rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2020-456-462rsp-2937Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL OBSERVATIONSCOVID-19 у пациентки с АНЦА-ассоциированным системным васкулитом, получавшей анти-В-клеточную терапию ритуксимабомCovid-19 in a patient with ANCA-associated systemic vasculitis, receiving anti-B cell therapy (rituximab)https://orcid.org/0000-0003-2641-9785БекетоваТ. В.BeketovaT. V.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow, 115522

tvbek@rambler.ruhttps://orcid.org/0000-0002-4503-7750БланкЛ. М.BlankL. M.https://orcid.org/0000-0002-6068-3080ЛилаА. М.LilaA. M.

115522, Москва, Каширское шоссе, 34А 

125993, Москва, Баррикадная ул., дом 2/1, строение 1

34A, Kashirskoe Shosse, Moscow, 115522 

2/1 Barrikadnaya St., Build 1, Moscow, 125993

ФГБНУ «Научно-исследовательский институт ревматологии имени В.А. Насоновой»РоссияVA Nasonova Research Institute of RheumatologyRussian FederationФГБНУ «Научно-исследовательский институт ревматологии имени В.А. Насоновой»; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияVA Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuing Prefessional Education, Ministry of Health of RussiaRussian Federation202004092020584456462Copyright © Бекетова Т.В., Бланк Л.М., Лила А.М., 20202020Бекетова Т.В., Бланк Л.М., Лила А.М.Beketova T.V., Blank L.M., Lila A.M.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2937

Несмотря на большое число публикаций, посвященных коронавирусной болезни 2019 (coronavirus disease – 2019; СOVID-19), в настоящее время представления о проблеме находятся лишь на этапе становления. Представлено клиническое наблюдение COVID-19 у пациентки с ремиссией АНЦА-СВ, получавшейлечение анти-В-клеточным препаратом ритуксимаб (РТМ). Через месяц после введения РТМ диагностирована инфекция COVID-19 с двусторонней пневмонией средней степени тяжести, лихорадкой и внелегочными проявлениями, включая поражение желудочно-кишечного тракта и центральной нервной системы. Обсуждаются немногочисленные сведения о применении РТМ в период пандемии COVID-19 и вопросы влияния деплеции В-клеток на течение и исходы COVID-19. Собственное наблюдение и доступные данные литературы не дают оснований относить лечение РТМ к факторам риска тяжелого течения и неблагоприятного исхода COVID-19. Исключительно важным является дальнейший анализ случаев COVID-19 у пациентов с АНЦА-СВ и другими иммуновоспалительными ревматическими заболеваниями. 

Despite numerous publications on COVID-19, at present, conceptual thinking of the problem is only at a nascence stage. Treatment of patients with ANCA-associated systemic vasculitis (AAV) during the COVID-19 pandemic is one of the relevant issues. Management of COVID-19 in AAV patients undergoing anti-B cell therapy with rituximab (RTM) requires comprehensive reasoning. This paper presents a case report about COVID-19 in a 59-year-old female with AAV in remission, who was previously treated with RTM. COVID-19 was diagnosed one month after the last RTM administration; there were moderate bilateral pneumonia, fever, and extrapulmonary manifestations, including lesions of the gastrointestinal tract and central nervous system. Clinical outcome of COVID-19 was favorable, with no signs of respiratory failure, and CRP values did not exceed 29 mg/l. We discuss published data on RTM use during COVID-19 pandemic and the effects of B cells and their depletion on the course and outcomes of COVID-19. Our case report and available published data do not allow to consider RTM therapy as a factor associated with severe course of COVID-19 and adverse outcome. Further analysis of COVID-19 in patients with AAV and other rheumatic diseases is important. 

COVID-19ритуксимабВ-клеткиАНЦАсистемный васкулитCOVID-19rituximabB cellsANCAvasculitisReferencesShi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, Fan Y, Zheng C. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020;20(4):425-434. doi:10.1016/S1473-3099(20)30086-4Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, Fan Y, Zheng C. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020;20(4):425-434. doi:10.1016/S1473-3099(20)30086-4Leisman DE, Deutschman CS, Legrand M. Facing COVID-19 in the ICU: vascular dysfunction, thrombosis, and dysregulated inflammation. Intensive Care Med. 2020 Apr 28. doi: 10.1007/s00134-020-06059-6Leisman DE, Deutschman CS, Legrand M. Facing COVID-19 in the ICU: vascular dysfunction, thrombosis, and dysregulated inflammation. Intensive Care Med. 2020 Apr 28. doi: 10.1007/s00134-020-06059-6Бекетова ТВ. Алгоритм диагностики системных васкулитов, ассоциированных с антинейтрофильными цитоплазматическими антителами. Терапевтический архив, 2018; 90(5):13-21. doi: 10.26442/terarkh201890513-21Terapevticheskiy Arkhiv= Therapeutic Archive Journal 2018; 90(5):13-21 (in Russ) doi: 10.26442/terarkh201890513-21Berti A, Matteson EL, Crowson CS, Specks U, Cornec D. Risk of Cardiovascular Disease and Venous Thromboembolism Among Patients With Incident ANCA-Associated Vasculitis: A 20-Year Population-Based Cohort Study. Mayo Clin Proc. 2018;93(5):597-606. doi: 10.1016/j.mayocp.2018.02.010Berti A, Matteson EL, Crowson CS, Specks U, Cornec D. Risk of Cardiovascular Disease and Venous Thromboembolism Among Patients With Incident ANCA-Associated Vasculitis: A 20-Year Population-Based Cohort Study. Mayo Clin Proc. 2018;93(5):597-606. doi: 10.1016/j.mayocp.2018.02.010Boraschi P. COVID-19 Pulmonary Involvement: Is Really an Interstitial Pneumonia? Acad Radiol. 2020 Apr 15. pii: S1076- 6332(20)30202-6. doi:10.1016/j.acra.2020.04.010Boraschi P. COVID-19 Pulmonary Involvement: Is Really an Interstitial Pneumonia? Acad Radiol. 2020 Apr 15. pii: S1076- 6332(20)30202-6. doi:10.1016/j.acra.2020.04.010Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, Akdis CA, Gao YD. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020 Feb 19. doi: 10.1111/all.14238Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, Akdis CA, Gao YD. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020 Feb 19. doi: 10.1111/all.14238Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, Baxter-Stoltzfus A, Laurence J. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl Res. 2020 Apr 15. pii: S1931-5244(20)30070-0. doi: 10.1016/j.trsl.2020.04.007Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, Baxter-Stoltzfus A, Laurence J. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl Res. 2020 Apr 15. pii: S1931-5244(20)30070-0. doi: 10.1016/j.trsl.2020.04.007Galván Casas C, Català A, Carretero Hernández G, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020 Apr 29. doi: 10.1111/bjd.19163Galván Casas C, Català A, Carretero Hernández G, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020 Apr 29. doi: 10.1111/bjd.19163Mao L, Jin H, Wang M, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020 Apr 10. doi: 10.1001/jamaneurol.2020.1127Mao L, Jin H, Wang M, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020 Apr 10. doi: 10.1001/jamaneurol.2020.1127Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. N Engl J Med. 2020 Apr 23;382(17):e38. doi:10.1056/NEJMc2007575Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. N Engl J Med. 2020 Apr 23;382(17):e38. doi:10.1056/NEJMc2007575Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020 Feb 19. doi: 10.1111/jth.14768.Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020 Feb 19. doi: 10.1111/jth.14768.Leonard-Lorant I, Delabranche X, Severac F, et al. Acute Pulmonary Embolism in COVID-19 Patients on CT Angiography and Relationship to D-Dimer Levels. Radiology. 2020 Apr 23:201561. doi: 10.1148/radiol.2020201561Leonard-Lorant I, Delabranche X, Severac F, et al. Acute Pulmonary Embolism in COVID-19 Patients on CT Angiography and Relationship to D-Dimer Levels. Radiology. 2020 Apr 23:201561. doi: 10.1148/radiol.2020201561Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020 doi: 10.1016/S0140-6736(20)30628-0Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020 doi: 10.1016/S0140-6736(20)30628-0Robson J, Doll H, Suppiah R, et al. Glucocorticoid treatment and damage in the anti-neutrophil cytoplasm antibody-associated vasculitides: long-term data from the European Vasculitis Study Group trials. Rheumatology (Oxford). 2015;54(3):471-81. doi: 10.1093/rheumatology/keu366.Robson J, Doll H, Suppiah R, et al. Glucocorticoid treatment and damage in the anti-neutrophil cytoplasm antibody-associated vasculitides: long-term data from the European Vasculitis Study Group trials. Rheumatology (Oxford). 2015;54(3):471-81. doi: 10.1093/rheumatology/keu366.Бекетова ТВ, Насонов ЕЛ. Десятилетний опыт индукционной и поддерживающей терапии ритуксимабом у пациентов с АНЦА-ассоциированными системными васкулитами. Современная ревматология. 2020;14(1):12-9. doi:10.14412/1996-7012-2020-1-12-19Beketova TV, Nasonov EL. Ten-year experience with rituximab for induction and maintenance therapy in patients with ANCAassociated systemic vasculitis. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2020;14(1):12-9. (In Russ.). doi:10.14412/1996-7012-2020-1-12-19Tesfa D, Ajeganova S, Hägglund H, Sander B, Fadeel B, Hafström I, Palmblad J. Late-onset neutropenia following rituximab therapy in rheumatic diseases: association with B lymphocyte depletion and infections. Arthritis Rheum. 2011;63(8):2209- 14. doi: 10.1002/art.30427Tesfa D, Ajeganova S, Hägglund H, Sander B, Fadeel B, Hafström I, Palmblad J. Late-onset neutropenia following rituximab therapy in rheumatic diseases: association with B lymphocyte depletion and infections. Arthritis Rheum. 2011;63(8):2209- 14. doi: 10.1002/art.30427Tudesq JJ, Cartron G, Rivière S, et al. Clinical and microbiological characteristics of the infections in patients treated with rituximab for autoimmune and/or malignant hematological disorders. Autoimmun Rev. 2018;17(2):115-24. doi: 10.1016/j.autrev.2017.11.015Tudesq JJ, Cartron G, Rivière S, et al. Clinical and microbiological characteristics of the infections in patients treated with rituximab for autoimmune and/or malignant hematological disorders. Autoimmun Rev. 2018;17(2):115-24. doi: 10.1016/j.autrev.2017.11.015Monti S, Balduzzi S, Delvino P, et al. Clinical course of COVID19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies. Ann Rheum Dis. 2020;79(5):667-8. doi:10.1136/annrheumdis-2020-217424Monti S, Balduzzi S, Delvino P, et al. Clinical course of COVID19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies. Ann Rheum Dis. 2020;79(5):667-8. doi:10.1136/annrheumdis-2020-217424Giovannoni G. Anti-CD20 immunosuppressive disease-modifying therapies and COVID-19 [published online ahead of print, 2020 Apr 18]. Mult Scler Relat Disord. 2020;41:102135. doi:10.1016/j.msard.2020.102135Giovannoni G. Anti-CD20 immunosuppressive disease-modifying therapies and COVID-19 [published online ahead of print, 2020 Apr 18]. Mult Scler Relat Disord. 2020;41:102135. doi:10.1016/j.msard.2020.102135Глыбочко ПВ, Фомин ВВ, Авдеев СН и др. Клиническая характеристика 1007 больных тяжелой SARS-CoV-2 пневмонией, нуждавшихся в респираторной поддержке. Клиническая фармакология и терапия. 2020;29(2):21-29. doi:10.32756/0869-5490-2020-2-21-29Glybochko PV, Fomin VV, Avdeev SN et al. Clinical characteristics of 1007 intensive care unit patients with SARS-CoV-2 pneumonia. Klinicheskaya farmakologiya i terapiya = Clinical Pharmacology and Therapy Jornal 2020;29(2):21-29 (In Russ.). doi:10.32756/0869-5490-2020-2-21-29Gianfrancesco MA, Hyrich KL, Gossec L, et al. Rheumatic disease and COVID-19: initial data from the COVID-19 Global Rheumatology Alliance provider registries [published online ahead of print, 2020 Apr 16]. Lancet Rheumatol. 2020;10.1016/ S2665-9913(20)30095-3. doi:10.1016/S2665-9913(20)30095-3Gianfrancesco MA, Hyrich KL, Gossec L, et al. Rheumatic disease and COVID-19: initial data from the COVID-19 Global Rheumatology Alliance provider registries [published online ahead of print, 2020 Apr 16]. Lancet Rheumatol. 2020;10.1016/ S2665-9913(20)30095-3. doi:10.1016/S2665-9913(20)30095-3Tomelleri A, Sartorelli S, Campochiaro C, Baldissera EM, Dagna L. Impact of COVID-19 pandemic on patients with large-vessel vasculitis in Italy: a monocentric survey. Ann Rheum Dis. 2020 Apr 28. pii: annrheumdis-2020-217600. doi: 10.1136/annrheumdis-2020-217600Tomelleri A, Sartorelli S, Campochiaro C, Baldissera EM, Dagna L. Impact of COVID-19 pandemic on patients with large-vessel vasculitis in Italy: a monocentric survey. Ann Rheum Dis. 2020 Apr 28. pii: annrheumdis-2020-217600. doi: 10.1136/annrheumdis-2020-217600Guilpain P, Le Bihan C, Foulongne V, et al. Rituximab for granulomatosis with polyangiitis in the pandemic of covid-19: lessons from a case with severe pneumonia. Ann Rheum Dis. 2020 Apr 20. pii: annrheumdis-2020-217549. doi:10.1136/annrheumdis-2020-217549Guilpain P, Le Bihan C, Foulongne V, et al. Rituximab for granulomatosis with polyangiitis in the pandemic of covid-19: lessons from a case with severe pneumonia. Ann Rheum Dis. 2020 Apr 20. pii: annrheumdis-2020-217549. doi:10.1136/annrheumdis-2020-217549Montero-Escribano P, Matías-Guiu J, Gómez-Iglesias P, et al. Anti-CD20 and Covid-19 in Multiple Sclerosis and related disorders: a case series of 60 patients from Madrid, Spain [published online ahead of print, 2020 May 7]. Mult Scler Relat Disord. doi:10.1016/j.msard.2020.102185Montero-Escribano P, Matías-Guiu J, Gómez-Iglesias P, et al. Anti-CD20 and Covid-19 in Multiple Sclerosis and related disorders: a case series of 60 patients from Madrid, Spain [published online ahead of print, 2020 May 7]. Mult Scler Relat Disord. doi:10.1016/j.msard.2020.102185Mayer L, Kappos L, Racke MK, et al. Ocrelizumab infusion experience in patients with relapsing and primary progressive multiple sclerosis: Results from the phase 3 randomized OPERA I, OPERA II, and ORATORIO studies. Mult Scler Relat Disord. 2019 May;30:236-43. doi: 10.1016/j.msard.2019.01.044Mayer L, Kappos L, Racke MK, et al. Ocrelizumab infusion experience in patients with relapsing and primary progressive multiple sclerosis: Results from the phase 3 randomized OPERA I, OPERA II, and ORATORIO studies. Mult Scler Relat Disord. 2019 May;30:236-43. doi: 10.1016/j.msard.2019.01.044Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, Liu S, Zhao P, Liu H, Zhu L, Tai Y, Bai C, Gao T, Song J, Xia P, Dong J, Zhao J, Wang FS. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420-2. doi: 10.1016/S2213-2600(20)30076-XXu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, Liu S, Zhao P, Liu H, Zhu L, Tai Y, Bai C, Gao T, Song J, Xia P, Dong J, Zhao J, Wang FS. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420-2. doi: 10.1016/S2213-2600(20)30076-XZheng M, Gao Y, Wang G, et al. Functional exhaustion of antiviral lymphocytes in COVID-19 patients. Cell Mol Immunol. 2020;17(5):533-5. doi: 10.1038/s41423-020-0402-2Zheng M, Gao Y, Wang G, et al. Functional exhaustion of antiviral lymphocytes in COVID-19 patients. Cell Mol Immunol. 2020;17(5):533-5. doi: 10.1038/s41423-020-0402-2Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020 Mar 12. pii: ciaa248. doi: 10.1093/cid/ciaa248Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020 Mar 12. pii: ciaa248. doi: 10.1093/cid/ciaa248Wen W, Su W, Tang H, et al. Immune cell profiling of COVID19 patients in the recovery stage by single-cell sequencing. Cell Discov. 2020 May 4;6:31. doi: 10.1038/s41421-020-0168-9Wen W, Su W, Tang H, et al. Immune cell profiling of COVID19 patients in the recovery stage by single-cell sequencing. Cell Discov. 2020 May 4;6:31. doi: 10.1038/s41421-020-0168-9Cao X. COVID-19: immunopathology and its implications for therapy. Nat Rev Immunol. 2020;20(5):269-270. doi:10.1038/s41577-020-0308-3Cao X. COVID-19: immunopathology and its implications for therapy. Nat Rev Immunol. 2020;20(5):269-270. doi:10.1038/s41577-020-0308-3Quinti I, Lougaris V, Milito C, Cinetto F, Pecoraro A, Mezzaroma I. A posible role for B cells in COVID-19? Lesson from patients with agammaglobulinemia. J Allergy Clin Immunol. 2020 doi: 10.1016/j.jaci.2020.04.013Quinti I, Lougaris V, Milito C, Cinetto F, Pecoraro A, Mezzaroma I. A posible role for B cells in COVID-19? Lesson from patients with agammaglobulinemia. J Allergy Clin Immunol. 2020 doi: 10.1016/j.jaci.2020.04.013Soresina A, Moratto D, Chiarini M, et al. Two X-linked agammaglobulinemia patients develop pneumonia as COVID-19 manifestation but recover. Pediatr Allergy Immunol. 2020 Apr 22. doi: 10.1111/pai.13263Soresina A, Moratto D, Chiarini M, et al. Two X-linked agammaglobulinemia patients develop pneumonia as COVID-19 manifestation but recover. Pediatr Allergy Immunol. 2020 Apr 22. doi: 10.1111/pai.13263Fill L, Hadney L, Graven K, Persaud R, Hostoffer R. The Clinical Observation of a CVID Patient Infected with COVID19. Ann Allergy Asthma Immunol. 2020. doi:10.1016/j.anai.2020.04.033Fill L, Hadney L, Graven K, Persaud R, Hostoffer R. The Clinical Observation of a CVID Patient Infected with COVID19. Ann Allergy Asthma Immunol. 2020. doi:10.1016/j.anai.2020.04.033Woodruff M, Ramonell RM, Cashman K, et al. Critically ill SARS-CoV-2 patients display lupus-like hallmarks of extrafollicular B cell activation. 2020; medRxiv preprint. doi: https://www.medrxiv.org/content/10.1101/2020.04.29.20083717v1Woodruff M, Ramonell RM, Cashman K, et al. Critically ill SARS-CoV-2 patients display lupus-like hallmarks of extrafollicular B cell activation. 2020; medRxiv preprint. doi: https://www.medrxiv.org/content/10.1101/2020.04.29.20083717v1Liu L, Wei Q, Lin Q, et al. Anti-spike IgG causes severe acute lung injury by skewing macrophage responses during acute SARSCoV infection. JCI Insight. 2019 Feb 21;4(4). pii:123158. doi: 10.1172/jci.insight.123158Liu L, Wei Q, Lin Q, et al. Anti-spike IgG causes severe acute lung injury by skewing macrophage responses during acute SARSCoV infection. JCI Insight. 2019 Feb 21;4(4). pii:123158. doi: 10.1172/jci.insight.123158Zhao J, Yuan Q, Wang H, et al. Antibody responses to SARSCoV-2 in patients of novel coronavirus disease 2019. Clin Infect Dis. 2020 Mar 28. pii: ciaa344. doi:10.1093/cid/ciaa344Zhao J, Yuan Q, Wang H, et al. Antibody responses to SARSCoV-2 in patients of novel coronavirus disease 2019. Clin Infect Dis. 2020 Mar 28. pii: ciaa344. doi:10.1093/cid/ciaa344Sun B, Feng Y, Mo X, et al. Kinetics of SARS-CoV-2 specific IgM and IgG responses in COVID-19 patients. Emerg Microbes Infect. 2020 Dec;9(1):940-948. doi:10.1080/22221751.2020.1762515Sun B, Feng Y, Mo X, et al. Kinetics of SARS-CoV-2 specific IgM and IgG responses in COVID-19 patients. Emerg Microbes Infect. 2020 Dec;9(1):940-948. doi:10.1080/22221751.2020.1762515Rondaan C, Furer V, Heijstek MW, et al. Efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases: a systematic literature review for the 2019 update of EULAR recommendations. RMD Open. 2019;5(2):e001035. doi: 10.1136/rmdopen-2019-001035Rondaan C, Furer V, Heijstek MW, et al. Efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases: a systematic literature review for the 2019 update of EULAR recommendations. RMD Open. 2019;5(2):e001035. doi: 10.1136/rmdopen-2019-001035

The authors declare that there are no conflicts of interest present.