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BackgroundAmid the coronavirus disease 2019 (COVID-19) crisis, two messenger RNA (mRNA) vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have benefitted most people worldwide. However, the safety of vaccine has not been established in patients with rheumatic arthritis (RA). Previous studies reported that flares of underlying RA following SARS–CoV-2 vaccination were not so frequent, and there was no report of severe flare. However, those reports did not assess patients' disease activity with validated disease activity measures and described only simple self-reported questionnaires. Hence, the effect of vaccination on disease activity in patients with RA is still unclear. Understanding the association between arthritis flare in patients in RA and vaccination is important to overcome vaccine hesitancy.ObjectivesTo clarify the effect of SARS-CoV-2 vaccination on disease activity in patients with RA and identify risk factors associated with RA flares following the vaccination.MethodsThis is a prospective cohort study in patients with rheumatic musculoskeletal disease including RA who received the SARS-CoV-2 mRNA vaccines BNT162b2 or mRNA-1273 from March 16, 2021, at Keio University Hospital. The disease activity was evaluated with disease activity score for 28 joints using C-reactive protein (DAS28), simplified disease activity index (SDAI), and clinical disease activity index (CDAI) before vaccination and after second vaccination (within two months). RA flare was defined as ΔDAS28-CRP>0.6with requirement of treatment intensification. All analysis in this study was carried out with JMP.ResultsWe enrolled 318 patients with RA in this analysis. The mean age was 61 years old, and 283 (89%) were female. The mean DAS28-CRP before vaccination and after 2nd dose of vaccination were 1.70±0.71 and 1.78±0.81, respectively (p=0.84). The increase in DAS28-CPR after vaccination > 0.6 was observed in 53 patients (16.7%), and among them, 23 patients (8.2%) needed treatment intensification. The types of SARS-CoV-2 vaccine, humoral immunogenicity including neutralizing antibody titer and its adverse effects including systemic reaction (fever or general fatigue) were not different between the flare and non-flare groups (9.8 vs 9.1 IU/mL, p=0.88;31.2% vs 18.7%, p=0.32, respectively). In the flare group, swollen joint counts (SJC), hourly erythrocyte sedimentation rates, DAS28-CRP, and SDAI were significantly higher than those in the non-flare group (0.5 vs 0.0, p<0.000;13 vs 11 mm/h, p=0.01;1.57 vs 1.45, p<0.001;3.9 vs 2.4, p=0.02, respectively). Multivariable logistic regression analysis revealed that the number of swollen joints before vaccination contributed RA exacerbation after SARS-CoV-2 vaccination significantly (odds ratio 1.3, 95% confidence interval 1.06-1.65, p=0.01). The receiver operating curve analysis identified that having two or more swollen joint counts predicts RA flares after vaccination with an area under the curve of 0.64, a sensitivity of 42.3%, and a specificity of 86.9%.ConclusionDisease flare with requirement of treatment intensification is observed in 8.2% of patients with RA. Patients with higher disease activity, especially having two or more swollen joint counts are at high risk of flare following mRNA SARS-CoV-2 vaccination.Reference[1]Connolly CM, Ruddy JA, Boyarsky BJ, et al. Disease Flare and Reactogenicity in Patients With Rheumatic and Musculoskeletal Diseases Following Two-Dose SARS-CoV-2 Messenger RNA Vaccination. Arthritis Rheumatol. 2022;74(1):28-32. doi: 10.1002/art.41924. Epub 2021 Dec 3.Figure 1.Risk factors associated with RA flares after vaccination[Figure omitted. See PDF]Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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Backgrounds: To report the first case of left optic neuritis and perineuritis associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) BNT162b2 mRNA vaccination. Case presentation: A 39-year-old woman was referred and admitted to our hospital due to transient left visual field abnormality with left ophthalmalgia and headache 12 days after the first vaccination dose of SARS-CoV-2 (BNT162b2). On admission (Day 2), she presented with left ophthalmalgia and headache without any other neurological deficits including the movement of eyeballs, visual field, visual acuity, or nystagmus. MRI on Day 2 suggested slight left optic neural swelling;Gadolinium-enhanced MRI on Day 4 revealed left optic perineuritis. Test for serum anti-aquaporin 4 antibody was negative, whereas anti-myelin oligodendrocyte glycoprotein (MOG) antibody was positive. She was diagnosed with left optic perineuritis after SARS-CoV-2 mRNA vaccination. Her visual disturbance never recurred and her ophthalmalgia and headache subsided only with anti-inflammatory agents. Discussion(s): Many cases of optic neuritis associated with vaccinations have been reported except for SARS-CoV-2 BNT162b2 mRNA. To our knowledge, only one neuromyelitis optica case was associated with anti-MOG antibody. Therefore, we propose that SARS-CoV-2 mRNA vaccination may induce transient optic neuritis and perineuritis, associated with anti-MOG antibody in the present case. Conclusion(s): This is the first case of left optic neuritis and perineuritis associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) BNT162b2 mRNA vaccination.Copyright © 2022
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Along with the rapid urbanization and economic growth of China over the past decades, the thermal comfort needs of the people in this region have risen dramatically, and at the same time, promoting building energy efficiency is cited as part of the major projects in the 14th five‐year plan for energy efficiency improvement. In addition, the outbreak of the COVID‐19 epidemic has plunged people into long‐term panic, and promoted the entire construction industry to think about a healthier and more sustainable living environment. To respond to the imbalance between energy supply and demand, an optimization analysis based on energy use is developed, assessing the energy efficiency of the window‐to‐wall ratio (WWR) design and calculating the energy consumption of three different types of residential buildings for both cooling and heating loads as well as for year‐round loads. Owing to its harsh climate and huge energy consumption, in this study, the Hot-summer and Cold‐winter (HSCW) zone of China was chosen as the experimental setting for the optimization analysis of WWR. Then, in the three main types of residential buildings, including detached houses, multi‐story dwellings and high‐rise dwellings, a correlation between WWRS and energy consumption in the cooling season, heating season and year‐round was built. The comparisons between the WWRS and energy consumption for different types of residential buildings are presented. The design optimization recommendation for WWRS are proposed. It has significant pos-itive meanings for the development of green and sustainably designed residential buildings that offer high levels of thermal comfort and energy efficiency. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.