Постковидный синдром: клиническая картина, диагностика и лечение с позиции ревматолога
https://doi.org/10.14412/1996-7012-2023-6-7-13
Аннотация
За прошедшие с начала пандемии COVID-19 два года многие пациенты столкнулись с проявлениями постковидного синдрома (ПКС), симптоматика которого нередко встречается при ревматических заболеваниях, что может вызвать диагностические трудности у практикующего врача. В статье представлены эпидемиология, современный взгляд на патогенез и возможные биомаркеры ПКС. В рамках дифференциального диагноза рассматриваются клинико-лабораторные проявления ПКС. Подчеркивается целесообразность вакцинопрофилактики COVID-19, обсуждается ее роль в развитии ПКС. Описаны актуальные медикаментозные подходы к терапии и реабилитационные программы.
Об авторах
Е. С. Аронова
ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»
Россия
Россия
115522, Москва, Каширское шоссе, 34А
Б. С. Белов
ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»
Россия
Россия
115522, Москва, Каширское шоссе, 34А
Г. И. Гриднева
ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»
Россия
Россия
115522, Москва, Каширское шоссе, 34А
Литература
1. Bliddal S, Banasik K, Pedersen OB, et al. Acute and persistent symptoms in non-hospitalized PCR-confirmed COVID-19 patients. Sci Rep. 2021 Jun 23;11(1):13153. doi: 10.1038/s41598-021-92045-x.
2. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 1/06/2022. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceof ongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/6january2022
3. World Health Organisation (WHO). A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition_Clinical_case_definition-2021.1
4. Davis HE, Assaf GS, McCorkell L, et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine. 2021 Aug:38: 101019. doi: 10.1016/j.eclinm.2021.101019. Epub 2021 Jul 15.
5. Parums DV. Editorial: Long COVID, or Post-COVID Syndrome, and the Global Impact on Health Care. Med Sci Monit. 2021 Jun 7:27:e933446. doi: 10.12659/MSM.933446.
6. Fortini A, Torrigiani A, Sbaragli S, et al. COVID-19: persistence of symptoms and lung alterations after 3-6 months from hospital discharge. Infection. 2021 Oct;49(5):1007- 1015. doi: 10.1007/s15010-021-01638-1. Epub 2021 Jun 6.
7. Karaarslan F, Güneri FD, Kards S. Long COVID: rheumatologic/musculoskeletal symptoms in hospitalized COVID-19 survivors at 3 and 6 months. Clin Rheumatol. 2022 Jan;41(1):289-296. doi: 10.1007/s10067-021-05942-x. Epub 2021 Oct 29.
8. Altmann DM, Whettlock EM, Liu S, et al. The immunology of long COVID. Nat Rev Immunol. 2023 Oct;23(10):618-634. doi: 10.1038/s41577-023-00904-7. Epub 2023 Jul 11.
9. Munblit D, Nicholson T, Akrami A, et al. A core outcome set for post-COVID-19 condition in adults for use in clinical practice and research: an international Delphi consensus study. Lancet Respir Med. 2022 Jul;10(7):715- 724. doi: 10.1016/S2213-2600(22)00169-2. Epub 2022 Jun 14.
10. Sharma SK, Mudgal SK, Thakur K, et al. Anxiety, depression and quality of life (QOL) related to COVID-19 among frontline health care professionals: A multicentric cross-sectional survey. J Family Med Prim Care. 2021 Mar;10(3):1383-1389. doi: 10.4103/jfmpc.jfmpc_2129_20. Epub 2021 Apr 8.
11. Reese JT, Blau H, Casiraghi E, et al. Generalisable long COVID subtypes: findings from the NIH N3C and RECOVER programmes. EBioMedicine. 2023 Jan:87:104413. doi: 10.1016/j.ebiom.2022.104413. Epub 2022 Dec 21.
12. Leppkes M, Neurath MF. Rear WindowWhat Can the Gut Tell Us About LongCOVID? Gastroenterology. 2022 Aug;163(2): 376-378. doi: 10.1053/j.gastro.2022.05.044. Epub 2022 Jun 2.
13. Stein SR, Ramelli SC, Grazioli A, et al. SARS-CoV-2 infection and persistence in the human body and brain at autopsy. Nature. 2022 Dec;612(7941):758-763. doi: 10.1038/s41586-022-05542-y. Epub 2022 Dec 14.
14. Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol. 2023 Mar;21(3):133-146. doi: 10.1038/s41579-022-00846-2. Epub 2023 Jan 13.
15. Choutka J, Jansari V, Hornig M, Iwasaki A. Unexplained post-acute infection syndromes. Nat Med. 2022 May;28(5): 911-923. doi: 10.1038/s41591-022-01810-6.
16. Dennis A, Wamil M, Alberts J, et al. Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome: a prospective, community-based study. BMJ Open. 2021 Mar 30;11(3):e048391. doi: 10.1136/bmjopen-2020-048391.
17. Matheson AM, McIntosh MJ, Kooner HK, et al. Longitudinal follow-up of postacute COVID-19 syndrome: DLCO, quality-of-life and MRI pulmonary gas-exchange abnormalities. Thorax. 2023 Apr;78(4):418-421. doi: 10.1136/thorax-2022-219378. Epub 2023 Jan 3.
18. Swank Z, Senussi Y, Manickas-Hill Z, et al. Persistent Circulating Severe Acute Respiratory Syndrome Coronavirus 2 Spike Is Associated With Post-acute Coronavirus Disease 2019 Sequelae. Clin Infect Dis. 2023 Feb 8; 76(3):e487-e490. doi: 10.1093/cid/ciac722.
19. Насонов ЕЛ, Бекетова ТВ, Решетняк ТМ и др. Коронавирусная болезнь 2019 (COVID-19) и иммуновоспалительные ревматические заболевания: на перекрестке проблем тромбовоспаления и аутоиммунитета. Научно-практическая ревматология. 2020;58(4):353-367.
20. Peluso MJ, Deveau TM, Munter SE, et al. Chronic viral coinfections differentially affect the likelihood of developing long COVID. J Clin Invest. 2023 Feb 1;133(3):e163669. doi: 10.1172/JCI163669.
21. Zubchenko S, Kril I, Nadizhko O, et al. Herpesvirus infections and post-COVID-19 manifestations: a pilot observational study. Rheumatol Int. 2022 Sep;42(9):1523-1530. doi: 10.1007/s00296-022-05146-9. Epub 2022 Jun 1.
22. Gold JE, Okyay RA, Licht WE, Hurley DJ. Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation. Pathogens. 2021 Jun 17;10(6):763. doi: 10.3390/pathogens 10060763.
23. Hopkins FR, Govender M, Svanberg C, et al. Major alterations to monocyte and dendritic cell subsets lasting more than 6 months after hospitalization for COVID-19. Front Immunol. 2023 Jan 4:13:1082912. doi: 10.3389/fimmu.2022.1082912. eCollection 2022.
24. Phetsouphanh C, Darley DR, Wilson DB, et al. Immunological dysfunction persists for 8 months following initial mild-to-moderate SARS-CoV-2 infection. Nat Immunol. 2022 Feb;23(2):210-216. doi: 10.1038/s41590-021-01113-x. Epub 2022 Jan 13.
25. Shi H, Zuo Y, Navaz S, et al. Endothelial Cell-Activating Antibodies in COVID-19. Arthritis Rheumatol. 2022 Jul;74(7): 1132-1138. doi: 10.1002/art.42094. Epub 2022 May 27.
26. Zuin M, Barco S, Giannakoulas G, et al. Risk of venous thromboembolic events after COVID-19 infection: a systematic review and meta-analysis. J Thromb Thrombolysis. 2023 Apr;55(3):490-498. doi: 10.1007/s11239-022- 02766-7. Epub 2023 Jan 18.
27. Prasannan N, Heightman M, Hillman T, et al. Impaired exercise capacity in postCOVID-19 syndrome: the role of VWF-ADAMTS13 axis. Blood Adv. 2022 Jul 12;6(13):4041-4048. doi: 10.1182/bloodadvances.2021006944.
28. Wechsler JB, Butuci M, Wong A, et al. Mast cell activation is associated with postacute COVID-19 syndrome. Allergy. 2022 Apr;77(4):1288-1291. doi: 10.1111/all.15188. Epub 2021 Dec 3.
29. Son K, Jamil R, Chowdhury A, et al. Circulating anti-nuclear autoantibodies in COVID-19 survivors predict long COVID symptoms. Eur Respir J. 2023 Jan 12;61(1): 2200970. doi: 10.1183/13993003.00970-2022. Print 2023 Jan.
30. Richter AG, Shields AM, Karim A, et al. Establishing the prevalence of common tissuespecific autoantibodies following severe acute respiratory syndrome coronavirus 2 infection. Clin Exp Immunol. 2021 Aug;205(2):99-105. doi: 10.1111/cei.13623. Epub 2021 Jun 13.
31. Sudre CH, Murray B, Varsavsky T, et al. Attributes and predictors of long COVID. Nat Med. 2021 Apr;27(4):626-631. doi: 10.1038/s41591-021-01292-y. Epub 2021 Mar 10.
32. Sen P, Naveen R, Nune A, et al. PostCOVID-19 condition in patients with autoimmune rheumatic diseases: The COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. Lancet Rheumatol. 2023 May;5(5):e247-e250. doi: 10.1016/S2665-9913(23)00066-8. Epub 2023 Apr 24.
33. Lai YJ, Liu SH, Manachevakul S, et al. Biomarkers in long COVID-19: A systematic review. Front Med (Lausanne). 2023 Jan 20: 10:1085988. doi: 10.3389/fmed.2023.1085988. eCollection 2023.
34. Petersen MS, Kristiansen MF, Hanusson KD, et al. Long COVID in the Faroe Islands: A Longitudinal Study Among Nonhospitalized Patients. Clin Infect Dis. 2021 Dec 6; 73(11):e4058-e4063. doi: 10.1093/cid/ciaa1792.
35. Каратеев АЕ, Амирджанова ВН, Насонов ЕЛ и др. «Постковидный синдром»: в центре внимания скелетно-мышечная боль. Научно-практическая ревматология. 2021;59(3):255-262.
36. Carvalho-Schneider C, Laurent E, Lemaignen A, et al. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect. 2021 Feb;27(2): 258-263. doi: 10.1016/j.cmi.2020.09.052. Epub 2020 Oct 5.
37. Ghosn J, Piroth L, Epaulard O, et al. Persistent COVID-19 symptoms are highly prevalent 6 months after hospitalization: results from a large prospective cohort. Clin Microbiol Infect. 2021 Jul;27(7):1041.e1-1041.e4. doi: 10.1016/j.cmi.2021.03.012. Epub 2021 May 10.
38. Sapkota HR, Nune A. Long COVID from rheumatology perspective – a narrative review. Clin Rheumatol. 2022 Feb;41(2):337-348. doi: 10.1007/s10067-021-06001-1. Epub 2021 Nov 30.
39. Migliorini F, Bell A, Vaishya R, et al. Reactive arthritis following COVID-19 current evidence, diagnosis, and management strategies. J Orthop Surg Res. 2023 Mar 15; 18(1):205. doi: 10.1186/s13018-023-03651-6.
40. Derksen VFAM, Kissel T, Lamers-Karnebeek FBG, et al. Onset of rheumatoid arthritis after COVID-19: coincidence or connected? Ann Rheum Dis. 2021 Aug;80(8):1096-1098. doi: 10.1136/annrheumdis-2021-219859. Epub 2021 Mar 1.
41. Mukarram MS, Ishaq Ghauri M, Sethar S, et al. COVID-19: An Emerging Culprit of Inflammatory Arthritis. Case Rep Rheumatol. 2021 Apr 26:2021:6610340. doi: 10.1155/2021/6610340. eCollection 2021.
42. Ciaffi J, Vanni E, Mancarella L, et al. Post-Acute COVID-19 Joint Pain and New Onset of Rheumatic Musculoskeletal Diseases: A Systematic Review. Diagnostics (Basel). 2023 May 25;13(11):1850. doi: 10.3390/diagnostics13111850.
43. McGonagle D, Bridgewood C, Ramanan AV, et al. COVID-19 vasculitis and novel vasculitis mimics. Lancet Rheumatol. 2021 Mar;3(3):e224-e233. doi: 10.1016/S2665-9913(20)30420-3. Epub 2021 Jan 7.
44. Rocha KO, Zanuncio VV, Freitas BAC, Lima LM. "COVID toes": A meta-analysis of case and observational studies on clinical, histopathological, and laboratory findings. Pediatr Dermatol. 2021 Sep;38(5):1143-1149. doi: 10.1111/pde.14805. Epub 2021 Sep 13.
45. El Hachem M, Diociaiuti A, Concato C, et al. A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain-like lesions: lights and shadows on the relationship with COVID-19 infection. J Eur Acad Dermatol Venereol. 2020 Nov;34(11):2620-2629. doi: 10.1111/jdv.16682. Epub 2020 Jul 2.
46. Mehta P, Bunker CB, Ciurtin C, et al. Chilblain-like acral lesions in long COVID-19: management and implications for understanding microangiopathy. Lancet Infect Dis. 2021 Jul;21(7):912. doi: 10.1016/S1473-3099(21)00133-X. Epub 2021 Mar 8.
47. Chaudhary H, Mohan M, Jain A, et al. Acral Gangrene: Ugly Cousin of "COVID Toes" in Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2? Pediatr Infect Dis J. 2021 Aug 1;40(8):e312- e313. doi: 10.1097/INF.0000000000003181.
48. Gracia-Ramos AE, Martin-Nares E, Hernandez-Molina G. New Onset of Autoimmune Diseases Following COVID-19 Diagnosis. Cells. 2021 Dec 20;10(12):3592. doi: 10.3390/cells10123592.
49. Wong K, Farooq Alam Shah MU, Khurshid M, et al. COVID-19 associated vasculitis: A systematic review of case reports and case series. Ann Med Surg (Lond). 2022 Feb:74: 103249. doi: 10.1016/j.amsu.2022.103249. Epub 2022 Jan 13.
50. Long Q, Li J, Hu X, et al. Follow-Ups on Persistent Symptoms and Pulmonary Function Among Post-Acute COVID-19 Patients: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2021 Sep 3:8:702635. doi: 10.3389/fmed.2021.702635. eCollection 2021.
51. Duong-Quy S, Vo-Pham-Minh T, TranXuan Q, et al. Post-COVID-19 Pulmonary Fibrosis: Facts-Challenges and Futures: A Narrative Review. Pulm Ther. 2023 Sep; 9(3):295-307. doi: 10.1007/s41030-023-00226-y. Epub 2023 May 20
52. Guinto E, Gerayeli FV, Eddy RL, et al. Post-COVID-19 dyspnoea and pulmonary imaging: a systematic review and meta-analysis. Eur Respir Rev. 2023 Aug 9;32(169): 220253. doi: 10.1183/16000617.0253-2022. Print 2023 Sep 30.
53. George PM, Barratt SL, Condliffe R, et al. Respiratory follow-up of patients with COVID-19 pneumonia. Thorax. 2020 Nov; 75(11):1009-1016. doi: 10.1136/thoraxjnl2020-215314. Epub 2020 Aug 24.
54. Mohabbat AB, Mohabbat NML, Wight EC. Fibromyalgia and Chronic Fatigue Syndrome in the Age of COVID-19. Mayo Clin Proc Innov Qual Outcomes. 2020 Dec;4(6):764-766. doi: 10.1016/j.mayocpiqo.2020.08.002. Epub 2020 Nov 13.
55. Clauw DJ, Häuser W, Cohen SP, Fitzcharles MA. Considering the potential for an increase in chronic pain after the COVID-19 pandemic. Pain. 2020 Aug;161(8):1694-1697. doi: 10.1097/j.pain.0000000000001950.
56. Wong TL, Weitzer DJ. Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)-A Systemic Review and Comparison of Clinical Presentation and Symptomatology. Medicina (Kaunas). 2021 Apr 26;57(5):418. doi: 10.3390/medicina57050418.
57. Ursini F, Ciaffi J, Mancarella L, et al. Fibromyalgia: a new facet of the postCOVID-19 syndrome spectrum? Results from a web-based survey. RMD Open. 2021 Aug; 7(3):e001735. doi: 10.1136/rmdopen-2021-001735.
58. The effectiveness of vaccination against long COVID: a rapid evidence briefing by UK Health Security Agency. https://www.regenhealthsolutions.info/2022/02/17/the-effectiveness-of-vaccination-against-long-covid-arapid-evidence-briefing-by-uk-health-securityagency/
59. Patel NJ, Cook C, Vanni K, et al. Impact of vaccination on postacute sequelae of SARS CoV-2 infection in patients with rheumatic diseases. Ann Rheum Dis. 2023 Apr;82(4): 565-573. doi: 10.1136/ard-2022-223439. Epub 2022 Nov 28.
60. Byambasuren O, Stehlik P, Clark J, et al. Effect of covid-19 vaccination on long covid: systematic review. BMJ Med. 2023 Feb 1; 2(1):e000385. doi: 10.1136/bmjmed-2022-000385. eCollection 2023.
61. Насонов ЕЛ, Лила АМ, Мазуров ВИ и др. Коронавирусная болезнь 2019 (COVID-19) и иммуновоспалительные ревматические заболевания. Рекомендации Общероссийской общественной организации Ассоциация ревматологов России. Научно-практическая ревматология. 2021;59(3):239-254.
62. Аронова ЕС, Белов БС. Гриднева ГИ. Ревматологические проявления постковидного синдрома (обзор литературы). Медицинский алфавит. 2022;(15):20-25.
63. Мартынов АИ, редактор. Методические рекомендации. Особенности течения Long-COVID инфекции. Терапевтические и реабилитационные мероприятия. https://www.rnmot.ru/public/uploads/2022/rnmot/%D0%9C%D0%95%D0%A2%D0%9E%D0%94%D0%98%D0%A7%D0%95%D0%A1%D0%9A%D0%98%D0%95%20%D0%A0%D0%95%D0%9A%D0%9E%D0%9C%D0%95%D0%9D%D0%94%D0%90%D0%A6%D0%98%D0%98.pdf
64. Chuang HJ, Lin CW, Hsiao MY, et al. Long COVID and rehabilitation. J Formos Med Assoc. 2023 Apr 13:S0929-6646(23) 00107-9. doi: 10.1016/j.jfma.2023.03.022. Online ahead of print.
Рецензия
Для цитирования:
Аронова ЕС, Белов БС, Гриднева ГИ. Постковидный синдром: клиническая картина, диагностика и лечение с позиции ревматолога. Современная ревматология. 2023;17(6):7-13. https://doi.org/10.14412/1996-7012-2023-6-7-13
For citation:
Aronova ES, Belov BS, Gridneva GI. Post-Covid syndrome: clinical picture, diagnosis and treatment from a rheumatologist perspective. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2023;17(6):7-13. (In Russ.) https://doi.org/10.14412/1996-7012-2023-6-7-13
Просмотров:
742
Послать статью по эл. почте 