неинфекционных заболеваний, среди которых важную позицию занимают иммуновоспалительные ревматические заболевания (ИВРЗ). В настоящее время установлено, что инфекция SARS-CoV-2 сопровождается развитием широкого спектра экстрапульмональных клинических и лабораторных нарушений, некоторые из которых характерны для ИВРЗ и других аутоиммунных и аутовоспалительных заболеваний человека. Наиболее тяжелым последствием дисрегуляции иммунитета при COVID-19 и ИВРЗ является развитие так называемого синдрома цитокинового шторма, который при COVID-19 определяется как COVID-19-ассоциированный гипервоспалительный синдром, а при ИВРЗ – синдром активации макрофагов. Развитие COVID-19-ассоциированного гипервоспалительного синдрома послужило основанием для репозиционирования (drug repurposing) и применения по незарегистрированным показаниям широкого спектра противовоспалительных препаратов, которые в течение последних 20 лет специально разрабатывались для лечения ИВРЗ. Существование общих иммунопатологических механизмов и подходов к фармакотерапии при COVID-19 и ИВРЗ определяет уникальное место ревматологии среди медицинских специальностей, вносящих вклад в борьбу с пандемией COVID-19. Представлены основные положения рекомендаций международных и Национальной ассоциаций ревматологов и Ассоциации ревматологов России (АРР), касающиеся ведения пациентов с ИВРЗ в период пандемии COVID-19.

Ключевые слова: COVID-19, иммуновоспалительные ревматические заболевания

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The 2019 coronavirus disease (COVID-19) pandemic become a major challenge for humanity and a unique opportunity to get an idea of the real achievements of modern biology and medicine. In the course of the pandemic, a large number of new fundamental and medical issues have been revealed regarding the relationship between viral infection and many common chronic non-infectious diseases, among which immune-mediated rheumatic diseases (IMRD) occupy an important position. It is now well known that SARS-CoV-2 infection is accompanied by a wide range of extrapulmonary clinical and laboratory disorders, some of which are characteristic of IMRD and other autoimmune and autoinflammatory diseases in humans. The most severe consequence of alterations in regulation of the immunity in COVID-19 and IMRD is the so-called cytokine storm syndrome, which is defined as COVID-19-associated hyperinflammatory syndrome in COVID-19, and as macrophage activation syndrome in IMRD. The COVID-19-associated hyperinflammatory syndrome was used as a reason for drug repurposing and off-label use of a wide range of anti-inflammatory drugs, which have been specially developed for the treatment of IMRD over the past 20 years. Common immunopathological mechanisms and approaches to pharmacotherapy in COVID-19 and IMRD determined the unique place of rheumatology among medical specialties contributing to combat the COVID-19 pandemic. The article provides the basic provisions of the International and National Association of Rheumatologists and the Association of Rheumatologists of Russia (ARR) recommendations for management of patients with IMRD during the COVID-19 pandemic.

Keywords: COVID-19, immune-mediated rheumatic diseases

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Авторы

Е.Л. Насонов*

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия;
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*nasonov@irramn.ru

________________________________________________

Evgeny L. Nasonov*

Nasonova Research Institute of Rheumatology, Moscow, Russia;
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*nasonov@irramn.ru

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